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ADVANCE Perspective: Nurses

World Holds Collective Breath in Face of Potential Swine Flu Pandemic

Published April 27, 2009 11:09 AM by Chuck Holt

Posted April 30, 2009

The American College of Emergency Physicians (ACEP) and the Emergency Nurses Association (ENA) issued a joint statement April 30 about the then 109 confirmed cases of swine flu in the U.S., and offered recommendations to the public about when to seek emergency care in the 11 states where the disease is present and beyond.

Saying the nation's emergency departments are on the front lines of any public health emergency, the two organizations urged the public to apply the "prudent layperson standard" to any illness or injury, which is "if the average prudent person would think you have the symptoms of a medical emergency then you need to seek emergency care."

"Emergency physicians and nurses are specially trained to assess your symptoms and treat you, and if you have any doubts about your medical condition, we are there for you," said Nick Jouriles, MD, president of ACEP. 

"While news reports about the swine flu may have raised alarm, remember there are still very few actual cases of the illness in the U.S.," Jouriles said. "And if you have no symptoms, then you do not need to seek emergency care. If you do not have a fever or cough, it is extremely unlikely that you have the swine flu."

Emergency physicians and nurses in different parts of the country are seeing people who do not have symptoms, but are simply seeking information and reassurance that they are not ill, which both organizations say is understandable, given the widespread news coverage. 

To help people understand this disease and get the information they need, CDC is maintaining up-to-date web pages about the symptoms of swine flu and when to seek immediate medical care (www.cdc.gov/swineflu).

"If you have symptoms that would not ordinarily take you to the emergency department but are considering going because you are afraid you have swine flu, you probably do not need to go," said Bill Briggs, RN, president of ENA. "Remember that many illnesses - not just swine flu - are transmitted in public places and very often the best way to avoid the spread of disease is to stay home until your symptoms subside."

"In the current push for healthcare reform, policymakers must recognize the unique role that emergency physicians and emergency nurses play, especially in times of crisis," the joint statement reads in part. "Emergency departments are the nation's safety net, a point driven home this week with the threat of pandemic swine flu filling ERs with patients fearing they are infected. The safety net is under extraordinary stress in the best of times, never mind the worst."

"Even those 'worried well' who have primary care physicians are being directed to the emergency department because of our specialized expertise," Jourlies added. "We stand on the front lines of any disaster and when all other doors are closed, our doors are always open. That is why true healthcare reform must strengthen America's healthcare safety net - emergency departments."

Posted April 29, 2008

Be sure to see the excellent Swine Flu Update by ADVANCE editors Adrianne O'Brien and Valerie Neff Newitt on the ADVANCE for Nurses homepage.  

Posted April 28, 2008 

The world's governments continued working Tuesday to avoid a pandemic and global hysteria as suspected and confirmed cases of swine flu (A/H1N1) continued to be reported around the globe.

By early Tuesday, April 28, Mexican officials suspected swine flu had caused 152 deaths and more than 1,600 illnesses. Fifty cases of swine flu had been confirmed in the U.S. as of Tuesday morning in five states including CA, KS, NY, OH and TX.

At least 98 cases of swine flu had been confirmed worldwide, with 11 cases in New Zealand; six confirmed cases had surfaced in Canada; seven suspected cases and one confirmed case in Spain; one confirmed case in Great Britain; one suspected case in France; and one confrimed case in Israel.

All U.S. cases have had mild influenza-like illness with only one requiring brief hospitalization, according to the World Health Organization (WHO). No deaths have been reported in the U.S., and the viruses in all cases have the same genetic pattern based on preliminary testing, according to a WHO press release. The virus is being described as a new subtype of A/H1N1 not previously detected in swine or humans.

At least 28 cases of swine flu had been confirmed among students at St. Francis Preparatory School in New York, the largest private Catholic high school in the U.S. Officials at the school said they knew something was wrong Thursday when 75 students reported to the nurse's office with complaints of fever, upset stomach and achy bones, MSNBC reported.  

The outbreaks prompted the U.S. Department of Homeland Security to declare a public health emergency April 26, which allows roughly 12 million doses of Tamiflu to be moved from federal stockpile for delivery to the affected states, the AP reported. President Obama, speaking before a group of scientists Monday morning, said the outbreaks of swine flu were reason for people in the U.S. to be concerned but "not cause for alarm."

At boarder crossings with Mexico, U.S. Customs officials had begun screening for sick travelers, according to several published reports.  

Richard Besser, acting head of the CDC, speaking on national television news programs Monday said authorities were undertaking "passive screening" at its borders and reiterated Obama's call for people to remain calm. U.S. officials at border checkpoints were "asking people about fever and illness, looking for people who are ill," Besser reportedly said.

In Mexico City, surgical masks reportedly are being given away on the subway system, public events were cancelled throughout the weekend, schools and public venues were closed and church services postponed. President Felipe Calderon has assumed new powers to isolate infected people, according to the AP.

Airports worldwide had begun screening travelers for flu symptoms as well, not only in Mexico, but also China, Russia and Taiwan. Officials in each country reportedly plan to put anyone with symptoms under quarantine.

The European Union on Monday warned against traveling to the U.S. and Mexico. Hong Kong and South Korea reportedly had already warned against travel to Mexico City and three provinces. Italy, Poland and Venezuela had already advised citizens to postpone travel to affected areas of Mexico and the U.S.

Meanwhile, WHO has asked all countries to step up detection of swine flu and will decide on Tuesday whether to raise the global pandemic threat level.

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