November 19, 2009

expert reaction to paper on potential shortage of intensive care beds caused by swine flu, to be published in Archives of Disease in Childhood (a BMJ journal)

The paper draws attention to a potential shortage in intensive care beds due to a high volume of critical patients with swine flu.

Prof Chris Cairns, Head of the Department of Pharmacy and a former critical care pharmacist, Kingston University, said:

“At a worst scenario of two in every 100 children who gets swine flu ending up requiring hospital treatment, at the peak of the outbreak almost all children’s intensive care beds will be filled with a child with swine flu. If the need for hospital care falls to one in every hundred, at the peak 45% of beds will be filled.

“These figures are predicted to occur at the peak of the outbreak, i.e. when most cases occur. Not throughout the outbreak. Usually 76% of the beds are occupied and half of them are with children who have had an elective (i.e. arranged and planned) operation. Elective operations can be delayed for the majority of patients if demand on critical care beds is great. Therefore the problem only arises at the worst scenario and at the peak of the outbreak, which hopefully will be limited.

“It is important to note that: (1) the paper makes no mention on the effect of vaccination which has already started. (2) The data on which the incidence of swine flu is based uses the Government’s worst case planning assumptions from July 2009. (3) The incidence of swine flu is presently falling (DoH info 12 November).

“If there is a worst case scenario, some children may have to be looked after in adult intensive care units. There are some parts of the country which are well provided for and should be able to cope: London, Yorkshire and the Humber and the North East. There are some parts of the country where there are inadequate numbers of children’s intensive care beds to cope with the outbreak (Wales, the South East Coast and the East of England) and seriously ill children may have to be moved to intensive care units elsewhere. Traditionally London has supported the South East Coast and parts of the East of England region.

“The role of paediatric retrieval services (i.e. those services for the transfer of critically ill children) will be very important. Concerns about staff availability due to illness should be minimised by the vaccination programme for NHS staff which is now into its third week, but it will be a concern as will the loss of staff to look after their children or relatives. The NHS contingency plan is well advanced and appears to be in good shape with respect to staff.”

Prof Robert Dingwall, formerly Director, Institute for Science and Society University of Nottingham, said:

“It has always been acknowledged that a flu pandemic would present a particular challenge to paediatric intensive care services. In routine practice, there is less demand for these than for adult intensive care, so fewer beds are needed per head of population. This also means that it is hard to expand services quickly because there is a smaller pool of trained staff. However, the NHS has planned for some expansion and should also be able to find extra capacity by moving older children into adult beds and postponing elective surgery. The pandemic is also not having a uniform national impact so there will be some scope to move children between different parts of the country depending on local availability of beds, as happens in normal times anyway. None of this will be easy, but it would be quite impossible without a nationally planned and organized health service that has the capacity to co-ordinate local facilities and to ensure that access reflects clinical need.”