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ERs fear crush of flu cases

Health-care worker Melinda Chambers, bottom right, passes out forms for people trying to get flu shots in San Francisco.
Health-care worker Melinda Chambers, bottom right, passes out forms for people trying to get flu shots in San Francisco.
Jakub Mosur, Associated Press

ATLANTA — Appalled by the loss of half this year's supply of flu shots, emergency room staffs across the country are predicting a crush of flu cases that will swamp overtaxed ERs, forcing sick and elderly patients to lie on gurneys for hours and squeezing out others who need immediate care.

The American College of Emergency Physicians, a professional organization of 22,000 doctors meeting this week in San Francisco, will issue an urgent plea Monday for money and personnel to counter the coming wave of patients, who are likely to be elderly or chronically ill and in need of complicated care.

"On any given night or day, in Atlanta and in major cities across the country, emergency departments are swamped with patients," said Dr. Arthur Kellermann, professor and chairman of emergency medicine at Emory University School of Medicine and a member of the group. "Where will we find the hospital capacity to handle potentially hundreds of thousands of flu victims that will need at least evaluation and possibly hospital care?"

In Georgia and elsewhere, hospitals are making plans to hire more nurses, put personnel on extra shifts and open closed wards — and if necessary to create temporary clinics in other locations where non-flu patients could be sent.

The institutions are preparing for the worst even though no one can yet say whether the coming season will bring more, or fewer, than the 36,000 flu-related deaths and more than 200,000 hospitalizations in the United States in an average year.

The crisis that the ER doctors envision is a health-care version of the perfect storm: a confluence of two trends, each challenging on its own, that together could produce "a disaster," according to Dr. Matthew Carius of Norwalk Hospital in Connecticut, a past president of the emergency physicians' group.

Two weeks ago, the federal government learned that British authorities, concerned about bacterial contamination, had impounded at least 46 million doses of flu vaccine headed to this country. That prevented delivery of almost half of this year's vaccine supply.

The Department of Health and Human Services has been unable to replace the lost doses because other flu-vaccine manufacturers have not licensed their products in the United States. Instead, the Centers for Disease Control and Prevention sharply adjusted its vaccination target recommendations to include only those at highest risk, hoping they would get what vaccine is available.

Those who nevertheless fall ill are likely to seek care at emergency departments, which are already severely stressed. Since 1990, more than 1,000 ERs have closed nationwide, and hospitals, needing nurses and lacking funds, eliminated more than 200,000 inpatient beds, according to the American Hospital Association.

The closures have produced a crunch: Fewer ERs for patients to go to and, when patients arrive, fewer inpatient beds to receive them. The result: emergency departments that are already at maximum capacity, unable to absorb fresh waves of the sick.

"The glass can never get more than completely full," said Dr. David Talan of the University of California in Los Angeles, a city where four hospitals have filed plans to close their ERs. "But the more you pour into it, the more runs down the sides."