The Corpus Callosum

Revere has an alarming post about one potential problem.  This
could occur if there is a serious influenza pandemic:

flu: breaking the acute care system

[H]hospitals and emergency departments have been shrinking, while their
patient populations have been growing. The Institute of Medicine
calculated in 2006 that ER visits rose by 26% between 1992 and 2003,
from 89.8 million to 114 million in a year, while 425 emergency
departments and 703 hospitals closed and the number of hospital beds in
use shrank by 198,000.

And last month, the American Hospital Association said that bed
closures and layoffs were accelerating because of the economic crash.
Half of 1,078 hospitals surveyed in March said they were seeing
increased numbers of uninsured patients in their ERs, and approximately
10 hospitals per month were laying off 50 staff or more.

“My hospital has almost no surge capacity; it is running full all the
time,” [Dr. Edward Panacek, a professor of emergency medicine at
University of California-Davis Medical Center] said. “If we had a 10%
increase in the need for admissions because of flu, we would have
nowhere in the hospital to put those patients. They would back up in
the ER, and they would lie on gurneys for days.”

How was this handled in 1918-19?


Fortunately, we are already getting some practice:


That is a tent city outside of Sacramento.  It is inhabited by
people who’ve lost their jobs and/or homes.  Maybe that is how we
could repurpose foreclosed houses.  Turn them into
infirmaries.  Of course it would help if the banks would stop
destroying perfectly good houses

Hospital Emergency Departments currently have little or no surge
capacity.  This is a good illustration of what James Surowiecki
calls “the peril
of efficiency
.”  Unused capacity costs money to maintain; it
is inefficient.  This is true in Emergency Departments, as it is
anywhere else.  By relentlessly cutting this capacity, in the
pursuit of efficiency, we have left ourselves open to dreadful
outcomes.  The same perils can be seen in the electrical grid, the
hydrocarbon delivery chain, and the food production and delivery chain.


  1. #1 Dr Tom
    May 12, 2009

    Nice story I liked it.We have a problem in my area that involves patients going to the hospital 10-12 times a month .

  2. #2 Monado
    May 18, 2009

    We had that problem during the SARS crisis. Not only were nursing staff getting sick; after years of running ever leaner and meaner, cutting staff, amenities, physios, helpers, assistants, and therefore beds, a normal weekend stacks patients in the corridors. SARS, with its deathly ill patients and the need for isolation rooms, changing gowns and gloves, and wearing breath-restricting masks, was very hard to take.

    I’m very glad it died down and I don’t think either SARS or the 1976 bird flu was a false alarm just because we managed to keep them under control.

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