Oct 26, 2009 (CIDRAP News) – In a measure designed to help hospitals respond more quickly to surging numbers of pandemic H1N1 cases, President Barack Obama on Oct 24 signed an emergency declaration that will help facilities establish alternative care sites and protocols for triage and transport.Pandemic H1N1 flu activity is now widespread in 46 states, according to a recent status update from the US Centers for Disease Control and Prevention (CDC). National indicators point to intensifying pandemic activity that could overwhelm local hospitals and emergency departments.At least two hospitals that experienced a surge of flu patients have already had to alter their flu triage and treatment by setting up tents adjacent to the emergency departments: Memorial Hospital in Bakersfield, Calif., in mid October and Dell Children’s Memorial Hospital in Austin, Tex., in mid September.The emergency H1N1 declaration fulfils one of two conditions that would be needed for the Department of Health and Human Services (HHS) to grant a waiver of section 1135 of the Social Security Act, which would ease certain restrictions on healthcare facilities in an emergency.The waiver still requires individual requests from facilities and would only apply to a specific emergency area and period and within 72 hours of when a hospital has instituted its disaster protocol.In the past, section 1135 waivers have been made for events including Hurricanes Katrina, Ike, and Gustav, Obama’s inauguration, and North Dakota flooding.The waiver affects requirements in several government health programs that provide certain patient protections that also may impair the ability of healthcare institutions to fully implement their disaster medical plans. The government programs include Medicare, Medicaid or the Children’s Health Insurance Program (CHIP), the Emergency Medical Treatment and Active Labor Act (EMTALA), and the Health Insurance Portability and Accountability Act (HIPAA).In background materials on the HHS’s flu.gov Web site, federal officials said the waiver doesn’t suspend HIPAA privacy rules. It said, however, that the president’s emergency declaration and an HHS secretary waiver could temporarily shield affected hospitals against sanctions for not complying with some provisions such as securing patient approval for the medical team to speak with family or friends involved in their care.Paula Steib, a spokeswoman with the Association of State and Territorial Health Officials, told CIDRAP News that Obama’s signing of the emergency declaration wasn’t unexpected.”It was a continuation of similar actions taken this past spring to ensure all authorities are in place so the federal government and the states have the flexibility to respond to needs should they arise,” she said.”It was not related to any specific events or vaccine supply issues, but an effort to be as prepared as possible.”In late April after the first novel H1N1 illnesses were identified, federal officials declared a public health emergency, which they said was a routine measure that allowed the government to free up resources to respond to the outbreak and deploy antiviral medications from the Strategic National Stockpile to states.See also:Oct 24 background information on Obama’s H1N1 emergency declarationhttp://www.flu.gov/professional/federal/h1n1emergency10242009.htmlOct 25 White House blog posthttp://www.whitehouse.gov/blog/2009/10/25/president-obama-signs-emergency-declaration-h1n1-fluOct 23 CIDRAP News story “Spikes in US indicators point to intensifying pandemic”Apr 26 CIDRAP News story “US swine flu cases rise as feds call health emergency”
Aston Villa ended their losing run but there was little respite for under-fire manager Paul Lambert as they ground out a 1-1 draw with Swansea. Press Association It was a meeting of two out-of-form teams, with Villa having lost their previous four matches while Swansea were without a win in five. The hosts scored in the first half at Villa Park for the first time this Barclays Premier League season through Gabriel Agbonlahor in the seventh minute but Swansea piled on the pressure and got their reward when Roland Lamah equalised eight minutes before half-time. The Welsh side dominated the second half but were unable to find a winner. Swansea boss Michael Laudrup made seven changes from the defeat by Chelsea on Boxing Day, while Villa had midfielder Ashley Westwood back after suspension. The hosts had left the field to jeers after losing at home to Crystal Palace on Thursday but they began positively, pressing high up the pitch and wasting no time breaking forward. They got their reward in the seventh minute as Andreas Weimann picked up the ball on the right and played in Agbonlahor, who exploited dreadful positioning by the Swansea defence and found himself all alone on the edge of the penalty area. The striker hesitated but then showed good composure to place the ball under Gerhard Tremmel. It was just what Villa needed, but as the half wore on Swansea became more and more dominant. Their first chance came in the 17th minute when Pablo Hernandez cut inside and tested Brad Guzan, who initially spilled the ball but quickly gathered it. Three minutes later the visitors should have been level but Ben Davies headed the ball into the ground and over the bar from six yards when he was picked out by Jonathan De Guzman’s corner. Villa threatened sporadically but their periods of possession were fleeting and the pressure continued to grow at the other end. The visiting fans celebrated erroneously when Antonio Luna’s poor clearance fell to De Guzman on the edge of the area and he flashed a shot just wide. But two minutes later Swansea were level, Jonjo Shelvey picking out the lively Hernandez on the left and his cross was headed in at the back post by Lamah. Guzan got an arm to the header but could not keep it out. The home fans again expressed their disgruntlement at the half-time whistle, and the pattern continued at the start of the second half. Guzan was called into action again in the 52nd minute, tipping over De Guzman’s free-kick, before Wilfried Bony fired well over the bar. Shelvey was the next to try his luck but his shot was blocked five yards out by Luna and Bony was unable to get to the rebound. The worry for the visitors was they were not testing Guzan nearly enough and there was always the danger that Villa could hit them on the break. Agbonlahor at least tried a shot at goal for the hosts in the 71st minute but it was from 25 yards and flew well over the bar. A goal appeared much more likely at the other end, and Villa did well to block Bony’s dangerous shot before Shelvey’s cross just evaded two Swansea players. Lambert sent on Karim El Ahmadi, Libor Kozak and Marc Albrighton in a bid to give Villa more attacking impetus but they were struggling to string two passes together. Fabian Delph, one bright spot for Villa this season, tested Tremmel with a well-struck shot but it was straight at the Swansea keeper. That turned out to be the final chance and there were again boos as referee Roger East blew the final whistle.