H1N1

[WolfmanHarris]

I say this with all due respect as I have never taken issue with comments before and I know it is probably a comment that wasn't really thought through but to say that you 'didn't pay much attention' is a demonstration of a lackadaisical attitude of where mistakes happen.

It's great that you are protected, but what about everyone else that could potentially be exposed to the patient? Hospital admin staff, general public in the waiting room, family members, etc. Our goal wherever possible should be to isolate the source while also protecting ourselves.

You got me. It wasn't thought through and rereading it implies exactly what you described. Allow me to clarify.

These masks have begun to show up on the trucks as a one to one replacement for standard N95's. Not universally though, not in separate cabinets and with little rhyme nor reason to when you'd find one vs. a standard NRB. No attempt has been made to draw attention to them or train on them. (I did just reconfirm this by scanning all the memos on the intranet to make sure I didn't miss anything from just before I was hired.) I did look at and open up one when I saw it doing truck check, noted the filter, but paid it little further thought until now. NRB's at the best of times provide a poor seal and when combined with the way pt's tend to fret with them filed it away as a gimmick. To say I wear an N95 as a matter of course referred more to my not counting on a filter added to a mask to mitigate my risk such that I would compromise my usual BSI precautions.

I can't confirm without any doubt that we don't carry the multiple sizes of the mask as I'm not at work, but I did not see any other sizes. Certainly not within the oxygen bag. Without a properly fitting mask, I can't imagine a filter providing much benefit. Now the N95 oxygen masks that I've seen advertised seem to be a much better option and have been examined in peer-reviewed literature. Below is a link to a summary from Annals of Emergency Medicine. Unfortunately, it is not noted in this summary whether the masks were fit tested before being applied to the volunteers so while the results are encouraging, the practicality is not clear.

http://www.annemergmed.com/article/S0196-0644%2806%2900942-5/abstract

[Quakefire]

ArticKat I started this wondering more along the lines as to what other people are seeing, and what other services are doing. We have had discussions during staff meetings and we have all of the health canada bulletins up as well. One of the things I like about forums is that I have access to people from all over the country to get ideas. I didn't know there were different levels of filters for the Bipap or intubated patients which makes me wonder what our hospital is using. We were told that with the "closed Loop" masks were not required

[ukcanuck]

Here in the UK we are "encouraged" to get both the seasonal flu and the H1N1 vaccination. We have been issued special masks with removalable filters but only been issued two sets and have to re use them for several patients, makes sense to me - not! We look like something from a movie like Outbreak!!! Freaks the kids out really well!!!!

We do have the problem that the bosses are so fixated on response times that the solo paramedic responders are usually in the house and assessing the patient when dispatch calls to advise them to take precautions. The calls will come in as SOB/unwell/chest pain/or pretty much anything else.

We are also exposed to people from all over the world including areas that have no or little health care.

The problem that the UK has is that they got so worked up about H1N1 that patients could get tamiflu over the phone using a hotline. So those patients have had H1N1 right???? So they don't need the Vaccination??? Or did they have H1N1 or just a bit of cold/flu??

As I understand the seasonal flu shot is the strain that the experts have worked out will be most prevalent in your area. So I will still get exposed to the variants/strains from all over Europe/the world and stand as much chance of getting that.

I have no underlaying health issues so will NOT be getting the H1N1 as I am not happy that it has been pushed through. Just like if I or my family get it we will not be taking anti virals unless we get actually really sick (ITU kinda sick) as they have some great S/E.

As for the excuse of thinking about my patients and should get the shot then please tell me - these patients will NOT EVER be exposed to someone who is H1N1 positive in everyday life by going out to the shops, their carers and family etc

I take precautions when I should and can and try to keep my patients clean from anything I have. I stay away from work when I am sick use gloves and wash my hands very often. I change my uniform every shift and monitor my health.

I am more worried about catching and bringing home a D&V bug or something like hep C

[tniuqs]

ukcanuk:

I am more worried about catching and bringing home a D&V bug or something like hep C

Firstly D+V could you please explain ?

http://www.phac-aspc.gc.ca/fluwatch/09-10/w43_09/index-eng.php

This from the colony's reporting and surveillance, yes I know, click on the link and look to the pretty graphs and take into account that this is week 43, not week 44 the demographic risk group is a changing. CDC is also report similar finding's in the US, although comparing a health care system private vs public delivery, apples to oranges, only those that can afford health care in the US have early access to HEALTH care, that said we have observed this as of late in Canada IMHO class or wealth distinction, appears bragging rights for best cost effective Health Care have changed (see below for the present WINNER)

Or did they have H1N1 or just a bit of cold/flu??

A bit of a cold interesting could you kindly explain the difference in symptom reporting ?

We are also exposed to people from all over the world including areas that have no or little health care.

You do realize the definition of pandemic do you not ? And as if the rest of the world does not observe the same type of international travel, granted IF your working at Heathrow you are much more likely to be exposed to TB than anything else (risk factor speaking) If you look back in the posts you may observe that I personally have been exposed to H1N1 from my very healthy brother, returning from Jordan, Egypt and Israel. Personal note so have you ever been hit by a logging truck ? Well that is what it feels like H1N1 ain't the normal sniffles

As I understand the seasonal flu shot is the strain that the experts have worked out will be most prevalent in your area. So I will still get exposed to the variants/strains from all over Europe/the world and stand as much chance of getting that.[/quote

Now both preventable disease(s) unfortunately that statement is also incorrect IDC experts concensis WHO is a big say, it appears that your employers NHS may be far more diligent than the employees, oh and if your in London say cheer's to Stephen Hines, the man has excellent pallet for beer(s)

Firstly your statements of you being exposed, do you not visit the shops or other families.

FAIL x one yourself and one for your system of Infectious Disease Control at the EMS level.

Correction late edit FAIL x 3 the absolute best way to develop resistant strains as we have observed this in many other cases ie MRSA and VRE ... if either of those little nasties jump or mutate to pulmonary system ... your 100% dead.

FYI:

AND THE WINNER IS (because it is now estimated that 25% of the population is inoculated as we speak, halting H1N1 in its tracks) CANADA delivery system receives a huge FAIL.

Further: Look like a freak or infect a kid, or the child infect you (your pick) if this WAS an Airborne Hemorrhagic Pathogen or H5N1, well it would make the movie OUTBREAK look like a walk in the park, this pandemic although IMHO we have gotten off very lightly and if it is not a clear WAKE UP to all involved in any aspect of health care ... then we all receive a FAIL.

cheers

[tniuqs]

A very cool maps:

http://gamapserver.who.int/h1n1/trend-resp-diseases/h1n1_trend-resp-diseases.html

Note the continent of Africa is not reporting.

I have a flight booked for Greenland

CDC update link:

http://www.cdc.gov/H1n1flu/update.htm

Edited November 9, 2009 by tniuqs

[ukcanuck]

tnuiqs

I was in the process of a lengthy answer to your reply about how the UK is responding to H1N1 when a crew mate called for a chat and mentioned that someone we know is being disciplined for comments deemed by our trust to be unbecoming of a paramedic and have reported them to our professional body.

I have deleted the text I had typed. I will also be curtailing my activity on boards like this one.

I do know people who know Stephen and the beer over here is one of the things I will miss when I move back to Canada. I am not part of Planet London though.

I will say that here in the NHS we do not take infection control seriously enough and the main point to my post was that there are several other things that I am worried about catching from patients. We seem to be overly worying about one virus when as you pointed out there are many out there and god help us if they mutate or become resistent to treatment.

D&V is diarrhea and vomiting.

The UK has caused mass panic about the H1N1 but not supplied the vaccine fast enough and not made it mandatory. They have issued some kit to front line staff but then we get in the house before we find out what we are going to and what PPE to put on.It is dying down here but I stand by what I feel.

The vaccine has not been properly tested and has been rushed through. There are too many dissenting voices to ignore it just yet.

I take precautions when I can which does include wearing masks with kids esp for suspected cases of TB. I wear gloves, gowns, eye protection and wash my hands incl the use of alcohol rubs.

If you want to discuss anymore PM me so it becomes a private conversation and so the trust can't ding me for anything I say on here.

Stay safe and stay well everyone

UKCANUCK

[tniuqs]

tnuiqs:

I was in the process of a lengthy answer to your reply about how the UK is responding to H1N1 when a crew mate called for a chat and mentioned that someone we know is being disciplined for comments deemed by our trust to be unbecoming of a paramedic and have reported them to our professional body.

Quite difficult to comment on that not knowing any details but it sounds as if "MUM" is the word.

I will say that here in the NHS we do not take infection control seriously enough and the main point to my post was that there are several other things that I am worried about catching from patients. We seem to be overly worying about one virus when as you pointed out there are many out there and god help us if they mutate or become resistant to treatment.

Your not alone in the first statement, second must agree.

D&V is diarrhea and vomiting.

Thanks: I don't use that abbreviation as one is loss of base one is loss of acid, two different systems ... we use N+V for upper GI and poo poo for lower

The UK has caused mass panic about the H1N1 but not supplied the vaccine fast enough and not made it mandatory. They have issued some kit to front line staff but then we get in the house before we find out what we are going to and what PPE to put on.It is dying down here but I stand by what I feel.

Mandate No ... but if your not inoculated for Yellow Fever, Diphtheria, will not let you in this or that country. I am of the opinion that if TB skin test was mandated before any international travel (and should be part and parcel) of a visa before one gets a boarding pass, we have security for terrorism why not infectious disease.

It was NOT the UK that caused panic it was media, I truly hope this is a big wake up and fortunately some common sense is prevailing now in Canada actually consulting with front line staff. I do enjoy omelette's.

The vaccine has not been properly tested and has been rushed through. There are too many dissenting voices to ignore it just yet.

This statement I will disagree, the H1N1 and the seasonal are some of the safest we have ever observed from E.B.M. ... the scary part is many of the public are listening to wackos and conspiracy theorists, with WHO stats only 8000 identified H1N1 have died SO far.

If you want to discuss anymore PM me so it becomes a private conversation and so the trust can't ding me for anything I say on here.

Well that is one of the saddest statements I have ever heard, best come back to the colony's brother.

[ukcanuck]

Thats what I am doing - getting out of the UK like many NHS staff that are fleeing to Oz/NZ/USA/Canada/insert name of country........

stay safe

[VentMedic]

Let's compile a list of informative websites that have been mentioned.

CDC guidelines for many different groups

http://www.cdc.gov/h1n1flu/guidance/

CDC with info for EMS

http://www.cdc.gov/h1n1flu/guidance_ems.htm

WHO

http://www.who.int/en/

CDC updates including each week's statistics

http://www.cdc.gov/h1n1flu/whatsnew.htm

CDC more updates and maps

http://www.cdc.gov/H1n1flu/update.htm

WHO map

http://gamapserver.who.int/h1n1/trend-resp-diseases/h1n1_trend-resp-diseases.html

OSHA

http://www.osha.gov/h1n1/

http://www.emsresponder.com/article/article.jsp?id=11020&siteSection=1

Oxygen Mask with filter (FloMax)

http://www.blssystemsltd.com/flomax.html

Edited November 10, 2009 by VentMedic

[tniuqs]

Bi-weekly and cumulative number of deaths due to Pandemic (H1N1) 2009, by province/territory,

Canada, as of 12 November, 2009, 11h00 EDT (from November 10, 2009 to November 12)

New Deaths Cumulative

British Columbia 0 23

Alberta 0 20 ..... or 34 ?

Saskatchewan 0 5

Manitoba 1 8

Ontario 24 61

Quebec 0 35

New Brunswick 0 0

Nova Scotia 1 2

Prince Edward Island 0 0

Newfoundland and Lab 0 5

Yukon 0 1

Northwest Territories 0 0

Nunavut 0 1

Total 26 161

Is this official Canada Fluwatch site accurately reporting? CTV News Reported 34 Deaths Total in AB alone tonight Nov 12.

Put this into perspective CAF in Afghanistan we have lost 136 KIA in 5 years.

Edited November 13, 2009 by tniuqs