HCPs caring for patients during a pandemic, will likely face:

•Increased risk of infection and the possibility of transmission to family

• Ethical conflict between role as HCP and parent, spouse; in difficult triage decisions

• Expectations to maintain level of care and perform unfamiliar tasks

• Stigmatization due to possible source of spreading virus

• Concerns about preferential selection for vaccines or anti-virals

• Physical isolation of PPE that limits inter-personal contact

• Possible individual or group quarantine - may include isolation from family

• Increased difficulties as patients increase, workers decrease, supplies depleted

• Infection and death of patients, colleagues, and family members – and fearing their own

HCPs need to know that their "management team" understands and cares about what they may experience during a pandemic and have a plan of action before an outbreak strikes their community:

• Ensure qualified behavioral services train HCPs, support staff, management and administrators; plus provide monitoring and assistance

• Train supervisor and staff for maintaining a supportive environment

• Prepare alternate commuting means to transport staff as public systems may be minimal

• Train staff on behavioral health, resilience, stress, grief, anger, fear, exhaustion, coping skills, importance of and how to listen

• Provide access to candid, up-to-date information on healthcare training issues and local pandemic status

• Establish services that will support staff in resolving related personal, professional, and family issues; help family deal with situations

• Establish pandemic policies that address salaries, insurance, sick-leave, work rotation, sick family

• Ensure access to means of communicating with families

• Keep an extra full set of clothes and comfortable shoes at the office – Assure staff you will be in the trenches with them

• Written procedures for critical tasks that may need to be performed by untrained HCPs

• Provide information on what to do if HCP or their children are discriminated against because they are caring for those infected

• Prepare access to stress relievers: rest, hot showers, nutritious snacks, light exercise, movies, music, board games, novels, etc.

• Listen to each HCP during pandemic; provide anonymous "comment box", confidential help line, website information updates

There are several things HCPs should do now to prepare for extended work hours for up to 10 weeks duration, the possibility of 3-4 such wave-outbreaks occurring, and the potential of home or healthcare facility quarantine. In so doing, guilt, frustration and worry are reduced and confidence builds. Depending on the HCPs circumstances, preparations may require them to:

• Store minimum 2-week food (no refrigeration needed), water, first aid supplies, flashlights, batteries, disinfecting supplies, alcohol-based hand sanitizers, soap, vitamins, thermometer, tissue, diarrhea and pain medication, electrolytes, gloves, masks (for patient), N95 respirators (for direct patient care)

• Write out a plan for taking care of sick family members

• Obtain an extra battery charger for your cell phone at work

• Ready for stress of agitated families/visitors/patients in quarantine

• Keep an extra full set of comfortable clothes at work—just in case

• Speak with neighbors or relatives who can immediately pick up or take care of the kids or dependent elderly in an emergency and plan for longer "what if’s"

• Teach family the how-to’s and critical importance of social distancing (6ft), cough and respiratory etiquette, frequent and proper hand hygiene

• Talk to your pharmacist and insurance Co. to understand how you can store or access needed medications

• Get family members vaccinated for seasonal (and pandemic flu if available)

• Have a planned means of communication in the event of an outbreak announcement

• Post phone numbers and/or email numbers of key contacts

• Mentally prepare for long hours, quarantine, PPE use, ethical decisions on priority care and cross training - just in case

• Explain to children you will be needed to take care of very sick people that will also help protect your family and the community (seeing the hero side helps them)

• Plan for school and daycare closures

• Insure adequate supplies and care plan set up for pets

• Mentally prepare for isolation and for supporting colleagues (even the ones you may now have a hard time with!)

Pandemic disease outbreaks may last 5 to 10 weeks in a community and repeat every few months for 3-4 waves. Thus, maintaining physically and mentally healthy, effective teams where individual staff members know their sacrifices are understood and appreciated, and that they are supported by their management is essential.

Resources:

• HHS Pandemic Influenza Plan: http://www.hhs.gov/pandemicflu/plan/sup11.html

• American Psychiatric Association http://www.psych.org/disasterpsych/links/weblinks.cfm

• CDC/American Red Cross. Maintaining a healthy state of mind: http://www.redcross.org/preparedness/cdc_english/health.asp

• Disaster Technical Assistance Center. Research listings and fact sheets on self-care: www.mentalhealth.samhsa.gov/dtac/Selfcare.asp

• Family Preparedness: http://pandemicflu.gov/individualfamily/