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H1N1 (Swine Flu) Updates

College Statement on H1N1 (swine) flu

The President of the College wishes to highlight the availability of this up to date H1N1 2009 (Swine Flu) information from the College and partner organisations.

This information consists of both guidance for personal protective equipment and a clinical practice note for the management of critically ill patients. The guidance has been produced after extensive discussions with the Health Protection Agency and Intensive Care Society together with other organisations and individuals with recognised expertise in advising UK healthcare at the highest level for such situations.

Both guidance notes are presented in a format which can be easily copied for reproduction locally for display in appropriate hospital departments.

The guidance is reviewed regularly to maintain currency and appropriate new and revised links will be added to theis page immediately they become available.

Main Guidance
Pandemic H1N1 2009 Influenza - Personal Protective Equipment Guidance and Clinical Practice Note »
11 August 2009

Latest News
Update from the Chief Medical Office as of 3 December 2009 »

Updates from the H1N1 Critical Care Clinical Group
As part of the work to help the NHS in England respond to the demands placed on it by the H1N1 pandemic, a Critical Care Clinical Group (CCCG) was set up and is chaired by Dr Judith Hulf CBE, former president of the Royal College of Anaesthetists.

The terms of reference of this group include offering advice on how the NHS should best surge adult and paediatric critical care capacity, as well as considering and advising on management, staffing, equipment, medicines and consumables issues associated with the increase in demand for critical care services to help front line staff deliver these services in a surge situation.

Advice from the H1N1 Critical Care Clinical Group »

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Swine Flu Clinical Critical Care ECMO Sub Group
  • Minutes of the ECMO sub-group meeting, held 4 November 2009 »
  • Glenfield protocol for referral of patients for ECMO »

    The following guidelines have been recently published by the Department of Health: Clinical Management Guidelines for Adults and Children and Clinical Management Guidelines for Pregnancy:

  • Adults and Children »
  • Pregnancy »

    GMC updates pandemic flu guidance » 2 November 2009

    The Department of Health for England H1N1 vaccination programme » 29 October 2009

    Paediatric practice note for the management of critically ill children with pandemic (H1N1) 2009 Influenza » 27 October 2009

    Cardiopulmonary Resuscitation and Pandemic H1N1 2009 Influenza in healthcare settings (including CPR algorithm) » 14 October 2009

    Nebulised zanamivir: safety issue » 13 October 2009
    Extract from a letter sent on behalf of Ian Dalton
    There has been a report of a fatality in the US where a patient with influenza who received Relenza (zanamivir) Inhalation Powder which was solubilized and administered by mechanical ventilation. Relenza (zanamivir) Inhalation Powder is not intended to be reconstituted in any liquid formulation and is not recommended for use in any nebulizer or mechanical ventilator.

    DH: October issue of Pandemic Flu News »
    from Professor Lindsey Davies CBE FFPH FRCP, National Director of Pandemic Influenza Preparedness

    European Medicines Agency recommends authorisation of two vaccines for influenza pandemic (H1N1) 2009 » 25 September 2009
    Press Release extract
    The European Medicines Agency has recommended to the European Commission that two vaccines against influenza A(H1N1) ('swine flu') be granted a marketing authorisation. Vaccines are one of the most important tools in the management of an influenza pandemic, helping to reduce illness and deaths by building up immune protection against the pandemic flu virus. To ensure that authorised vaccines are available before the start of the flu season in the coming autumn and winter months the Agency’s Committee for Medicinal Products for Human Use (CHMP) expedited its assessment.

    The following document was presented at a press conference held on 10th September 2009 regarding the H1N1 influenza pandemic:
    Critical care strategy: Managing the H1N1 flu pandemic »

    See also two letters from Ian Dalton, National Director of NHS Flu Resilience:
    Letter to the Secretary of State »
    Letter to NHS Chief Executives »

    Three checklists to support clinical care for pandemic (H1N1) 2009 influenza have been produced by Birmingham City Hospital:

    Background information on these checklists is contained in the following document.
    Checklists to support Clinical Care for Pandemic (H1N1) 2009 Influenza »

    The Critical Care Services department of City Hospital Birmingham has produced a clear and useful checklist for Pandemic (H1N1) 2009 Influenza Critical Care Admission
    Critical Care Admission Checklist »

    In addition, Birmingham Critical Care Services department have also provided Patient Pathway and Quality and Safety Checklists which departments may find particularly useful.
    Patient Pathway »
    Safety and Quality Checklist »

  • Additional information
    Global alert and response information UK specific Pandemic Flu updates
    World Health Organization Health Protection Agency
    World Health Organization » Health Protection Agency »
    APAGBI Clinical practice information and guidance for the care of affected children is available directly from the homepage of the Association of Paediatric Anaesthetists of Great Britain and Ireland:
    The Association of Paediatric Anaesthetists of
    Great Britain and Ireland »
    Good medical practice for doctors in a national pandemic:
    The General Medical Council »

    The department of Health is working to support NHS preparedness and to reduce the impact of pandemic flu on the UK population:
    Department of Health for England »

    Additional information for Scottish residents and workers:
    Department of Health for Scotland »

    Additional information for Welsh residents and workers:
    Department of Health for Wales »

    Additional information for Irish residents and workers:
    Department of Health for Northern Ireland »

    Guidance and support for the preparedness of UK of those practicing in emergency departments:
    The College of Emergency Medicine »

    Prior to a declaration by the World Health Organization that a pandemic has started, hospitals and practitioners should be alerted to cases of influenza caused by a novel virus that has not yet fully adapted to humans and that may become a pandemic virus. The number of such cases is expected to be small, and they are most likely to occur in travellers returning from affected parts of the world. The infection control guidance in this document does not apply to the management of such cases, and practitioners should follow current guidance as issued by the Health Protection Agency.
    Pandemic Influenza: Guidance for infection control in critical care » (NHS document)

    The latest direction from the Department of Health on Managing Demand and Capacity in Health Care Organisations (Surge) »

    NHS Emergency Planning Guidance 2005: underpinning materials. Critical Care Contingency Planning in the event of an emergency where the numbers of patients substantially exceeds normal critical care capacity. Best Practice Guidance. »

    Leaflets, posters and information to share with patients:
    Resources from the national Swine Flu campaign »

    Additional information for patients can be sourced from NHS Choices:
    www.nhs.uk/news/2009/04April/Pages/Swineflulatest.aspx »

    This page will be updated as and when further information is received.

    08 Feb 2010

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