US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

[hawkeye]

US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

The US Department of Health and Human Services (HHS) contracted with the American Association for Respiratory Care (AARC) to perform a comprehensive inventory of mechanical ventilators in every hospital in the country. A survey is being taken to gain an accurate account of the number of ventilators that would be available in the event of a nationwide pandemic.

The Office of Preparedness and Response requested this inventory information “as the nation braces for the nH1N1 virus that may affect record numbers of Americans,” according to an announcement from AARC. The announcement goes on to explain, “Initial experience shows that many individuals are placed on ventilators as a result of this flu.”

All information gained from the survey will be kept in confidence and will not be available through the Freedom of Information Act. The AARC clarifies that no relocation of ventilators will be performed as a result of this survey; the information is sought so that the government can acquire or assist in augmenting current ventilator capacity.

Information on filling out the surveys has been sent to the Manager of Respiratory Care at each hospital in the United States.

"We are urging all hospitals to immediately begin this survey," said Timothy Myers, AARC president. "We hope to have this data gathered by September 10. There is an urgency to the effort."

[hawkeye]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

More About The National Ventilator Survey

Disaster preparedness has been a priority in the United States and around the world since the events of September 11th, 2001. Mass casualty respiratory failure represents a serious challenge to the US healthcare system with respect to both personnel and materiel. Mass casualty respiratory failure may result from man-made or natural disasters such as explosions or earthquakes. It may also be infectious in origin resulting from man-made or naturally occurring agents such as anthrax or the recent H1N1 flu.

Public health preparedness for mass casualty respiratory failure includes surveillance and appropriate counter measures. The current H1N1 flu epidemic has resulted in small pockets of severe respiratory failure around the world. With the fall flu season of 2009 ahead of us, planning and preparation are priorities.

A major limitation in the US preparation for mass casualty respiratory failure is our inability to account for the number of ventilators currently available in US hospitals. Attempts at counting US ventilators have resulted in numbers from 65,000 to 105,000 devices.

Why is this important? As the Federal government plans for the possibility of mass casualty respiratory failure, the purchase of ventilators for the strategic national stockpile represents one countermeasure. The important question is how many ventilators are necessary? The single greatest impediment to answering this question, is not knowing how many ventilators are currently available.

The purchase of ventilators for mass casualty respiratory failure results in an approximate cost of $10,000 per device. If the estimation of ventilators is off by 10,000 devices, then an unnecessary purchase of that volume of equipment represents inappropriate allocation of $100M.

The Department of Health and Human Services has enlisted the American Association for Respiratory Care in completing what amounts to a census of ventilators in United States hospitals. The success of this project is critical in assisting the government in planning for mass casualty respiratory failure. This endeavor is a vital first step in meeting the threat of a severe fall flu season.

The AARC will be reaching out to each of you for help. As leaders of the Respiratory Care Community, your rapid, accurate, and complete response to the survey is the key to the success of the project. We are looking for one complete survey from each institution, completed by the individual with the best knowledge of the hospitals ventilator resources. Your Government has placed its trust in the AARC as the one organization with the membership and expertise to accomplish this task. The success of this project rests with each of you. The AARC and your Government are counting on you!

[wotan]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

The number of vents in the US is a matter of national security? How is it not available under FOIA?

[hawkeye]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

The survey is open to the public. I'm pretty sure one could complete the survey entering false data without a problem. Rather insane if you ask me considering the impact this survey could have on our national stockpile and available funds.

Here is the privacy statement on the survey page:

The U.S. Department of Health and Human Services further secures the privacy of your institution’s data through participation in the Protected Critical Infrastructure Information (PCII) program administered by the U.S. Department of Homeland Security. Resulting from the Critical Infrastructure Information Act (CII) of 2002, the PCII program protects voluntarily submitted critical infrastructure information from public release through Freedom of Information Act (FOIA), state and local disclosure laws, and use in civil litigation. Additionally, PCII can not be used for regulatory purposes. Institutions and facilities sending important data into the Federal government can be assured of the highest commitment to confidentiality and security of their data.

[Lizw]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

The number of vents in the US is a matter of national security? How is it not available under FOIA?

FOIA gets you existing documents that are already in public possession (by virtue of belonging to the federal government). If a hospital doesn't have a document saying how many ventilators it has on hand, or if the hospital is owned by a state, county, city or commercial company, as most of them are, FOIA gets you a boilerplate email, if that much. Or a series of secretaries and clerks on the phone, each of which knows less than the last one. Been there, done that.

FOIA is only for documents held by the US government, and even then only if the document actually exists.

[mixin]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

That's interesting they intend to keep this information confidential. What reasons can they possibly have for not sharing the results with the public?

Here's what I have from last year on vents in our Strategic National Stockpile. I don't have anything on how many there are in hosptial (or long term care) settings. If anyone has any more info to add, I'd appreciate it.

----------------------------------------------------

On May 25, 2005, The Association for Respiratory Care did a study.
On the understanding there were 6,000 vents the Strategic National Stockpile, they recommended the current inventory be expanded by
at least 5,000 to 10,000 more vents.

On June 5, 2006 the study was amended to include a notification from the CDC there were actually only 4000 vents in stock and another 486 were ordered but not yet received.

http://www.aarc.org/resources/mass_casualty/index.asp

On October 3, 2007, testimony on the status of HHS pandemic plans state the goal is to purchase 2,000 vents in 2007.

If the 2000 actually were purchased, we possibly have 7000 of the recommended 11,000-16,000.

It was also noted that contract solicitatian would be issued in early 2008 for the advanced development of next generation vents.

http://www.hhs.gov/asl/testify/2007/10/t20071003a.html

[Lizw]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

That's interesting they intend to keep this information confidential. What reasons can they possibly have for not sharing the results with the public?

I suppose the reasoning is that knowing how many (or how few) ventilators the US has would be useful information for our enemies. That presumes, of course, that we have so few that it would make us more vulnerable in case of an attack. What's ironic is that wording it as a homeland security secret instantly prompts one to suspect that we don't have as many as we need. It would make a lot more sense to make the information available to everyone, but no one has accused TPTB of using common sense.

[hawkeye]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

If what you say is true. I'd also add that having the survey page public is also a national security risk. Being able to falsify data or even flood the survey with garbage data could result in the survey being unreliable.

I suppose the reasoning is that knowing how many (or how few) ventilators the US has would be useful information for our enemies. That presumes, of course, that we have so few that it would make us more vulnerable in case of an attack. What's ironic is that wording it as a homeland security secret instantly prompts one to suspect that we don't have as many as we need. It would make a lot more sense to make the information available to everyone, but no one has accused TPTB of using common sense.

[mixin]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

I didn't understand that this survey will be made public. They say:

Information on filling out the surveys has been sent to the Manager of Respiratory Care at each hospital in the United States... We are looking for one complete survey from each institution, completed by the individual with the best knowledge of the hospitals ventilator resources.

I wonder if it really has anything to do with national security. We already have an idea of hospitalizations for the first mild wave and they have predicted numbers for the second wave. I wonder how the number of vents stacks up against their predictions for fall.

Last October, HHS/BARDA put out a pre-solicitation for next generation vents. I can't find the original posting at the moment, but here are 2 of the requirements I noted, It appears they are well aware of the fact that we don't have nearly enough vents:

# The Offeror must be able to ramp up production in an emergency to supply at least 1700 fully kitted ventilators in one month to meet a capability goal of at least 10,000 fully kitted units within 6 months.

# The anticipated period of performance will be two years or 24 months.

[kiwibird]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

New York City has already made an assessment of available ventilators and publicly posted the results. The figures are 3 years old but the machines should all still be serviceable. http://www.nyc.gov/html/doh/download...202-pres08.pdf

[Evelyn]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

A question that keeps coming back to me: will the limiting factor be ventilators, or professionals who know how to care for ventilated patients?

For what it's worth, there were about 122,000 respiratory therapists in the US as of 2006 (http://www.bls.gov/oco/ocos084.htm). Though the profession has been expected to grow, enrollment in training programs has been declining for the last few years (http://www.aarc.org/education/school_protection/). Not all respiratory therapists are experienced in critical care settings; I don't know what percentage of RTs routinely work with patients on ventilators.

If anyone's got information or opinions, I'd like to hear them.

[wotan]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

A question that keeps coming back to me: will the limiting factor be ventilators, or professionals who know how to care for ventilated patients?

For what it's worth, there were about 122,000 respiratory therapists in the US as of 2006 (http://www.bls.gov/oco/ocos084.htm). Though the profession has been expected to grow, enrollment in training programs has been declining for the last few years (http://www.aarc.org/education/school_protection/). Not all respiratory therapists are experienced in critical care settings; I don't know what percentage of RTs routinely work with patients on ventilators.

If anyone's got information or opinions, I'd like to hear them.

I have been quite concerned about a shortage of RT's. They could conceivably be at higher risk than other HCW given the nature of what they do.

[Gert van der Hoek]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

Swine origin influenza A (H1N1) virus and ICU capacity in the US

Are we prepared?

We developed a model simulating the potential impact of influenza H1N1 pandemic on the volume of acute respiratory failure requiring mechanical ventilation (ARF-MV) and the accompanying mortality rate in the US.

We calculate that 46 million people will contract the infection, resulting in 2.7 million hospitalizations, 331,587 episodes of ARF-MV and nearly 200,000 deaths, suggesting that the US may require the ability to provide MV at a volume approximately 33% over the current annual use.

INTRODUCTION

In March of 2009 a novel strain of swine origin influenza A (H1N1) virus (S-OIV) was detected in Mexico. It has now spread to the rest of the world. With over 170,000 laboratory-confirmed cases worldwide, the World Health Organization (WHO) has declared a global pandemic[1].

In the United States, current estimates suggest an attack rate of approximately 6-8% in affected communities, which according to officials from the Centers for Disease Control and Prevention (CDC) may more than double during the traditional flu season[2].

Although reports of both severe illness and fatalities are uncommon, concern exists about the potential for this virus to cause severe acute respiratory failure necessitating mechanical ventilation (ARF-MV) with specialized methods[3].

Since H1N1 is predicted to affect a significant proportion of the population, even a low incidence of concomitant ARF-MV may overwhelm the already-stretched emergency department and intensive care unit (ICU) resources[4].

To estimate what the S-OIV may portend for the ARF-MV in the US, we developed a model simulating its potential impact on the volume of ARF-MV and the accompanying mortality rate.

METHODS

Because the situation is evolving rapidly and information is scant, in addition to peer-reviewed studies we relied on other sources of credible estimates and reasonable assumptions for model inputs (Table).

We employed data from the CDC to estimate the H1N1 incidence and mortality in the US population, and those from the Mexican experience for our baseline rates of hospitalization and ARF-MV[5].

We explored a range of potential values for model inputs given the uncertainties surrounding them, and each outcome was subjected to 10,000 Monte Carlo simulation trials.

RESULTS AND DISCUSSION

In the base case, we calculate that 46 million people will contract the infection, resulting in 2.7 million hospitalizations, 331,587 episodes of ARF-MV and nearly 200,000 deaths (Table), suggesting that the US may require the ability to provide MV at a volume between 23% and 45% over the current use[4] (Table).

Tornado diagrams for each outcome indicated that the estimates are equally sensitive to all corresponding inputs (data not shown).

Our model is limited by the accuracy of the input parameters. As the flu season progresses, more precise inputs may become available.

Additionally, we did not model the impact of an effective vaccine on the attack rates or the outcomes; however, because of the uncertainties surrounding the timing and the number of doses available, and its effectiveness, this too will require updating when the information becomes available.

Finally, the applicability of data from Mexico is uncertain[5]. Differences in the delivery of and access to healthcare between the US and Mexico may alter both rates of progression to ARF-MV and mortality.

These limitations notwithstanding, the model is informative in several ways.

First, our findings represent an attempt to quantify the potential need for surge capacity in our ICUs in response to this evolving pandemic.
We should point out that, although we modeled the burden over the entire epidemic period, the vast majority of the cases will likely occur during the peak flu months, thus straining the ICU and MV capacity even more intensely over a shorter period of time.

For this reason, our estimates emphasize the need for careful planning and prioritization schemes as they relate to the allocation of scarce ICU resources.

Second, in light of the recent report of severe ARF-MV cases requiring advanced MV modes available only in specialized centers and requiring special equipment not commonly stockpiled at the state and federal levels, planners must explore the feasibility of regionalizing S-OIV-related ARF-MV care[3].

Third, as this infection will likely disproportionately affect areas of higher population density, regional response plans are urgently needed.

CONCLUSION

In summary, estimates of what may be expected with S-OIV should help ICU directors, hospital administrators and other policy makers allocate appropriate resources for an effective coordinated response. In addition to education and prevention, efforts must focus on planning for the impact of this virus on ARF-MV.




Source and references:

http://knol.google.com/k/marya-d-zilberberg/swine-origin-influenza-a-h1n1-virus-and/3htiswudddv6h/1?collectionId=28qm4w0q65e4w.1&position=2#

[Chuck]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

That's interesting they intend to keep this information confidential. What reasons can they possibly have for not sharing the results with the public?

I think the purpose of keeping the information confidential is to get as complete information as possible from hospitals that might otherwise be reluctant to share information that might somehow be used in a liability lawsuit.

[mixin]

Re: US Hospitals Urged to Take Survey on Ventilator Numbers by September 10

From a Cidrap story regarding the vent survey:

The report will be confidential and will not be used to relocate machines.

But then we have this from the PCAST report:

Expected benefits: Acute stress on ICUs or increased demand for ventilators may be a trigger for resource reallocation from less affected areas and/or for intensifying community mitigation measures. Accuratemeasures of health care system utilization would facilitate more efficient sharing of resources.

So will they change their minds and use the info to relocate vents if necessary or are vents just one of those resources that won't be reallocated?