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ERs hustling to keep up with H1N1 cases

By Danielle Dellorto, CNN Medical Producer
  • Hospitals from coast to coast are bracing for the influx of H1N1 patients
  • Many hospitals are creating alternative care sites to handle an overflow
  • Some officials worry ERs are being unnecessarily strapped by kids who don't need to be there

(CNN) -- Nate Wordell, 7, just feels lousy: swollen eyes, cough, high fever, stomach ache and he's dehydrated. Nate has H1N1.

After toughing it out for three days at home, Nate's parents brought him to the emergency room at Children's Hospital Boston, Massachusetts. "The hardest thing for us was that we couldn't stay ahead of the medication or get him to keep any water down," says Nate's father, Michael Wordell of Auburndale, Massachusetts.

Hospitals from coast to coast are bracing for the influx of patients, just like Nate. Children's Hospital Boston has seen a 40 percent increase in patients this week alone.

"This could get pretty bad," says Dr. Anne Stack, clinical chief of emergency medicine at Children's Hospital Boston. "So we are trying to do as much as we can to prepare. But no one knows when it will end."

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Video: H1N1 kids fill hospitals

Many hospitals are creating alternative care sites in parking lots or in office buildings to handle an overflow of patients in the weeks ahead. Children's Hospital Boston has designated a conference room as a go-to H1N1 triage center. "We don't have additional space so we had to think outside the box," Stack says.

The conference room can be "flipped" in 24 hours, Stack says. "All we have to do is wheel in portable sinks, exam tables, computer equipment, cots and curtains. Everything is on standby. We're ready."

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But some state health officials say emergency rooms are being unnecessarily strapped by children who don't actually need to be there. Most physicians don't test for the virus or prescribe medicine to healthy children who come in with flu-like symptoms.

"The children we are worried about are those who have influenza symptoms and chronic disease [neuromuscular, heart disease, lung disease] or kids under the age of 2. Their immune systems can't fight things off as well, and the severity of their symptoms can grow rapidly," Stack says.

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These high-risk children often report having trouble breathing. That's because H1N1 virus lowers the lungs' ability to pump out enough oxygen.

I can't stress enough that most parents don't need to bring [their] child to the ER.
--Dr. Anne Stack

Intensive care units are also preparing for an increase in patients by tapping into reserve medical equipment, machines like the heart-lung device called ECMO or Extracorporeal Membrane Oxygenation. ECMO helps the lungs heal faster by delivering small breaths into the lungs frequently, rather than large breaths less frequently.

Watch: Children's Hospital Boston is handles the influx of H1N1 patients

"This machine helps a child get 900 breaths a minute, which is one of the best ways we treat critically ill children with H1N1," says Dr. Jeffrey Burns, chief of the Division of Critical Care Medicine and director of the Medical/Surgical ICU at Children's Hospital Boston. Burns has treated over 40 critically ill kids so far this year.


Of the children who have died, two-thirds had underlying health conditions, according to the Centers for Disease Control and Prevention. "The children without a pre-existing condition who died appear to have developed a secondary infection after their system was compromised," Stack says.

However, some parents fear not seeking medical treatment will result in their child's symptoms becoming exacerbated and life-threatening. Experts advise parents be alert for symptoms that develop that are uncommon with influenza. The red flags are rash, trouble breathing, no urinating in six to eight hours, mental disorientation or the inability to keep liquids down.

"One thing to not worry too much about is a fever. A fever is one of our body's best defense mechanisms again infection. The H1N1 virus does not like to live at high temperatures, so it is a good protective mechanism," Stack says.

Until the rush of children to the ER slows down, hospitals continue to work on their contingency plans to handle the increase. "I can't stress enough that most parents don't need to bring [their] child to the ER. Lesson Number One is to stay home, manage the fever, watch for worrisome signs."

This is a lesson learned for seven-year-old Nate Wordell and his father. After a few hours in his hometown ER, he was given a prescription to be a "couch potato," then sent on his way home. "He'll probably be back playing with his siblings and back to his old self about two days from now," Stack says.