Swine flu raises ICU-overload concerns

A Winnipeg intensive-care specialist hopes an international conference taking place in the city will find ways to deal with the flood of patients that hospitals could see this fall during a second swine flu pandemic.

Dr. Anand Kumar worked during the first wave of the swine flu, or H1N1 influenza A, crisis in the spring.

"Quite frankly, professionally, it was the most frightening experience of my life," he said. "We simply didn't know if we would have sufficient beds in three to four days because we were getting six patients a day. We were fortunate, because the epidemic abated within three to four days of when we would've overloaded."

At one point, there were 60 patients with proven or suspected H1N1 infection in a city with only 70 ICU beds, Kumar said. Most people will not need hospitalization if they get infected with H1N1, but for those who do, about 15 per cent will require ventilators in the ICU, he said.

"It will not just be ventilators [of concern]. Hopefully, we've put into place preparations for medications that might be short sedatives is one large group of those," Kumar said.

'Quite frankly, professionally, it was the most frightening experience of my life.' Dr. Anand Kumar

"Then most importantly, manpower. One of big chokepoints is nursing and respiratory tech manpower. While there are agreements in place to allow transfer of these people between places, how do you actually operationalize that if it becomes necessary? I don't know that planning has progressed too far."

The Manitoba Nurses Union also has concerns, given a shortage of ICU nurses. During the spring outbreak, ICU nurses worked dozens of hours of overtime while the union scrambled to help them by bringing in nurses from other departments nurses with past intensive care experience.

They received retraining and were temporarily shifted back into ICU, but that left their current departments short staffed, said union president Sandi Mowat.

With resources stretched thin across the city, the union was forced to put a hold on some vacation requests.

"Nurses who actually work in the intensive care are already working long hours, many hours of overtime through out the system. And this [H1N1 outbreak] just sort of exacerbated that. Then of course, there weren't enough nurses to staff a number of beds required for the very sick H1N1 patients," Mowat said.

The union has requested the province do more to identify ICU-ready nurses who can be seconded to help deal with another outbreak expected in the fall.

A spokesperson for the Winnipeg Regional Health Authority said they are recruiting nurses from the pool of current employees for that purpose and will run an ICU training course this month.

The goal is to be prepared to deal with twice as many patients as during the spring.

International conference

Medical experts from across Canada and around the world are gathering in Winnipeg on Wednesday and Thursday for a conference on preparation for the resurgence of H1N1 in the fall.

Health Minister Leona Aglukkaq said the pandemic conference is the first of its kind. She said delegates will review possible outcomes of the epidemic, and develop standardized guidelines for medical personnel in rural communities and hospital intensive care units.

Canada's chief public health officer David Butler-Jones said the conference will play a key role in determining many of Canada's H1N1 guidelines for the fall flu season.

Public health officials say an H1N1 vaccine will be available by mid-November and they're confident that will be enough time to protect every Canadian who wants it.