Posted on Wed, Feb. 15, 2006
Classes struggle over crisis planPonder ethics of vaccine choicesBy Michael SchroederThe Journal GazetteMilitary-minded Michael Henry wasn?t shy about directing traffic.
?There needs to be a ? very solid chain of command,? he said, unwavering.
He called for a strict quarantine and reminded peers that losses would be inevitable. If necessary, Henry said, force should be used to carry out quarantine orders ? even authorizing the military to shoot people who violated them.
?I know it sounds harsh but that?s what?s got to be done,? he said. A not-so-silent observer in a mock flu pandemic planning exercise, Henry wasn?t alone among his IPFW peers in taking the exercise to heart.
Students in a medical ethics class at Indiana University-Purdue University Fort Wayne and a logic class at the University of Saint Francis took part in the exercises this month and last. Dr. Deborah McMahan, Allen County health commissioner, and other health department officials led the exercises. They collaborated with professors Bill Bruening of IPFW and Earl Kumfer of Saint Francis, who are working with the county on the ethics aspect of its own pandemic plan. That plan is expected to be complete this summer.
Pressed to decide who would receive 1,500 doses of antiviral medication and 2,000 vaccines, students considered personal values, children and jobs in responding. Using input from classmates, a mock health commissioner, county commissioner and mayor crafted an abbreviated plan answering these questions and two others about involving limited patient admissions at local hospitals and controlling the virus? spread.
The interactive exercises followed a presentation and news clip on H5N1, a flu strain that has gained worldwide attention. Although the strain does not currently pass easily between humans, reported cases of H5N1 have resulted in an extremely high rate of death ? killing more than 50 percent of humans who have contracted it from birds.
Although it?s not known how many doses of vaccine or antiviral medication would be available in the event of a pandemic (because the current strain of H5N1 would have to mutate before it could be passed easily between humans), health officials say treatment would be severely limited. For instance, there are only about 250 respirators available to the public county-wide, McMahan said.
This was not lost on students, some who commented after class that they didn?t take the issue lightly. Those given mock public service jobs also learned first hand about the pressures public officials face in times of crisis.
?I hate being in this role,? said Alicia Tomlinson, the appointed health commissioner in Bruening?s ethics class, which meets Monday nights. Combined with a sheepish smile, the comment during the brainstorming phase of the process Feb. 6 elicited some laughter. McMahan, too, smiled at the assertion.
Levity was not lost on either class during the exercises, which wrapped up in late January and Monday night.
Jokes served as a means of perspective. But students? interest seemed piqued. Even side conversations in both classes ? including those out of professors? earshot ? often revolved around the topic at hand.
In Kumfer?s Jan. 27 logic class, assigned health commissioner Adam Colclesser hunkered down as he delivered a prepared response to the four emergency plan questions. His slumped shoulders gave him the look of a leader physically pushed down by the weight of a crisis.
Responses called for 1,300 doses ? of 1,500 total doses available according to the mock scenario ? to be given on a first-come, first-served basis to infected persons between 15 and 30 years of age. According to the scenario, children, teens and adults were at highest risk for life-threatening complications and death from the imagined flu strain. The other 200 doses would be reserved for licensed health care workers with at least five years of experience, Colclesser explained.
Later on, he said county borders would be ordered closed ? McMahan told the other class that would be an impossible feat, especially given that military might would be needed elsewhere, such as in Marion County. Public events would be canceled and children would be ordered to stay home, he said.
Still for all its answers, the mock plan prompted more questions from classmates, at least one who was concerned about infected people walking around and infecting their neighbors.
?Unfortunately, we didn?t think it out that far,? Colclesser finally conceded. McMahan applauded the response calling such openness crucial toward improving such a work in progress.
Both classes gave vaccine priority to first responders and promoted some form of quarantining or restricting movement. And going beyond the script, students addressed questions that weren?t even posed in the exercise.
While Bruening?s class said certain hospitals would be designated to handle patient overflow, Kumfer?s class called for off-site venues, a scenario being considered by the county for the real thing. The question: Who will you allow to be admitted to the hospitals, with the conditions that each of the five local hospitals could only take on 20 extra patients a day and average treatment for the flu would last two weeks?
In the end, most students said they would be more likely to buy into a communitywide pandemic plan if they felt they had input. That buy-in and the hope that students would act as ambassadors for the cause were desired outcomes of the exercise, health officials said. In videotaping the exercises, the health department hoped to learn a thing or two from the students? reactions to the mock crisis, as well.
On Monday night, the chalk board in Room 144 in IPFW?s Classroom-Medical Building was peppered with values students said affected their pandemic planning decisions, per McMahan?s request.Such values included integrity, fairness and a wild card: personal obligations. Deeply ingrained in some students from the older of the two classes was the desire to put children first, even ? a few said ? if it meant lying and undermining other values central to a plan.
Outside Bruening?s class, McMahan said she had not expected students to take the exercise so seriously. Moreover, she said, the exercise generated a level of intensity that she hadn?t even seen in committee meetings for the county?s pandemic plan.
?I can feel their tension,? she said of the class. She ascribed that to the fundamental question students were faced with: to dole out limited vaccines and medicine.
?Who you are as a community is in the rationing,? she said.
mschroeder@jg.net
Classes struggle over crisis planPonder ethics of vaccine choicesBy Michael SchroederThe Journal GazetteMilitary-minded Michael Henry wasn?t shy about directing traffic.
?There needs to be a ? very solid chain of command,? he said, unwavering.
He called for a strict quarantine and reminded peers that losses would be inevitable. If necessary, Henry said, force should be used to carry out quarantine orders ? even authorizing the military to shoot people who violated them.
?I know it sounds harsh but that?s what?s got to be done,? he said. A not-so-silent observer in a mock flu pandemic planning exercise, Henry wasn?t alone among his IPFW peers in taking the exercise to heart.
Students in a medical ethics class at Indiana University-Purdue University Fort Wayne and a logic class at the University of Saint Francis took part in the exercises this month and last. Dr. Deborah McMahan, Allen County health commissioner, and other health department officials led the exercises. They collaborated with professors Bill Bruening of IPFW and Earl Kumfer of Saint Francis, who are working with the county on the ethics aspect of its own pandemic plan. That plan is expected to be complete this summer.
Pressed to decide who would receive 1,500 doses of antiviral medication and 2,000 vaccines, students considered personal values, children and jobs in responding. Using input from classmates, a mock health commissioner, county commissioner and mayor crafted an abbreviated plan answering these questions and two others about involving limited patient admissions at local hospitals and controlling the virus? spread.
The interactive exercises followed a presentation and news clip on H5N1, a flu strain that has gained worldwide attention. Although the strain does not currently pass easily between humans, reported cases of H5N1 have resulted in an extremely high rate of death ? killing more than 50 percent of humans who have contracted it from birds.
Although it?s not known how many doses of vaccine or antiviral medication would be available in the event of a pandemic (because the current strain of H5N1 would have to mutate before it could be passed easily between humans), health officials say treatment would be severely limited. For instance, there are only about 250 respirators available to the public county-wide, McMahan said.
This was not lost on students, some who commented after class that they didn?t take the issue lightly. Those given mock public service jobs also learned first hand about the pressures public officials face in times of crisis.
?I hate being in this role,? said Alicia Tomlinson, the appointed health commissioner in Bruening?s ethics class, which meets Monday nights. Combined with a sheepish smile, the comment during the brainstorming phase of the process Feb. 6 elicited some laughter. McMahan, too, smiled at the assertion.
Levity was not lost on either class during the exercises, which wrapped up in late January and Monday night.
Jokes served as a means of perspective. But students? interest seemed piqued. Even side conversations in both classes ? including those out of professors? earshot ? often revolved around the topic at hand.
In Kumfer?s Jan. 27 logic class, assigned health commissioner Adam Colclesser hunkered down as he delivered a prepared response to the four emergency plan questions. His slumped shoulders gave him the look of a leader physically pushed down by the weight of a crisis.
Responses called for 1,300 doses ? of 1,500 total doses available according to the mock scenario ? to be given on a first-come, first-served basis to infected persons between 15 and 30 years of age. According to the scenario, children, teens and adults were at highest risk for life-threatening complications and death from the imagined flu strain. The other 200 doses would be reserved for licensed health care workers with at least five years of experience, Colclesser explained.
Later on, he said county borders would be ordered closed ? McMahan told the other class that would be an impossible feat, especially given that military might would be needed elsewhere, such as in Marion County. Public events would be canceled and children would be ordered to stay home, he said.
Still for all its answers, the mock plan prompted more questions from classmates, at least one who was concerned about infected people walking around and infecting their neighbors.
?Unfortunately, we didn?t think it out that far,? Colclesser finally conceded. McMahan applauded the response calling such openness crucial toward improving such a work in progress.
Both classes gave vaccine priority to first responders and promoted some form of quarantining or restricting movement. And going beyond the script, students addressed questions that weren?t even posed in the exercise.
While Bruening?s class said certain hospitals would be designated to handle patient overflow, Kumfer?s class called for off-site venues, a scenario being considered by the county for the real thing. The question: Who will you allow to be admitted to the hospitals, with the conditions that each of the five local hospitals could only take on 20 extra patients a day and average treatment for the flu would last two weeks?
In the end, most students said they would be more likely to buy into a communitywide pandemic plan if they felt they had input. That buy-in and the hope that students would act as ambassadors for the cause were desired outcomes of the exercise, health officials said. In videotaping the exercises, the health department hoped to learn a thing or two from the students? reactions to the mock crisis, as well.
On Monday night, the chalk board in Room 144 in IPFW?s Classroom-Medical Building was peppered with values students said affected their pandemic planning decisions, per McMahan?s request.Such values included integrity, fairness and a wild card: personal obligations. Deeply ingrained in some students from the older of the two classes was the desire to put children first, even ? a few said ? if it meant lying and undermining other values central to a plan.
Outside Bruening?s class, McMahan said she had not expected students to take the exercise so seriously. Moreover, she said, the exercise generated a level of intensity that she hadn?t even seen in committee meetings for the county?s pandemic plan.
?I can feel their tension,? she said of the class. She ascribed that to the fundamental question students were faced with: to dole out limited vaccines and medicine.
?Who you are as a community is in the rationing,? she said.
mschroeder@jg.net