General conclusions:
• We have an immediate and obvious concern about cleanliness: Rob observed a member of the cleaning staff, on more than one occasion, cleaning and touching equipment inside the ICU with water used to clean the window sills.
• We have concerns over what we have observed of the treatment of swine flu sufferes. As an example; Gemma being told to wait in the car until she collapsed outside of the hospital.
• The first two points beg the question; is national policy being made clear to, and implemented by, clinicians?
• Andy Burnham will arrange a meeting with the chief medical officer, to discuss our concerns and questions, and including them in the upcoming review of swine flu and its handling.
• We’ll provide a list of issues for him and his staff to review before the meeting.
• Andy Burnham will also arrange a meeting for us with the specialist commissioning group, and for us to have access to their reports and minutes of their meetings before the meeting.
• After the meeting with the chief medical officer we’ll make a decision on if/how to campaign for access to ECMO in the northwest.
• We’ll make contact with other parties (such as Gemma and her family) concerned over ECMO and the recent handling of swine flu
Unanswered questions on ECMO:
• Why are so few ECMO devices distributed so unevenly, and in such tight clusters? This restricts access, especially for those who are to unwell too be moved large distances (or at all).
• Why is the north entirely without access to ECMO?
• NICE has not reviewed the use of ECMO since 2004, and in the interveneing time a wealth of clinical data supporting its use has emerged.
• There are no future plans for the development and use of ECMO.
• There are doubts in some quarters over the effectiveness of ECMO treatment in cases like Susans:
1. Why has more, and more recent, research not been done into this matter?
2. What action can be taken to improve understanding of ECMO and how appropriate it would have been to cases such as Susans?
• Given that ECMO technology applies to many conditions (transplant patients, ARD, premature births), can more effort be made to reduce the prohibitive level of resources needed for one machine?
• What was the reasoning behind the rejection of ECMO as a treatment for Acute respiratory distress? A considerable amount of foreign research prior to last summers outbreak supports its use as a palliative treatment.
• While the value of ECMO specifically may be debated by some, it seems beyond argument that a device of the ECMO type (an external circuit for oxygenating the blood) could save lives in cases of severe lung failure. What research is being done on such devices?
On the vaccination program:
• Susan became infected at the beginning of October. Had the vaccine been generally available one month earlier her chances of survival might have been greatly improved.
• Was the Adjuvant ( Part of the relevant virus that must be combined with the model vaccine) taken at the earliest possible opportunity?
• Could vaccine production have been begun prior to the pandemic declaration?
• Was the vaccine manufactured and delivered as fast as possible?
Time line
2004 to 2005: H5N1 (bird flu) is considered a danger. ‘Model vaccine’ produced requiring an ‘adjuvant’ (check spelling) from a virus to be tailored to a particular strain of virus.
Unknown date: ECMO is considered for palliative treatment of Acute Respiratory Distress (end result of swine flu) and rejected by the Specialist commissioning group.
2007-8: H1N1 is identified as a threat. Pre-pandemic planning takes place (pandemic meaning a disease that is spreading through populations in at least three countries). As a result a £120,000,000 pre-purchase agreement is made with Glaxco-smithclyne and Baxter, for 90,000,000 doses (two per citizen).
NB: This buys vaccine production capacity for great Britain, so that when the vaccine begins production Britain will be one of the first in the line. The vaccine does not go into production until a pandemic declaration in issued by the World Health Organization, and an adjuvant of the relevant strain of virus is taken.
Tamiflu and Rulenza stockpiled.
2008: Baxter fail to deliver a satisfactory vaccine.
June 2009: WHO issues a pandemic declaration Pre-purchase agreement goes into effect. First batches of vaccine are delivered September 2009.
October 2009: Vaccine is generally available.
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