2. Isolation by co-operation and education, to a point where it does not
diminish the willingness of the physician to report.
3. Placarding would seem to be subject to the same limitations as is
isolation.
4. The closing of schools, prohibition of funerals, etc., being
preventive measures, are not touched upon in this report, except to
mention that the closing of many agencies will release medical, nursing,
and volunteer services for special influenza work.
5. It may be necessary to grant authority and power to the health
authorities to administer relief.
_II. Preliminary Measures._
1. The listing and distribution of resources, including physicians,
nurses, social workers, nurses’ aids, clerks, domestics, laundresses,
automobiles, chauffeurs, mask makers, and volunteers of all kinds.
All available publicity channels should be used to promote volunteer
service.
An appeal should be made for voluntary donors of human blood serum from
convalescent influenza patients, to be held in readiness for use in
treatment.
2. The centralization of resources, under one control, with central and
branch headquarters, the city being districted for medical, nursing and
other work.
The central headquarters should be ordinarily under the supervision of a
board representative of the most important agencies concerned, the
board’s work to be administered through a manager (presumably the health
officer) selected for his fitness.
3. The service should be maintained on a 24–hour basis, and a system of
outgoing and incoming telephone service is essential.
4. The local authorities should get and keep in touch with state and
national agencies.
_III. Current and Continuous Analysis of Case Situation._
1. In the smaller communities a canvass should be made of all
physicians, soliciting information as follows:
(a) Number of cases under care.
(b) Number of cases needing hospital treatment.
(c) Number of cases needing home nursing care.
(d) Number of cases requesting medical service but not reached.
This information will indicate the situation as regarding the need for
emergency nursing and medical service, and should be acquired as fully
as possible in larger communities, through various agencies such as a
current lay or police canvass of homes, etc. The continuous
classification of cases according to these groupings is of practical
value.
_IV. Analysis, Augmentation and Organization of Principal Facilities._
(A) _Field Nursing._
1. Ordinarily nursing facilities utilized in general public health work
should be diverted to meet the epidemic situation, and should be used on
a district basis, with all other available facilities, under one
supervision.
2. Nursing assistants, volunteers, etc., should be used wherever
possible in homes and institutions, under expert supervision, after
classification and assignment on a basis of minimum standards as to
fitness, and such intensive training in the care of influenza and
pneumonia patients as may be feasible.
3. From the standpoint of the patient, home treatment is to be
advocated, if medical, nursing, disease preventive and other facilities
are adequate.
4. Restriction so far as possible through the pressure of public opinion
should be brought against the unnecessary use of private nurses.
5. Automobile transportation should be provided, and the nursing service
used to encourage isolation and education.
6. Special record forms are essential for this and the medical work, and
a special sub-committee is proposed to meet this problem.
7. Provision as to housing and care should be made for out of town
nurses.
8. We recommend further training with reference to influenza for all
graduates of Red Cross Home nursing courses and more extensive use of
their services. This would necessitate frequent and careful registration
(names, addresses and telephone numbers) and further information
regarding personal health, age and ability and willingness to serve.
(B) _Emergency Medical Service._
1. The medical service should be handled through the central office, the
physicians being responsible to the central office, though perhaps
assigned to district offices.
2. In this emergency service there should be utilized all available
physicians such as school and factory physicians, volunteers,
practitioners on a paid basis, fourth year medical students, etc. This
service should cover all calls reported as unreached by private
physicians or received through other channels, and should be
co-ordinated with the special nursing service, being provided with
automobile transportation, machines being hired if necessary.
3. The emergency medical service should be used to select cases needing
hospital care.
4. It may be feasible to institute a central clearing house in certain
districts for private physicians’ calls.
5. An arrangement should be made through the medical licensing board for
granting of temporary permits to practise to reputable physicians from
out of the state, at the request of the Central Influenza Committee.
6. In some localities it may be feasible to district the local
practitioner and to have him meet special calls on a part time basis for
adequate compensation.
7. Certain of the relatively non-essential specialties should be
discouraged, and the physician in those specialties urged to volunteer
for emergency district work. This type of service may be operated on a
pay or free basis.
8. Presumably some effort should be made, through an authoritative
medical commission, to suggest standard methods of treatment, and wise
limitations as to therapeutic procedure.
(C) _Hospital Facilities._
1. It is essential that the facilities, if possible, be kept ahead of
the demand. A daily canvass should be made and data collected regarding
available beds, medical and nursing needs, domestics, food, cots,
supplies, etc. A regular visit by an inspector will probably prove more
effective than an attempt at telephone communication.
2. Under most conditions a central clearing house, covering most if not
all of the hospitals, is advisable for the admission of cases. Through
this channel the severer cases may receive first consideration. Owing to
constant changes in the hospital bed situation, the daily canvass of
facilities may not be wholly depended upon; on the contrary, it may
usually be necessary to telephone the hospital in order to make sure
regarding the admission of a particular case. In any event the
hospitals, if facilities are inadequate, should be impressed with the
necessity for admitting only the most severe or needy cases, pay or
free. Special hospital arrangements should be provided for pregnant
women.
3. It is advisable to add wards or tents or new equipment to existing
institutions rather than to establish entirely new emergency hospitals.
If practicable, certain hospitals may be urged to handle influenza cases
exclusively.
4. Non-emergency surgical and chronic medical cases amenable to home
treatment should be de-hospitalized.
5. A convalescent home, if adjacent to the hospital, may serve for the
care of mild and convalescent cases, thereby increasing the space in the
hospital for acute cases, obviously involving an increase in the nursing
facilities.
6. A canvass of ambulance facilities should be made, ambulances being
requisitioned with payment, or hired by contract, if necessary.
Automobiles and motor trucks should be potentially mobilized for this
purpose. Frequently military equipment may be used if accessible.
_V. Social and Relief Measures._
1. The central office should keep the family advised regarding the
patient, thereby saving telephone calls, trolley fares and worry on the
part of the family, and thereby increasing the willingness for
hospitalization.
2. Volunteer workers such as Red Cross volunteers, teachers, relatives,
etc., should be placed in care of families where the responsible members
are dead or hospitalized, this service being under expert social
supervision, and the families in touch with the supply system.
Supervision of placed-out children is also necessary.
3. Homes should be investigated before patients are discharged into
them, when destitution or other untoward circumstances are apparent.
4. Precaution should be taken that institutions and families too busy
with the influenza situation to look after their own needs, are covered
by the general relief measures.
5. Ordinary charitable relief should be handled through the routine
agencies, the service co-ordinated with the other epidemiological
measures. Churches, lodges, etc., should be urged to handle their own
cases, in order to relieve the pressure on the central agency. Aid
should be immediate, without protracted investigation.
6. Recreation facilities (motoring, etc.) should be provided for the
physicians and nurses while off duty.
_VI. Food._
1. Available central cooking facilities should be used so far as is
necessary, such as the dietetic equipment in high schools, normal
schools, colleges, etc., with a delivery system to families and
institutions in need.
2. Individual families should be encouraged to cook additional amounts,
the same to be delivered to central diet kitchens for distribution, a
standard list of prepared foods needed being devised and advertised,
with recognition of racial customs and preferences.