Sunday, April 20, 2008

Are the Ventilator Numbers Real?

Last week I wrote about why there is a need for a pandemic ventilator and used facts, numbers and statistics from various sources to support my statements. Whenever I write an article, I generally compose it, then go back to a list of articles and websites I have saved to validate what I have written. Most of the information is easy to validate, but I always find it difficult to come up with verifiable numbers. Often I see the same number used in many reports and assume that it must be correct. It may be though, that everyone is just referencing the same inaccurate source.

The numbers for US ventilators and usage I used last week are ones that I have commonly seen used in other places. I got a good comment on the article that suggested that the actual number of ventilators may be lower, and that usage rates may also be a bit lower as well. I have had some concern with the inability to obtain good solid numbers.

When I reviewed the Ontario Health Plan for an Influenza Pandemic, I noted that the per capita numbers of ventilators for Ontario was significantly lower than the US numbers. Ontario has a comprehensive socialized medical system that treats everyone needing care, and I have never heard of anyone being refused the use of a ventilator in Ontario that required one. I checked the pandemic plans for the region where I live and also the hospital I work at, and the number of ventilators is pretty close to what you would expect from the numbers in the OHPIP report based on population. The utilization rates though are usually pretty high, and it is not uncommon for a hospital to borrow vents from other hospitals if they run short.

The 105,000 number for the number of ventilators in the US for the US population size is 4 times as many as the ratio in Ontario. It is hard to believe that it should be so different. Even the 70,000 number quoted by the comment last week seems high by this criteria.

I think that every pandemic plan should explicitly state how many ventilators they have, and what the utilization rates are. They should also have a good idea of how much they believe that they can extend the capacity of their staff to handle additional ventilated patients if the additional ventilators were made available. Proper planning requires that they know the present status, calculate how much they can extend their capabilities, and compensate as much as possible for any shortfalls in staff or equipment. I have seen very few plans that give figures for all these variables. If they do not have good numbers to base the plans on they are really just guessing.

1 comment:

Joel said...

That is the very issue I'm struggling with now. I am the pandemic planner for a local government. I am working with the hospitals in town to get a feel for their ventilator situation (following the "FluSurge" software model). The real problem is with SNS ventilators. The Strategic National Stockpile has XX ventilators which are assigned to states under some rubric, and then the states dole them to communities. I can't get any information on how they will be distributed to us.

One other thing - I was at a meeting two weeks ago where ADM Vanderwagen (the Assist Sec for Preparedness and Response) spoke. He specifically mentioned inexpensive ventilators as a current project of the ASPR's office.