Swine flu - critical care bed shortage revealed

By Niall Hunter & Joanne McCarthy

Hospital specialists have warned that Ireland does not have enough critical care bed capacity or staffing to deal with an upsurge in swine flu.

And it has emerged that a national unit at Dublin's Mater Hospital which could provide vital specialised lung treatment to some patients seriously ill with swine flu is not yet open.

It is expected that many hospital patients admitted with swine flu will be experiencing breathing difficulties and will need intensive care treatment.

Concern has been expressed by a group representing consultants in intensive and critical care medicine about the capacity of our hospital system to cope with the expected surge, which could lead to 26,000 extra patients being admitted to the hospital system.
 
Dr Brian Marsh of the Intensive Care Society of Ireland told irishhealth.com that figures from the UK suggest that up to 20% of hospital admissions with swine flu would require critical care facilities.
 
He said this indicates that an upsurge in swine flu, with many patients requiring hospital admission, would clearly put considerable pressure on existing intensive care/critical care beds in Irish hospitals.
 
Dr Marsh said many intensive care units in major hospitals already had 100% bed occupancy, and should there be a surge in swine flu cases in Ireland, this would clearly need to be rectified.
 
“The whole critical care system in Irish hospitals is under-resourced as it is. There are not enough beds, so a surge in swine flu admissions is likely to prove very challenging.”
 
While he praised the efforts of the HSE to date in coping with the current outbreak and in planning for the expected upsurge in swine flu, he warned that Ireland, in terms of its critical care bed capacity, is less well placed than other countries when it comes to dealing with a swine flu upsurge.
 
An audit of intensive care beds in Ireland carried out by the Society in early 2007 found that critical care units at four of the country's major hospitals - Tallaght, Cork University, St James’s and St Vincent’s, were operating at greater than 100% bed occupancy.
 
On the day the audit was carried out, patients were being managed and ventilated outside these intensive care units.

The Society had told the HSE back in 2006, at the time of the avian flu scare, that depending on the virulence of a pandemic, up to 100% extra temporary ICU beds may be needed.
 
Dr Marsh said the same capacity issues were still there more than two years after the audit. “An 80% occupancy rate is regarded as the international norm for intensive care bed occupancy.”
 
He pointed out that in New Zealand, 20% of hospital beds are currently being occupied by patients being treated for swine flu, but the health authorities have managed to keep hospital activity going because the bed configuration in that country is better than in Ireland.
 
Similarly, in the UK, Dr Marsh said the hospital system there appears to be in a better position to cope with swine flu as its critical care unit occupancy levels are nearer to the desired rate of 80%.
 
“We are not yet at this level in Ireland,” he said.

It has also emerged that Ireland does not yet have a functioning national unit which could provide vital ECMO (Extracorporeal Membrane Oxygenation) to seriously ill swine flu patients.

According to Dr Marsh, ECMO is used for patients with severe lung problems who have not responded to maximal advanced ventilatory strategies.

He said to date, ECMO therapy has been sourced outside of Ireland for patients who needed it. "It is unrealistic to expect that there would be capacity in such international centres for a surge in demand from Ireland while reacting to their own national demand."

Dr Marsh said the ECMO centre for Ireland at the Mater is at an advanced stage of planning but is not up and running yet.

Our Lady's Children's Hospital in Crumlin currently has an ECMO machine for child patients.

Recently a pregnant woman from Scotland suffering from swine flu had to be flown to Sweden for ECMO treatment. The UK's National ECMO unit in England was too full to admit her.

Dr Marsh said intensive care specialists would continue to work with the HSE and Department of Health on  planning for an upsurge in swine flu cases. The Intensive Care Society here, he added, was also liaising with similar bodies in other countries on planning for an upsurge.

He said another area of concern was availability of crucial health staff during a major swine flu outbreak.

Pointing out that 15% to 20% of health staff could become ill as a result of swine flu, he said there is already a shortage of critical care nursing staff.

Dr Marsh said the capacity issue needed to be addressed.

He said intensive care specialists would continue to work with the HSE and Department of Health on  planning for an upsurge in swine flu cases. The Intensive Care Society here, he added, was also liaising with similar bodies in other countries on planning for an upsurge.

He said specialists would be discussing with the HSE capacity solutions for intensive care beds, such as the use of private hospital beds and maximising the available ICU beds.

More than 220 cases of swine flu have been confirmed in Ireland to date.

View our swine flu Q&A here


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