Staffing worries hospitals


Hospitals in Nevada have the rooms to handle an excess number of patients if the H1N1 emergency worsens, officials said Monday.

The problem is staffing the rooms with medical personnel.

"All hospitals have contingency plans for providing extra beds," said Dr. Dale Carrison, head of emergency services at University Medical Center. "But where do we get the caregivers to care for people? That's the limiting factor in this community."

President Barack Obama late Friday signed a declaration that made the H1N1 outbreak a national emergency. The declaration is a preemptive measure that gives Health and Human Services Secretary Kathleen Sebelius the power to allow hospitals to move emergency rooms off-site. The intent is to improve treatment efficiency and create separate areas for patients infected with H1N1.

But rooms and beds are not Carrison's biggest concern. The real problem in a true emergency will be a lack of doctors and nurses, Carrison said. There is no contingency plan to deal with a medical personnel shortage, he said.

"If every nurse has four patients in their care, what happens if you ask them to handle eight patients?" he asked. "Obviously, a nurse can't do that."

Every state will be dealing with that same issue, Carrison said. "I don't know where you'd get them (nurses and doctors)."

Nevada hospitals do have places to put patients because they have access to two portable, inflatable hospitals and have their own tents, which can be used in case of overflow, Carrison said.

The portable hospitals would have been legally available for use before Obama's declaration, he said. "The declaration doesn't make any difference with that."

UMC officials have other plans to keep rooms available, such as discharging medically cleared mental health patients, who can hold rooms for more than 24 hours, he said.

Dr. James Swift, medical director of Sunrise Children's Hospital in Las Vegas, said Obama's declaration gives hospital officials more leeway with emergency measures.

"What the declaration allows is more relaxed regulations with how we screen people for emergency room visits, as well as how it's paid for," Swift said. "It allows us the comfort of knowing we're not running afoul of the law."

Swift said Sunrise's emergency room has seen a 20 percent increase in outpatient care compared with last year, with a 15 percent to 20 percent increase in hospitalizations.

Like UMC, Swift said Sunrise is prepared to use tents for emergency room patients who are minimally to moderately ill if admission rates continue to climb through the winter.

"We won't be seeing someone with heart attack symptoms outside," he said.

He does not expect severe staffing issues but noted it's a concern.

"What happens if the hospitals are all full?" he asked. "All of us (the hospitals) are struggling with that question. ... There is a legitimate concern that staffing could be a problem."

Swift said hospitals could hire nurses from agencies but said they would be vying with every hospital in the nation for the same nurses. He hopes the situation doesn't come to that.

"We're trying to stay ahead of the curve," he said.

Both doctors agreed prevention will be the key, which is why news of slow vaccine production has disturbed some in the medical community.

Last week, the Southern Nevada Health District said it temporarily would stop giving the H1N1 flu shot for seven to 10 days, so it would not exhaust its supply.

The health district will provide only the H1N1 FluMist vaccine, which is inhaled through the nose and is only available for healthy people between 2 and 49 years old who are not pregnant.

Carrison said he realizes concern exists about the H1N1 vaccine, especially the FluMist, which is made with a weakened virus tamed in the lab so it cannot cause illness.

But the repercussions of not receiving immunizations could be much worse, he said.

"I'm an old guy. I still remember kids in my classes dying from diseases we now immunize for," he said. "People need to get their shots."

Contact reporter Mike Blasky at mblasky@reviewjournal.com or 702-383-0283.

 

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