Pandemic Critical Care Capacity
Planning Survey: Preliminary
Results and Future Directions
Erich Giebelhaus, MPP (egiebelh@health.nyc.gov)
Lewis Soloff, MD (lsoloff1@health.nyc.gov)
New York City Department of Health and Mental Hygiene
Bioterrorism Hospital Preparedness Program
1

 Introduction
• U.S. Centers for Disease Control
(CDC) FluSurge 2.0 models used for
NYC pandemic influenza planning
suggested a possible shortage in
citywide critical care surge capacity
• Need for updated data on ventilator
and staff capacity in NYC hospitals
• Discussion of how DOHMH could best
supplement existing capacity
2

 Methodology (1)
• 11/2005: Survey developed by DOHMH
• 12/2005 – 01/2006: Survey sent to 68
hospital EP Coordinators
• 01/2006: Data reviewed and approved by
hospital Directors of Respiratory Therapy
• 01/2006: Data clarified and tabulated

3

 Methodology (2)
• NYC DOHMH conducted survey to ascertain:
– accurate number of ventilators and “surge ventilators”
in NYC hospitals: by type of ventilator and population
served
– hospitals’ familiarity with portable ventilators used in
the U.S. Strategic National Stockpile (SNS)
– hospitals’ willingness to train, maintain, and possibly
use portable ventilators purchased externally
– NYC hospital system’s reliance upon oxygen vendors
– under what scenarios during pandemic influenza more
ventilators would be needed
4

 Results
• 65 hospital units analyzed in survey,
which represents ALL acute care
hospitals in New York City
– Data from 2 hospitals reported as part of
other hospitals’ data
– 1 hospital excluded from analysis (hospice)

• Thank you for your excellent response,
EP Coordinators!
5

 Mechanical Ventilators in NYC
Hospitals (N=65), December 2005
Variable

Number

Full-Featured Ventilators– Adult/Pediatric

1,857

Full-Featured Ventilators - Adult-Only

561

Full-Featured Ventilators - Neonatal Only

270

Total Full-Featured Ventilators

2,688

Automatic Resuscitators

614

Anaesthesia Machines (N = 62)

790

Portable Ventilators

186

Source: 12/2005 - 01/2006 NYC DOHMH Survey of Ventilator/Staff Capacity

6

 Distribution of “Adult and Pediatric” Full-Featured
Ventilators in NYC Hospitals per 100,000 Population
(N = 65) December 2005
Bronx
Manhattan

22.6

39.2
Citywide Avg: 23.2
Queens

Staten Island

14.1

21.9
Brooklyn
25.6

Sources: 2000 Census; 2005-2006 DOHMH
Survey of Ventilator/Staff Capacity;
7

 NYC Hospital Willingness to Store Additional
Portable Ventilators (N = 65 Hospitals)
December 2005
Uncertain
16%

No
8%

Yes
76%
Source: 12/2005 - 01/2006 NYC DOHMH Survey of Ventilator/Staff Capacity

8

 Other Results
• SNS Ventilator Issues: Only 2/65 hospitals had
experience with the Impact 754 ventilator; only
1/65 with the Puritan-Bennett LP-10 ventilator
• Oxygen Issues:
– 16 vendors reported as contracted vendors for
oxygen citywide, either for liquid oxygen, for oxygen
cylinders, or for both:
– A total of 40 hospitals reported contracting with
either CGI-Welco or Praxair (now one company)
– BOC Gases (12 hospitals) and AGA (11 hospitals)
were the next most often reported vendors
Source: 12/2005 - 01/2006 NYC DOHMH Survey of Ventilator/Staff Capacity

9

 Estimated National Impact of Pandemic
Influenza on Healthcare Utilization

Source: U.S. Health and Human Services Pandemic Influenza Plan (11/2005), p. 18

10

 Flu Surge 2.0 Projected Use of Ventilators in New York City Hospitals
During Influenza Pandemics of Varied Severity
Full-Featured
Mechanical Ventilators
(FFV) Owned/Part of
Long-Term Lease in
NYC Hospitals
(Baseline: 2,711)

15% of pandemic patients
require ICU care, with 50%
of those patients requiring
mechanical ventilation
("MODERATE NEED FOR
VENTILATORY CARE")

15%
attack
rate
Total # staffed ICU beds in NYC hospitals
ICU beds needed for pandemic patients
Total # full-featured mechanical ventilators (FFV) in
NYC hospitals
Total # ventilators needed for pandemic patients

25%
attack
rate

35%
attack
rate

25% of pandemic patients
require ICU care, with 50%
of those patients requiring
mechanical ventilation
("MODERATE NEED FOR
VENTILATORY CARE")

15%
attack
rate

25%
attack
rate

35%
attack
rate

25% of pandemic
patients require ICU care,
with 100% of those
patients requiring
mechanical ventilation
("EXTENSIVE NEED FOR
INTENSIVE CARE")
15%
attack
rate

25%
attack
rate

35%
attack
rate

1,713

1,713

1,713

1,713

1,713

1,713

1,713

1,713

1,713

684

1,141

1,597

1,141

1,901

2,662

1,141

1,901

2,662

2,711

2,711

2,711

2,711

2,711

2,711

2,711

2,711

2,711

342

570

799

570

951

1,331

1,141

1,901

2,662

FFV Vents available for pandemic patients - with 25%
vents already in use

2,033

1,691

1,463

1,234

1,463

1,082

702

892

132

-629

FFV Vents available for pandemic patients - with 50%
vents already in use

1,356

1,014

786

557

786

405

25

215

-546

-1,307

** Survey Data: FFV Vents available - with 60% vents
already in use

1,084

742

514

285

514

133

-247

-57

-817

-1,578

FFV Vents available for pandemic patients - with 75%
vents already in use

678

336

108

-121

108

-273

-653

-463

-1,223

-1,984

FFV Vents available for pandemic patients - with 100%
vents already in use

0

-342

-570

-799

-570

-951

-1,331

-1,141

-1,901

-2,662

Note: These projections are based on CDC FluSurge 2.0 projections and data from the 2005-2006 DOHMH Ventilator/Staff Survey conducted at 68 New York City hospitals.
Reported data are from 65 hospitals out of a total of 65 surveyed hospitals considered for this analysis. Survey data indicate a 60% citywide average baseline use of full-featured
ventilators (FFV) on a given day during the 2004-2005 influenza season, which is assumed to be a period of "peak" ventilator use. These assumptions do not account for the
possible decrease in ventilator and ICU bed use/need if elective surgery is curtailed.

11

 Example of Estimated Ventilator Shortfall Using Flu Surge 2.0
Full-Featured
Mechanical Ventilators
(FFV) Owned/Part of
Long-Term Lease in
NYC Hospitals
(Baseline: 2,711)

25% of pandemic patients
require ICU care, with 50%
of those patients requiring
mechanical ventilation
("MODERATE NEED FOR
VENTILATORY CARE")

15%
attack
rate

25%
attack
rate

35%
attack
rate

Total # staffed ICU beds in NYC hospitals

1,713

1,713

1,713

ICU beds needed for pandemic patients

1,141

1,901

2,662

Total # full-featured mechanical ventilators (FFV) in
NYC hospitals

2,711

2,711

2,711

570

951

1,331

Total # ventilators needed for pandemic patients
FFV Vents available for pandemic patients - with 25%
vents already in use

2,033

1,463

1,082

702

FFV Vents available for pandemic patients - with 50%
vents already in use

1,356

786

405

25

** Survey Data: FFV Vents available - with 60% vents
already in use

1,084

514

133

-247

FFV Vents available for pandemic patients - with 75%
vents already in use

678

108

-273

-653

0

-570

-951

FFV Vents available for pandemic patients - with 100%
vents already in use

12

-1,331

 NYC
Health

Impact 754 Uni-Vent Ventilator

 

13

Impact 73X Ventilator
(Pending FDA Approval)

Jul-?r?

 

 

 

 

14

NYC
Health

Training Overlap

 

 

 

 

 

15

Ventilator Cost Estimate
Explanation

Cost to purchase portable vents consistent with the Vents in the
SNS @ $7500 per vent estimated-- one time cost per vent

Cost of
single item
$7,500.00

Number needed for 8 week
period
same vent used for all patients

Cost per single
Vent for 8 week
use
$7,500.00

Includes 1-90 degree elbow, 1-6 inch aerosol hose, 1-ventilator
exhalation valve with drip chamber, 1-proxmial airway pressure
adapter with port cap, 1-72 inch aerosol hose with cuttable cuffs,
1-72 inch green pressure sensing line with connector, 1-72 in

$11.15

estimated change every 10
days or duration of patient
treatment on vent (6 changes
during 2 month period )

$66.90

10 days--insp filter=$4.00, exp filter=$7.00

$11.00

one of each filter for duration
patient is on vent. (6 changes
during 2 month period )

$66.00

Heat moisture exchanger-changed daily

$0.70

change daily for 56 days

$39.20

One in-line per day--keeps circuit closed for infection control

$9.00

change daily for 56 days

$504.00

Ambu bag=$14.00 with peep valve=$13.00==$27.00 per patient

$27.00

one per patient--estimated
change of patient every 10
days (6 changes during 2
month period )

$162.00

Cost for meds to be given to patient = $10.00

$10.00

one per patient--estimated
change of patient every 10
days (6 changes during 2
month period )

$60.00

Cost includes the initial cost of purchase of ventilator and
the durable medical equipment used on the patients who
would be ventilated by a single vent over the 8-week period.

$8,398.10

Additional cost for each 10-day period (single patient on
vent. (only durable equipment costs)

Total cost for purchase of 1 vent per hospital (71 facilities);
total of 71 vents with durable equipment provided for 8-week
use

$596,265.10

16

 Summary (1)
• The DOHMH survey clarified the total
number of full-featured ventilators in
NYC hospitals
• Hospitals were not experienced with
ventilators contained in the SNS
• Most hospitals agreed to store,
maintain, and train staff on portable
ventilators if purchased externally
17

 Summary (2)
• DOHMH survey/use of Flu Surge identified
potential need for additional ventilatory and
ICU capacity in NYC hospitals
• The number of ventilators needed in a
pandemic depends on population attack rate,
severity of illness, number of ventilators
already in use for non-pandemic patients, and
criteria for ventilator utilization.
• The major issues with developing any
ventilator cache are staff familiarity with
equipment, maintenance, and staff training
18

 Future Directions
• Develop a working group of critical care
specialists, including:
– Physicians
– Respiratory therapists
– Nursing staff

• Work with NYSDOH in developing practice
guidelines for ICU care in the event of limited
supplies of beds and equipment
• Make recommendations for future equipment
purchases to try to develop a standard of
interchangeability
• Analyze the oxygen delivery system in NYC
and assess vulnerabilities

19

  Ti".

Questions?

20