Cory Doctorow (of BoingBoing fame) wrote an interesting short sf story called "When sysadmins ruled the earth", based on the premise that the people running the server farms will be protected from global disaster, since their work environment would be sealed off from everyone else, and have generators, etc. to weather the crisis.

You can download the story as a series of readings here.

Thank you for the interesting comments.

The CDC uses the following planning assumptions:

In a moderate flu pandemic, 64,875 Americans will require mechanical ventilation, and in a severe flu pandemic 745,500 will.

There are currently a little over 100,000 ventilators on hand in the entire country. Most of them are already in use on any given day.

The Strategic National Stockpile contains about 6,000 ventilators, but has been acquiring more. The SNS is the nation's main resource for large scale surge medical supplies, equipment, and medications in the event of a national medical emergency.

What we are discussing, for planning purposes, is mechanical ventilation capable of controlling rate, tidal volume and PEEP. Some of the possible alternatives you describe sound interesting, but are not the same thing, with the same capacities, as those used for planning purposes. Maybe somebody with more expertise will weigh in.

How many people did you need to bag one patient, and for how long? Depending on pulmonary and anatomic resistance, you can get pretty tired, pretty quick. Around the clock bagging will take a lot of people, and it is not very consistent or reliable, but it can be done.

My point exactly. There is a shortage. Moreover, many nurses currently working in home health care are expected to be drawn into acute or custodial care settings to meet acute surge demand and absenteeism shortfalls. People today lack the skills, resources and ability to provide lay "home nursing" as was often done in the past.
I agree.

Jeff

Let's also keep in mind that different viral infections manifest varying symptoms, so each strain has it's own peculiar epidemiology. H5N1 seems to be more fatal/devastating to people with the healthiest and strongest immune systems, because this virus overstimulates the body's immune system response, and the various components that are triggered (such as histamine response) overwhelm the cardio-pulminary and respiratory systems. Those whose immune response is diminished, as with older but not yet geriatric victims, seem to have the best rate of survival. Males in their twenties seem to be at greatest risk.

I still contend that there are loads of portable home ventilators sitting on shelves in nearly every community in the US that are probably not in that 100,000 figure. But I would have to agree- there aren't 750,000 of anything sitting out there if that is the number we're working with.

Regardless, for planning purposes, when the supplies run out, you would hope the call would go out for home vents, Bipap's, and any other device that has been used for this purpose however arcane and untested. That was my reason for including my thoughts on the alternatives. Same with bagging- it was, I recall, 4 people over 12 hours, and yes, very difficult. But the patient lived, and none of the four were of any medical discipline, all family members.

I may be wrong, but I would also submit that home care nursing is a different critter, and just like you wouldn't send a med surg nurse to a psych ward, you wouldn't send a home care or nursing home nurse to a hospital, or an acute care nurse to the home. Different skill sets and training. Another reason why the lesser disciplines have continually taken on a larger role in all settings, besides insurer mandates and the obvious shortage. But I may be splitting hairs here.

When nurses complete their CEU's to maintain their licenses, I think it's safe to say that they would probably lean towards continuing education specific to their discipline? So perhaps they should be encouraged to take CEU's specific to these scenarios?

That's not to say they wouldn't answer the call if asked, just wonder if there would be the bang for the buck, so to speak. Certainly anyone with training would be better than nothing at all. However, they have a patient load that would now be without licensed caregivers if they all reported to acute care.

In a large percentage of home care cases, there are family members that are the primary caregivers, because our insurance industry doesn't pay for around the clock care, so I am of the mindset that there are more lay caregivers out there than ever before. Especially since people are living longer.

Yikes, 750,000- it's staggering, eh? My original post seems kinda naive in retrospect.