M E R I D I A N M A G A Z I N E

Caring For First Responders
By Carolyn Nicolaysen

The Center for Disease Control now estimates 1 million Americans have been infected with the H1N1 swine flu. Lyn Finelli, a flu surveillance official for the CDC, says the estimate is based on mathematical modeling. This suggests the number of those infected was under-reported due to a lack of kits for testing and apathy on the part of those who felt the symptoms were too mild to be a concern. Now we have a credible authority announcing far more cases than the public has been told about.

In another development, we now learn the vaccine being developed to combat a pandemic of swine flu will require multiple shots to provide immunity. Two injections will be required three weeks apart for adults. In addition, a third vaccine will be needed for seasonal flu. Children younger than 9 years will need a total of four vaccinations.

The World Health Organization estimates all the vaccine manufacturers throughout the world will be able to produce 400 million (or so) doses each month. With 304 million people living in the United Sates alone, it is easy to surmise that access to the vaccine will be very limited. The good news is that the H1N1 has not yet mutated and for most people remains mild. The big questions still remain - when will the virus return and how strong will it be when it does?

Furthermore, according to a report in the June 19 th 2009 issue of the CDC's Morbidity and Mortality Weekly Report, a sample of 26 health-care workers found that half became infected with the H1N1 while at work. This is another big reason to be concerned about the availability of medical help should this flu return in a virulent form in the fall.

It reminds me of a popular TV commercial for Volkswagen in the 1960's. It showed a Volkswagen ?Bug? being driven up a winding, snow covered road with nothing but headlights and street lamps illuminating the path through deep snow. The VW was making the first set of tracks up the hill to a large shop where the door opened to reveal a truck with a huge snow plow waiting. Then the announcer said: ?Ever wonder how the driver who drives the snow plow, drives to the snow plow??

Our first responders are like the driver of the snow plow. In order to do what they do, they have to make the first tracks after the storm. We depend on them, and we need them to get to their job every day, no matter how bad things get.

Thus, it is time to consider the first responders in our lives and their health during a pandemic. If you live with a healthcare worker, firefighter, police officer, military reservist, repair personnel for our infrastructure, or news reporter, it is time to plan for their care.

The first question to answer is whether or not your loved one will live at the office. If they will, is their employer prepared to provide all the resources they will need? Every office that will be called ?home? during a pandemic quarantine should be well equipped. There should be plenty of food for everyone who will be housed there. Foods should be easy to prepare and appropriate for breakfast, lunch and dinner. There should be a way to heat food. There should be a supply of drinks and the ingredients to make rehydration formulas. (see Meridian article: Caring For Family During a Pandemic-Part 1 ). Please remember, Gatorade is not a rehydration drink!

Each office should have a stock of paper plates, cups, bowls, napkins and disposable utensils. There should also be supplies for washing dishes used to cook meals. There should also be plenty of trash bags for disposing of paper products.

A first responder's office should be supplied with N95 masks and disposable gloves. These should be available every time anyone needs to leave the office for any reason. Masks and gloves are both meant for a one time use only. If personnel are leaving the office more than once in a day they will need protection each time they venture out. There should be hand sanitizer both at the office and for use in the field as persons go out into the public. This may seem silly the first time, but get over it! In a real pandemic like the 1918 pandemic, people you know will be dying, and nobody in their right mind will want to do less than all they can to prevent being infected.

Offices will need to be supplied with items needed for sleeping and for sanitation. They will also need disinfectants to kill germs left on hard surfaces. There should be a well equipped first aid kit and over the counter medications for the symptoms of the flu, should someone become ill. A room should be designated for the quarantine of any staff member who becomes ill.

If there is no plan by your employer, then you need to create a plan of your own. According to my medical advisors, quarantining one member of the family in your home is possible, but needs planning to be successful.

If a member of your family needs to leave your home, but you don't want them bringing the flu back home to the rest of the family, you need to create an efficiency apartment to meet their needs. This could be in a garage or a bedroom with a private entrance. In either case, all family members except one adult will need to remain out of that room until the flu has ended. Consider the needs of your first responder now, and formulate a plan.

First responders need to eat. If they are isolated at home, food will need to come from your kitchen. You will not want your loved one eating fast food and further risking exposure to the flu. During a quarantine grocery store shelves will be sparse at best. Your refuge will need a stock of foods that are appropriate for breakfast, lunch and dinner. Dinners can be placed in a small refrigerator when your family member is at work. Foods can then be heated or cooked in a microwave, toaster oven, or electric skillet, so long as you have electricity.

Dishes and a way to wash them will be needed, or plenty of disposable plates, cups, bowls and utensils. If the electricity should go out, first responders at the workplace or at home will need to use a barbecue or camp stove to cook. This should only be done outdoors, NEVER in a garage or room in your home.

First responders need a place to sleep. A comfortable bed, bedding, pillow and plenty of blankets are needed, especially if you live in a cold climate and are relegating them to the garage. If you live in a cold climate, plan for a space heater in case the electricity goes out, whether they are staying in the house, or garage. If it is very cold, set up a tent in the garage and place the bed, chair and lamp inside. Body heat and heat from the lamp will be more contained and will help to raise the temperature.

Should your first responder become infected with the virus or forced to live under quarantine because they might have been infected, they will need a place to stay with some comforts and things to do to pass the time. Your first responder will need a place to sit ? a chair. Sitting on the edge of the bed to eat a meal is miserable and a recipe for a great backache. A lamp for the evening hours is a must.

Being alone gets boring and depressing very quickly. Plan for a way to pass the time - a TV with DVD player, internet connection, some good books, puzzles, magazines (even older ones that may not have been read yet), paper and pens? Think about what they really enjoy doing, but may not have taken time to do. This would be a great time to work on family history, for example.

Naturally you will need a restroom facility. If this is not available, then you will need to think camping. A port-a-potty, pitcher and a bowl for washing up, and a portable shower may be needed in extreme circumstances. Hand sanitizers are also important to have on hand.

A few more items you may want to include: trash cans, trash bags, snacks, first aid kit, over the counter medications, prescription medications, plastic wrap and paper bags for fixing a sack lunch, a clock (preferably battery operated), a plastic container for clean clothes, family pictures, tissues, hygiene items, an extension phone, a flashlight or glow sticks in case of a power outage, a radio which is battery operated or hand cranked, cell phone charger, extension cord, and a hamper or two lined with a plastic bag which can be taken directly to the laundry room. Having two hampers enables your family member to sort their clothes by color and then you only need to take the bag and dump it directly into the washer. This reduces your chance of contamination.

The adult who will be entering this room to bring in food, pick up the laundry or leave notes and crafts from the kids, should treat this the same way they would a recovery room. Always wear gloves and a mask when entering, and sanitize as soon as you leave.

What can you do to help keep your exiled family member from going crazy? Set a time to "meet" as a family. Call on the phone, put the phone on speaker, and read a book together, or have the kids report on their day. Bake a batch of cookies or other favorite homemade treat and leave some on their bed while they are gone. ?Heart attack? them. Make hearts out of construction paper and write notes on each heart about how much you love that family member. Attach the notes to the outside of the outside door and when they come home they will be met with the messages. Chat on the internet. Take pictures during the day and post them on your family blog or Facebook page. Have your loved one collect the mail each day, if it is still being delivered, and have them read it to you over the phone. The mail will have lots of germs on it so you may not be collecting it. At least, not without sanitizing it before you bring it into the house.

The possibility of a serious pandemic is real. If not now, then in the future. Does anyone remember our concern about the H5N1, avian flu just a few months ago? It is still a possibility, too. We all hope none of this information will be necessary, but history tells us some day it will be vital.