Progress for tomorrow: Preparing for the next disaster
HEALY: Do you think people in emergency rooms would tolerate if we were getting closer to a major communicable disease outbreak, whether it's this or something else, to anybody who goes into a hospital having a mask put on them, because part of the issue is –
KELLERMANN: Sure, absolutely, and we do that all the time. We certainly did that during the SARS outbreak and we would do that in flu season.
ATKINSON: I think people come to hospitals with the assumption you're going to do what's best for them, and we hope that happens more frequently than not, but I think people are usually pretty reasonable about the advice they're given in that setting, and if not, you just have to deal with it in an enforceable way that's reasonable for the circumstances.
KELLERMAN: In fact, one strategy that I think there's some discussion about we have to work more on is helping people to know when not to come to the hospital, when not to come to the ER. Obviously if and when we have a major outbreak of influenza or another infectious disease, people who are getting symptoms and worried, the first thing they want to do is run to the doctor's office or run to the ER, but if they're not infected, they could leave that waiting room infected. So we need to give people access to Web resources, call lines, maybe even drive-by clinics where you can screen people and say, you need to come in to the hospital; you can go home with home care, and, again, try to keep people apart as much as possible so you don't inadvertently pass the disease from one to another.
ATKINSON: In fact, in the all-hazards approach that I think we're taking to disaster preparation around the nation, the concept is not necessarily to see the hospital as a destination at all for someone who may have something they perceive as minor. I think we think about anthrax and you look at the Senate building and other buildings when there's a microscopic level of presence, but we shut down entire buildings for long periods of time, appropriately so. The last thing you want to do is take someone that's been exposed to an agent like anthrax and introduce them to an emergency department and shut down a major hospital if there are alternative sites – if you realize it's not an injury and you can move them in that location. If we were dealing with a pandemic, alternative care sites, exactly like happened in 1918 - however we would do that - need to be one of the things we think about and plan for, and the separation of those patients that have the symptomatology of the pandemic from those that have other items because, as we know, in all disaster situations, the routine emergencies and acute needs continue also. People are going to have heart attacks, they're going to have strokes, they're going to have other things that need to be treated, and you just don't stop doing one emergency because other ones come along.
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