Red News Readers,
I note that several Sydney Hospitals have had to cancel elective surgery to cope with the swine flu. This pandemic will be a real test of the health system’s ability to cope with a crisis, like widespread flu, or a terrorist event, or whatever. I heard through the grapevine about 2 weeks ago that RPA and other hospitals were struggling because of the number of staff off sick with the flu, so I am not surprised that they have had to cut elective surgery. Their HR practices of getting rid of experienced staff because they were too expensive will be coming back to bite them at a time like this. I wonder how well the critical care units are coping with that many patients on Extra Corporeal Membrane Oxygenation when they have so many young and inexperienced staff? And I wonder if that is why there has been a service reduction as well to allow for the inexperienced staff ?
Swine flu warning as deaths increase
Kate Benson and Andrew Clennell
smh, July 14, 2009
HEALTH experts fear the state's swine flu death toll could soar with six young, healthy people in Sydney fighting for their lives on last-resort cardiac bypass machines because their lungs are too damaged or diseased for regular mechanical ventilation.
The surge in the number of people with swine flu needing life-saving treatment has forced NSW Health to consider closing elective surgery at some big hospitals to allow staff to redirect resources.
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Four people have now died in NSW since the pandemic hit on May 9, a woman, 61, being the latest victim. Her death on Saturday at Lismore Base Hospital was followed by two more suspected swine flu deaths, of men aged between 30 and 50, at Royal North Shore Hospital. Their deaths have been referred to the coroner.
Almost 350 people have been admitted to hospital with swine flu since the pandemic began. Fifty have been treated in intensive care, but doctors say the surge in patients needing cardiac bypass treatment is putting a huge strain on intensive care units and on staff and resources across the state.
All six of the victims on cardiac bypass are at Royal Prince Alfred Hospital, where staff have been forced to borrow three machines to treat 10 patients in the past two weeks. The hospital usually treated about five patients a year using the machines, the head of intensive care services, Robert Herkes, said yesterday.
"This is not an ordinary winter. Swine flu is hitting young, otherwise healthy people … they start with a sore throat, develop shortness of breath and within 12 to 24 hours have rapidly developed respiratory failure and are being ventilated."
Dr Herkes said extracorporeal membrane oxygenation, or ECMO, was considered a last-resort treatment, but staff were "throwing everything" at the patients because they were young and relatively healthy.
Patients in respiratory distress are given anticoagulants by machine, and their blood is drained through tubing in their femoral or jugular veins. It is oxygenated outside the body, allowing the lungs to recover.
Three patients with swine flu had been taken off the treatment at Royal Prince Alfred in the past few days. One was "sitting up talking, on a ward", but two were still critical and were being mechanically ventilated, Dr Herkes said.
Brad Frankum, a general physician and immunologist at Campbelltown Hospital, said he had heard anecdotal reports that "more people than ever before" were being treated with ECMO this winter. "This is of great concern because it would suggest that the number of serious cases [of acute respiratory distress] are threatening the capacity of the system," he said.
The deputy director-general of NSW Health, Tim Smyth, said yesterday five big hospitals in Sydney had now been designated to treat swine flu victims with ECMO, up from two a fortnight ago. He said about a third of swine flu patients in intensive care were needing this treatment, but there was still capacity to deal with the pandemic.
He said the department had stockpiled 130 new standard ventilators two years ago as part of the state's disaster plan and would open more intensive care beds on high dependency units if the number of patients continued to surge.
But Peter Collignon, a professor in infectious diseases at the Australian National University, played down the use of the machines, saying "this happens every winter - it just doesn't get publicity".
A spokesman for the State Government said elective surgery could be cancelled at Royal North Shore, Royal Prince Alfred and St Vincent's hospitals, and patients due for surgery would be moved to less affected hospitals.
"There's no move at this stage to move to a different [status] in our pandemic plan," a spokesman for the Health Minister, John Della Bosca, said.
There are many hundreds of flu deaths every year, but a senior health source said swine flu was likely to hit harder as there was no vaccine and no immunity.
THE STORY SO FAR
- 2029 people have tested positive in NSW.
- 346 have been admitted to hospital (255 in Sydney's west and south-west).
- Four have died, with two more deaths awaiting coroner's confirmation.
- Five major Sydney hospitals now treating victims with cardiac bypass machines.
- One-third of the population expected to get swine flu.