Alternative Care Sites: An Option in Disasters

During the current COVID-19 pandemic, the limited surge capacity of the healthcare system is being quickly overwhelmed. Similar scenarios play out when an institution’s systems fail, or when local or regional disasters occur. In these situations, it becomes necessary to use one or more alternative care sites (ACS). Situated in a variety of non-healthcare structures, ACS may be used for ambulatory, acute, subacute, or chronic care. Developing alternative care facilities is the disaster-planning step that moves communities from talking to doing. This commitment pays real dividends if a disaster of any magnitude strikes. This paper discusses the basic criteria for selecting, establishing and ultimately closing an ACS, difficulties of administration, staffing, security, and providing basic supplies and equipment

Healthcare Ethics During a Pandemic

As clinicians and support personnel struggle with their responsibilities to treat during the current COVID-19 pandemic, several ethical issues have emerged. Will healthcare workers and support staff fulfill their duty to treat in the face of high risks? Will institutional and government leaders at all levels do the right things to help alleviate healthcare workers risks and fears? Will physicians be willing to make hard, resource-allocation decisions if they cannot first husband or improvise alternatives? With our healthcare facilities and governments unprepared for this inevitable disaster, front-line doctors, advanced providers, nurses, EMS, and support personnel  struggle with acute shortages of equipment—both to treat patients and  protect themselves. With their personal and possibly their family’s lives and health at risk, they must weigh the option of continuing to work or retreat to safety. This decision, made daily, is based on professional and personal values, how they perceive existing risks—including available protective measures, and their perception of the level and transparency of information they receive. Often, while clinicians get this information, support personnel do not, leading to absenteeism and deteriorating healthcare services. Leadership can use good risk communication (complete, widely transmitted, and transparent) to align healthcare workers’ risk perceptions with reality. They also can address the common problems healthcare workers must overcome to continue working (ie, risk mitigation techniques). Physicians, if they cannot sufficiently husband or improvise lifesaving resources, will have to face difficult triage decisions. Ideally, they will use a predetermined plan, probably based on the principles of Utilitarianism (maximizing the greatest good) and derived from professional and community input. Unfortunately, none of these plans is optimal

The Next Pandemic: Prepare for “Disease X”

The organism that will cause the next pandemic, which WHO labels “Disease X,” probably already exists. The COVID-19 pandemic will, slowly, and with some hiccups and many tragedies, pass into memory. This coronavirus may disappear and later recur, continue endemically under vaccine control, or simply attenuate and vanish. The economy and healthcare systems will return to a new normal, some parts more quickly than others. Like the multiple plagues humanity has endured since our ancestors gathered into cities, it will generate recriminations for slow and misguided responses, profiteering, and over- or under reacting to economic, social, and healthcare events that will, retrospectively, be obvious. The individuals and organizations most culpable for exacerbating the disaster will escape responsibility while they scapegoat others and try to re-write history. Heroes, whether individuals who helped provide clear risk communication and leadership or groups that persevered in the face of fear and life-threatening danger will emerge. Without fanfare, most will return to their normal jobs, scarred but proud of their efforts. As they have before, pundits and scholars will write endlessly about the pandemic’s cause, effects, and ways to ameliorate the next pandemic’s brutal destruction of lives and ways of life. The problem is, we have done all this before and seemed not to have learned the lessons our predecessors taught

False-positive urine pregnancy tests - clinicians as detectives

Reliably diagnosing pregnancy in women presenting with nonspecific abdominal pain can be lifesaving. If diagnostic tests are unreliable, however, valuable time and resources can be wasted pursuing unnecessary and potentially harmful interventions. After four false positive-urine pregnancy tests in one week, we began investigating the laboratory’s entire process involving the UPreg tests. We discovered that, as is common in resource-poor settings, the laboratory repeatedly reused test tubes. We found that the false-positive tests resulted from performing the UPreg tests in test tubes that were improperly cleaned and, for the most part, had been used immediately beforehand to test women coming into the maternity ward. Sufficient residua from the pregnant women’s high ß-HCG levels had remained in the test tubes to cause subsequent false-positive results in our emergency ward patients. Although pregnancy can now be reliably diagnosed with inexpensive, disposable and simple tests, these tests must not only be used properly, but also, when used in the laboratory, be accompanied by appropriate cleaning and quality-control procedures. This is particularly essential in resource-constrained environments

Glove and mitten protection in extreme cold weather: an Antarctic study

Background: Myths, misconceptions and a general lack of information surround the use of gloves and mittens in extreme cold environments. Objective. This study assessed how well an assortment of gloves and mittens performed in a very cold environment. Methods. A convenience sample of gloves and mittens were tested in Antarctica during the winter of 2016 using a calibrated thermometer (range: -148 degrees F to +158 degrees F/-1008C to +70 degrees C) three times over a 0.5-mile distance (similar to 20 minutes). A small sensor on a 10-foot-long cable was taped to the radial surface of the distal small finger on the non-dominant hand. The tested clothing was donned over the probe, the maximum temperature inside the glove/mitten was established near a building exit (ambient temperature approximately 54 degrees F/12 degrees C), and the building was exited, initiating the test. The hand was kept immobile during the test. Some non-heated gloves were tested with chemical heat warmers placed over the volar or dorsal wrist. Results. The highest starting (96 degrees F/36 degrees C) and ending (82 degrees F/28 degrees C) temperatures were with electrically heated gloves. The lowest starting temperature was with electrically heated gloves with the power off (63 degrees F/17 degrees C). Non-heated gloves with an inserted chemical hand warmer had the lowest minimum temperature (33 degrees F/1 degrees C). Maximum temperatures for gloves/mittens did not correlate well with their minimum temperature. Conclusions. Coverings that maintained finger temperatures within a comfortable and safe range (at or above 59 degrees F/15 degrees C) included the heated gloves and mittens (including some with the power off) and mittens with liners. Mittens without liners (shell) generally performed better than unheated gloves. Better results generally paralleled the item's cost. Inserting chemical heat warmers at the wrist increased heat loss, possibly through the exposed area around the warmer.Open access journal.This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

SARS-CoV-2 (COVID-19) Vaccine Development and Production: An Ethical Way Forward

The world awaits a SARS-CoV-2 virus (i.e., COVID-19 disease) vaccine to keep the populace healthy, fully reopen their economies, and return their social and healthcare systems to “normal.” Vaccine safety and efficacy requires meticulous testing and oversight; this paper describes how despite grandiose public statements, the current vaccine development, testing, and production methods may prove to be ethically dubious, medically dangerous, and socially volatile. The basic moral concern is the potential danger to the health of human test subjects and, eventually, many vaccine recipients. This is further complicated by economic and political pressures to reduce government oversight on rushed vaccine testing and production, nationalistic distribution goals, and failure to plan for the widespread immunization needed to produce global herd immunity. As this paper asserts, the public must be better informed to assess promises about the novel vaccines being produced and to tolerate delays and uncertainty.Open access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Tackling the Global Challenge: Humanitarian Catastrophes

“Humanitarian catastrophes,” conflicts and calamities generating both widespread human suffering and destructive events, require a wide range of emergency resources. This paper answers a number of questions that humanitarian catastrophes generate: Why and how do the most-developed countries—those with the resources, capabilities, and willingness to help—intervene in specific types of disasters? What ethical and legal guidelines shape our interventions? How well do we achieve our goals? It then suggests a number of changes to improve humanitarian responses, including better NGO-government cooperation, increased research on the best disaster response methods, clarification of the criteria and roles for humanitarian (military) interventions, and development of post-2015 Millennium Development Goals with more accurate progress measures