In recent months, as isolated cases of Ebola have been reported in the United States, there has been a renewed attention to the potential for a public health emergency and "worst case scenarios." As medical experts continue to assure the public that precautions and measures are in place to prevent an Ebola outbreak on U.S. soil, the topic of preparedness is square in the national spotlight. What is often not broadcast or printed in the daily coverage are the initiatives taking place behind the scenes to ensure that when the next attack or outbreak threaten public health, there are plans ready for activation and resources ready for deployment. In fact, the U.S. government has stockpiles of emergency medical equipment and supplies at various locations across the country and has development contracts in place to expand and enhance the U.S. emergency preparedness capability.
As the government monitors domestic and foreign health threats, including Ebola, careful attention is being paid to influenza. A global or pandemic flu outbreak is rare. According to government records, there have only been four pandemic flu outbreaks in the past 100 years.1 Unlike the seasonal flu, people typically have no resistance to a pandemic strain because their immune systems have not been previously exposed, and there is no vaccine to keep the virus from spreading in the early stages. A pandemic flu has the potential to impact large populations around the world, prompt widespread travel restrictions, cause business and school closures, and threaten domestic and world economies if it is not stopped quickly.
Disaster and pandemic preparedness efforts were accelerated after the attacks of 9/11. While the attacks were not a public health emergency, they raised serious questions about national preparedness. Recognizing the need to amplify the buildup of supplies and resources in anticipation of an episode that could put the health of thousands, if not millions of Americans, in jeopardy, the U.S. government moved to create the Biomedical Advanced Research and Development Authority (BARDA), within the Office of the Assistant Secretary for Preparedness and Response in the U.S. Department of Health and Human Services to develop countermeasures for public health emergencies.
BARDA has made tremendous progress in the area of pharmaceutical reserves, stockpiling vaccines and antidotes to public health threats including small pox and anthrax. Now there is a focus on developing and producing the medical devices that will be needed to treat large numbers of medically compromised patients, specifically ventilators. During any mass medical emergency that includes a large number of people in respiratory distress, ventilators will be in high demand.
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Each year more than 800,000 severely ill patients hospitalized in the U.S. require mechanical ventilation.2 In the event of a pandemic or other public health emergency, this number could skyrocket, overwhelming the current health system with demand for ventilators and staff who are trained to operate them. Envision what a pandemic would look like. If patient volume exceeds what hospitals can handle, treatment centers could be established in large, public venues. Medical professionals will be on hand to oversee care, but there will not be enough specialists to go around. People with little or no clinical experience could be called to assist medical personnel.
Ventilators are in a special class of the supplies the government is acquiring as part of its preparedness initiative. Unlike vaccines which can be administered relatively quickly by anyone with basic medical training, ventilation is more complicated. The devices used in hospitals and homes today are not suitable for mass deployment. The ventilators needed in the event of a pandemic or disaster will need to provide the same life-saving respiratory therapy, in a rugged and simplified system. Earlier this year, Philips Respironics was awarded a contract to assist BARDA in the development of a next-generation disaster readiness ventilator.
The ventilators currently in development are for the sole purpose for disaster preparedness. They will be easily manufactured, cost-effective, and offer the flexibility and versatility to be used on a variety of patients with unpredictable illness. Designed for ease-of-use, the new ventilators will enable a wide group of clinicians, or possibly people with little clinical background, to operate them in time of crisis. While this generation of ventilators will be different from ones sold commercially, the modes of operation need to be similar so the medical community is already familiar with their use.
Ventilation is just one small piece of the preparedness pie. Other drugs and devices are also in development and production, not for use today, but for use some day. No one can know when, or if, that day will come. In anticipation, all divisions of the medical community, from researchers to clinicians, policymakers to equipment manufacturers, should collaborate and innovate in meaningful ways so that the United States is well armed to protect and save the many lives that may be in jeopardy.
Eli Diacopoulos is vice president and general manager, Philips Respironics.
- Flu.gov. Pandemic history. Available at: www.flu.gov/pandemic/history/index.html.
- Wunsch H, Linde-Zwirble WT, Angus DC, et al. The epidemiology of mechanical ventilation use in the United States. Crit Care Med 2010: 38;1947-53.