Crowdinforming During Public Health Emergencies: A Commentary

Abstract

During the recent 2009 Novel H1N1 influenza pandemic, public health safety efforts included prevention and mitigation actions such as mass vaccination programs, community education focused on infection control, social distancing and how to avoid contracting and spreading influenza.[1-3] There were also programs to rapidly deploy caches of ventilators, antivirals and personal protective equipment to treat and reduce transmission of influenza infection.[1,3,4] Despite these efforts, many became ill.[12] Where and when to seek medical care was part of the public health education message. The problem becomes continuing to meet concurrent public health prevention goals, plus ongoing medical obligations with existing staff and space.[4,6,7] The same medical staff members delivering antiviral medications to those exposed and running mass vaccination programs were also treating the ill. In addition, aggressive viral culture acquisition and special processing was instituted.[1,9] Screening for febrile employees and exposed personnel in high risk facilities was started so that antiviral prophylaxis could be rapidly administered. Alternate care sites were initiated to address the increased volumes and to sequester possibly infective patients. [1] Hospitals often make plans to delay routine care and redeploy the staff and treatment space if the influenza surge required this step.[6,7] In addition to all that new activity, some jurisdictions instituted new influenza-like-illness (ILI) reporting requirements for hospitals.[2] Even normal staffing levels may be insufficient to meet these new responsibilities and existing staff numbers may be further reduced due to illness during this pandemic.[10] Emergency departments (EDs) are a good place to begin addressing load distribution during patient surge events such as the 2009 novel H1N1 pandemic. They are open 24/7, serve all who present for treatment, and do not incur the scheduling delays associated with primary care or other office-based appointments. They are prepared to address the most severe acuity of illness and are in hospitals which are often centrally located and highly familiar to the local community. Indeed, unprecedented patient surges were reported during the 2009 influenza season. [1, 8] In OJPHI, Vol 2, No. 1, Bob McLeod introduced a novel combination of agent based modeling (ABM), electronic medical record dashboards to predict ED waiting room times, and Crowdinforming as a method to redistribute patients seeking ED care.[11] The purpose is to balance area hospital waiting room loads during pandemics surges. This is a very innovative idea with important applications in medicine and public health.