# swine flu--is anyone concerned?



## NJnewbie (Oct 12, 2009)

Correct me if I'm wrong, but from reading through the threads on here, I don't get the impression any of you are too concerned about contracting the swine flu.  I've been wanting to join my local volunteer squad, but with all the talk in the news about the swine flu, I admit I'm getting cold feet.  Is it all just hype?  I'm thinking maybe I should wait until it all blows over, but I don't know.  :unsure:


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## Chelle (Oct 12, 2009)

H1N1 could be picked up at the grocery store or any place we work.  After it has passed, it will likely be replaced by the "next thing".  

Fear not & serve now - that's my motto.


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## Hal9000 (Oct 12, 2009)

Half my friends have gotten it, yet none of my partners (WORK partners.) have.


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## akflightmedic (Oct 12, 2009)

Seeing how 30000+ people die every year from the plain old "regular flu", and swine flu deaths have not reached anywhere near that number....I feel ok with my chances.

I will continue to use proper hand washing techniques, reduce unnecessary exposure between myself and my patients (if any of us are showing symptoms) and go on about my life.

I will take the vaccine first chance I can. I only started taking flu vaccines a few years ago and now I never get sick as opposed to all the years previously when I seemed to catch everything going around.


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## medichopeful (Oct 12, 2009)

Hal9000 said:


> Half my friends have gotten it, yet none of my partners (WORK partners.) have.



So how many of your NON-work partners have gotten it? <_<


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## Hal9000 (Oct 12, 2009)

Point taken.  There is a lot to be said for good grammar when it comes to things like dangling modifiers. 

The vaccine isn't required where I work, and I don't know how many people have gotten it.


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## Dwindlin (Oct 12, 2009)

As someone else mentioned regular old seasonal influenza kills around 36,000 each year in the U.S. alone.  So far current data suggests H1N1 carries with it about the same mortality as seasonal flu.  The one caveat is in some people (which I honestly don't know if a cause has been confirmed yet) it can create cytokine storm and trash the lungs.  This is the part that concerns the CDC as while normal flu targets an immunodeficient population, the issues with cytokine related deaths were in young healthy people.


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## RescueYou (Oct 13, 2009)

Eh...we've had local schools close around here temporarily and had a pt in a local county (young kid) stop breathing from it, but we're not too concerned. We're highly encouraged to get the shot, but it can't be forced. We do get it free at my school if we want it though. I personally don't see it being an issue. The only difference in this and the reg. flu is that this can stay alive longer outside the body so it spreads more. EMS is well protected though with your BSI so...


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## silver (Oct 13, 2009)

i am worried how virulent the strand is. It really is a matter of time until the virus mutates and becomes more dangerous. I feel like a previous epidemic did the same thing. Not bad in the fall, then it mutated (effectively in the sense of a virus) and killed many people.


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## Dwindlin (Oct 13, 2009)

silver said:


> i am worried how virulent the strand is. It really is a matter of time until the virus mutates and becomes more dangerous. I feel like a previous epidemic did the same thing. Not bad in the fall, then it mutated (effectively in the sense of a virus) and killed many people.



The seasonal flu could do the exact same thing.


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## silver (Oct 13, 2009)

atkinsje said:


> The seasonal flu could do the exact same thing.



the seasonal flu is currently much less contagious and not as easily passed. For instance some middle sized universities have already had over 2000 cases of H1N1, they probably get 1/3 the amount of seasonal flu in a year.


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## RescueYou (Oct 13, 2009)

silver said:


> the seasonal flu is currently much less contagious and not as easily passed. For instance some middle sized universities have already had over 2000 cases of H1N1, they probably get 1/3 the amount of seasonal flu in a year.



And that is the ONLY difference. More contagious, but not necessarily more dangerous. EVERY virus can, and probably will, mutate. Swine flu and the seasonal flu are no exceptions of course. But truth be told, BSI takes care of most things and honestly, flu cases are not super duper abundant for EMS ppl to get called to and the swine flu is even less. 
Most people in EMS can tell you that there are bigger things to be concerned about contracting than H1N1. And as a volunteer, you are really doing it because you enjoy the field despite the risks. If you are really this concerned or worried about it, then nobody is making you join right now. It's your choice as to when you feel most comfortable joining and how big of "risks" you are willing to take.


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## NJnewbie (Oct 13, 2009)

RescueYou said:


> And that is the ONLY difference. More contagious, but not necessarily more dangerous. EVERY virus can, and probably will, mutate. Swine flu and the seasonal flu are no exceptions of course. But truth be told, BSI takes care of most things and honestly, flu cases are not super duper abundant for EMS ppl to get called to and the swine flu is even less.
> Most people in EMS can tell you that there are bigger things to be concerned about contracting than H1N1. And as a volunteer, you are really doing it because you enjoy the field despite the risks. If you are really this concerned or worried about it, then nobody is making you join right now. It's your choice as to when you feel most comfortable joining and how big of "risks" you are willing to take.



Thanks.  That's very good advice and I will consider what you've said.


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## MikEMS (Oct 19, 2009)

The last little while all the talk we have heard about 'swine flu' this 'swine flu' that, I think alot of it is hype created by the people in the media who are scared about it because it is relatively new and unheard of so the story gets alot of attention. It reminds of 5 years ago when the SARS virus scare came along, everyone went crazy fearing SARS, and now how much do we hear about that? You know, and it's not to say SARS wasn't real or posed no threats, but sometimes maybe these things are played up to much...perhaps this is the same now as 'swine flu', and personally I think it is.


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## Summit (Oct 19, 2009)

It's the flu. It sucks. Just like the flu.


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## MIkePrekopa (Oct 20, 2009)

I won't be working in EMS till beginning of next year, hopefully in January. I have never had a flu shot, and have only once had the flu. I am getting a shot this year due to going into EMS, and I'll be getting a few other shots just to stay up to day, so why not. My mom works in the ED and they are "looking for volunteers" to get the swine flu shot. Based strictly on the terminology, I'll pass. based on a random swine flu tracker i found online, apx. 30 "confirmed/suspected" cases in my county... 

as a friend always says when theres a new fad illness, "wash your hands, and don't lick sick people, and you'll survive."


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## bunkie (Oct 20, 2009)

They think I have it right now, so I'm obviously not worried. It's not that much worse from the flu if it is. Flu's a flu's a flu. They all suck.


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## 8jimi8 (Oct 20, 2009)

i've been taking care of h1n1 patients in my icu.  Just try to limit exposure, wear your ppe and wash your hands.  oh and try not to disconnect any ventilator tubing!


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## mycrofft (Oct 20, 2009)

*Mods could you invite an epidemiologist here for a guest post?*

I went through the first of two swine flu shots in 1976. In the late Eighties it was gospel that AIDS-related disease would overwhelm the American health "system". SARS would slide throuigh like a scythe. Bird flu was going to wreak havoc. West Nile, Hanta...malaria reappearing in the southern US. E.Coli in mass processed food.
And yet we are still here.
Practice hygeine, insist your coworkers go home if sick, stay home if you're febrile, and stand firm.


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## Aidey (Oct 21, 2009)

akflightmedic said:


> I will take the vaccine first chance I can. I only started taking flu vaccines a few years ago and now I never get sick as opposed to all the years previously when I seemed to catch everything going around.



I'm the same way, I got pneumonia every winter for 5 years straight until I finally started getting the flu shot, and poof, no more pneumonia. 

I am both concerned and not concerned. I'm not concerned for my self really. My immune system tends to be pretty decent (with the exception of the pneumonia noted above) and I've been exposed to it more than enough times to get it, and I haven't yet.

I am concerned that we could be seeing a lot more serious respiratory calls, especially once the "regular" flu season starts. People who were told 'oh it's just the swine flu, you'll be fine in a few days' and just kept getting sicker.


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## VFFforpeople (Oct 21, 2009)

I dont get the flu shot, mainly cause I think it is a joke. People swear by it, others laugh at it (IE. me). If I get sick I don't go around spreading it. I use my PPE, and that is it. You will get sick in this job but I can bet it will be by you walking around the store or touching money than by majority of your PTs. You do what it takes, I picked this to help, if I am scared or worried about getting sick..I should probably walk away now. Follow your training and PPE, common sense and things will be ok.

Saying that I sat through a swine flu lecture. I learned that swine flu is the flu with higher temp. No big deal.

I wouldn't worry about it.


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## bunkie (Oct 21, 2009)

Aidey said:


> I'm the same way, I got pneumonia every winter for 5 years straight until I finally started getting the flu shot, and poof, no more pneumonia.
> 
> I am both concerned and not concerned. I'm not concerned for my self really. My immune system tends to be pretty decent (with the exception of the pneumonia noted above) and I've been exposed to it more than enough times to get it, and I haven't yet.
> 
> *I am concerned that we could be seeing a lot more serious respiratory calls, especially once the "regular" flu season starts. People who were told 'oh it's just the swine flu, you'll be fine in a few days' and just kept getting sicker.*



That's whats happening with me and how I ended up in the ER. Went from "probably just the flu" to needing a whole lot of meds and a few chest xrays.


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## NJnewbie (Oct 21, 2009)

I'm the OP.  It turns out I tore the labrum in my shoulder and will be having surgery so my EMT plans are on hold for now.  :sad:  I have the textbook that is used in the class so I will be reading through that while I'm recuperating and hopefully I can take the class in the summer or next fall and maybe can at least attend meetings at my local squad.  This sucks though.  I was really getting psyched to do this and now I've got to put it off.


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## JCampbell (Oct 22, 2009)

Friends and family have asked me the same thing. "Aren't you gonna get the shot?" I say no I'm not, thanks. My reasoning is that myself and my girlfriend are in a combined 10 or so facilities a day, ranging from doctors offices to ER quarantine rooms. I have personally transported a couple confirmed cases in my rig. That being said, neither of us have caught it, and we haven't gotten the flu for years. I'm pretty sure we have strong immune systems, and I really don't like to fix what ain't broke.  That's my reasoning for better or worse. I consider it a fad that will be replaced by the next big story soon enough, maybe this time it'll be GOOD news.


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## zaboomafoozarg (Oct 22, 2009)

People seem scared of vaccines for some reason. 


I see no reason not to get 'em. Sure, no reason to fix what aint broke, but also no reason not to make it stronger either.

 I've got the Tetanus, MMR, meningococcal, TB, hepatitis, flu, and H1N1 vaccines in the past 2 months. 


Went and got my swine flu vacc today at the health clinic, I got one of the last ones available due to the shortage. Interestingly it was by far the least painful injection I've ever had. Felt like someone tapped me very lightly with a toothpick. On the other hand the MMR vacc I got made my entire arm hurt like the ****ens all the way down to the hand.


But I see no reason not to top off my immune system either.


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## mycrofft (Oct 23, 2009)

*Language aside, this one cracked me up..and I'm pretty crack-proof.*

CENSORED
(uses the "B" word that surmises that your folks met briefly at a masked ball).

Oh wait a work around!

http://www.fmft.net/Swine%20flu%20joke%20jokes%20cartoons.jpg

Remember I warned you it has a naughty word.


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## VentMedic (Oct 23, 2009)

zaboomafoozarg said:


> People seem scared of vaccines for some reason.
> 
> 
> 
> I've got the Tetanus, MMR, meningococcal, *TB*, hepatitis, flu, and H1N1 vaccines in the past 2 months.


 
What country are you in to be given the  BCG vaccine for TB?


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## mycrofft (Oct 23, 2009)

*Okokok....*

Polio shots (annually until early Sixties), then sugar cube X 3.
Tetanus/Diptheria
Plague
Yellow Fever
HEP a
HEP b
Typhoid
Flu shots since they were available
Swine flu #1 in 1977
Rhinovirus (military 1976)
Pertussis
Smallpox (military 1976)
Andromeda Strain


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## zaboomafoozarg (Oct 23, 2009)

Sorry, the TB wasnt a vaccine. just a TB test done, SubQ injection. you know the drill im sure

dunno why I lumped it in there with the vaccines.


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## Seaglass (Oct 23, 2009)

mycrofft said:


> Andromeda Strain



Now, where might I sign up for that?


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## Sasha (Oct 23, 2009)

> People seem scared of vaccines for some reason.



People still foolishly believe vaccines can cause autism in children, and also every single complication with the vaccines have been exploited by the media, who'se job is to make you feel as unsafe as possible. No wonder they're scared.


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## Sasha (Oct 23, 2009)

> H1N1 could be picked up at the grocery store or any place we work. After it has passed, it will likely be replaced by the "next thing".



Next year it will be the bunny flu.


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## absolutesteve81 (Oct 23, 2009)

Sasha said:


> Next year it will be the bunny flu.



HA! Exactly what I've been saying.

Personally, I'm not concerned in contracting H1N1.  I have gotten the seasonal vaccination last week and I may get the H1N1 vaccine.  The only reason I havent is because the days that the health dept are giving the free ones to healthcare professionals are days I work.

Do I spaz out when I get sneezed on or coughed on? No.  If by chance I contract H1N1 or the seasonal version, then I'll take my sick days and recoup at home.  No big deal aside from lost wages for the first day out.

I'm tired of hearing 'H1N1 this' and 'Swine flu that'.  Lousy media has to make a big deal over something.


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## HuiNeng (Oct 23, 2009)

absolutesteve81 said:


> HA! Exactly what I've been saying.
> 
> ...
> 
> I'm tired of hearing 'H1N1 this' and 'Swine flu that'.  Lousy media has to make a big deal over something.



So ignore the media hype and go straight to the WHO and CDC. H1N1 does have characteristics which make it worrisome to epidemiologists. Most importantly for the young adults in this forum, H1N1 deaths are not concentrated in the usual infant/elderly/immune-compromised population. Rather, this strain hits young adults. That's what the 1918 influenza did.

The present strain is perhaps not such a scary thing. What the epidemiologists are watching for is a change in the strain after it runs around in the population for a while.

 I'm not recommending that any of the posters here get the shot or not; just tossing in some information.


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## mcdonl (Oct 23, 2009)

I have been in healthcare for so long I have always gotten the flu shot and have never gotten the flu.


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## mycrofft (Oct 23, 2009)

*slicing the baloney thinner...getting farther off topic*

PPD test for TB is (drum roll) INTRAdermal.
Of course we had a nurse give them at a 90 degree anger, up to to the hilt.

She thought we were thick skinned I guess.


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## zaboomafoozarg (Oct 23, 2009)

Pfft, ID, SubQ, only a difference of what, a millimeter or so at most? Hardly matters!  

k, maybe a little bit.


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## bunkie (Oct 23, 2009)

Just wanted to say I had a confirmed case of H1N1 and it really wasn't that much worse then regular flu. Had respiratory problems likely due to my asthma that required an ER trip but they managed to get it under control and I didn't develop any complications. 

However, now people are using it as an excuse not to come anywhere near me. Whats great about it is that I get to use it too. 

As far as vaccines are concerned, some people have logical reason to skip them. Don't assume that just because someone doesn't vax or vax completely they are uneducated. 

It wasn't vaccines in general they feared caused autism. It was the MMR vax in particular. The fear was it was caused by the thermosil. The problem was in proving/disproving was the MMR vax was administered within the window for autism to present. The argument was that the compounds in the vaccine triggered an invisible hook so to speak. The parents believed their children were normal until vax and would have remained so without it.  Now the vax is clear of thermosil and more parents are now delaying until after the window of autism rather then skipping the vax completely. 

As far as other vaccines, some can be argued not to be as helpful or necessary as they are made to be. Chicken Pox is a big one and HPV is another.


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## nemedic (Oct 24, 2009)

Sasha said:


> Next year it will be the bunny flu.



I disagree. If the media of late is to be believed, it will mutate with another certain panic causing flu into the ........flying pig flu


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## zaboomafoozarg (Oct 25, 2009)

It's not as bad as it is reported to be by some, but it shouldnt be downplayed either. my cousin had it and said she just wanted to die. its pretty rough


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## bunkie (Oct 26, 2009)

zaboomafoozarg said:


> It's not as bad as it is reported to be by some, but it shouldnt be downplayed either. my cousin had it and said she just wanted to die. its pretty rough



I didn't find it that bad and I have several preexisting health conditions to make it as such.


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## VentMedic (Oct 26, 2009)

Sasha said:


> Next year it will be the bunny flu.





absolutesteve81 said:


> HA! Exactly what I've been saying.
> 
> I'm tired of hearing 'H1N1 this' and 'Swine flu that'. Lousy media has to make a big deal over something.


 


nemedic said:


> I disagree. If the media of late is to be believed, it will mutate with another certain panic causing flu into the ........flying pig flu


 
It is sad to see some gettting such pleasure out of a flu that is killing children.  Look at this year's stats already and compare to previous years.  Maybe some should take a field trip to a children's ICU and watch a child with H1N1 struggle for life while hooked up to some serious technology.  Then, you can do you laughing in the parents' faces. 

How many who thought they had the H1N1 got a confirmation from a reliable lab?   Is it possible you had the seasonal flu instead?  How many live or work with children?  What if you gave it to one of them and they got very ill or died?  Would you still think this is bullcrap and hype from the media?   Hopefully that will not be the case and you won't see this first hand.  But, for those of us that do see what this flu is capable of in children and young adults we will take our precautions seriously.   If you believe you are part of the medical system, you should also read some medical journals and stay informed.   Those that rely only on getting their medical education from the newspapers and TV shows like Trauma fail to understand much of anything going on around them in medicine. 

And yes, next season it may be replaced by something else.  But then most of the bacterial infections have mutated to become very resistant to treatment and can have many complications.   Part of the reason for the spread of many  diseases is from some poorly educated heath care providers and the public about how diseases can spread.  That definitely includes EMT(P)s.    The media at least has been attempting to educate people with whatever data they get from the CDC.   If you don't believe it, the CDC has a great website for you to confirm whatever you are hearing.  

Maybe instead of laughing at something that can turn out to be extremely serious if not this season but the next, some should be more proactive in their own education and that of others.


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## Sasha (Oct 26, 2009)

Whoa whoa whoa! There is nothing wrong with getting a little humor out of something that doesn't mean you're getting pleasure from the flu killing children. Jeez, how did you make that jump? It was sarcasm, my dear! I understand that the swine flu is serious, but I also understand that it has been seriously sensationalized while the media works people up bordering on hysteria!

Do you never get any humor from your job???

I find it kind of funny that you specifically use children to make your poiint, are the elderly not being hit hard and dying from it too? Wasn't there a couple young adults as well?


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## VentMedic (Oct 26, 2009)

Sasha said:


> Whoa whoa whoa! There is nothing wrong with getting a little humor out of something that doesn't mean you're getting pleasure from the flu killing children. Jeez, how did you make that jump? It was sarcasm, my dear! I understand that the swine flu is serious, but I also understand that it has been seriously sensationalized while the media works people up bordering on hysteria!


 
Your statements are fueling the swine flu to be one big joke for some here to believe that the media is doing their articles for no reason.

The thing is most posting on this forum do not understand the extent of the situation and coming off very cocky.  Their failure to realize the serious of the situation may not "hurt them" but it may cause great harm to their patients or family.    



Sasha said:


> Do you never get any humor from your job???


 
Not when I am working at the bedside of a child dying from H1N1.  This thread is not about work place humor.  It is about the swine flu.   

How many here have seen a dead child and found it to be humorous?  Even in a situation where the MVC might be kinda funny, a dead child still does not bring out the laughter in me.   But, most here will never see a dead child or for that matter see much death.  Few will last very long as an EMT because they will eventually discover it is about patient care which isn't what some thought the job was about.

The only humor here is from ignorance of those who do not know much about what they are talking about and don't care to seek out more information.

And I am NOT your dear.  If you were trying to present a valid argument you lost it with your obvious disrespectful use of those words.


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## VentMedic (Oct 26, 2009)

Sasha said:


> I find it kind of funny that you specifically use children to make your poiint, are the elderly not being hit hard and dying from it too? Wasn't there a couple young adults as well?


 
What makes this flu so different from others seasons is that those who normally would not be affected the hardest are the ones dying.

Young adults should not die from the flu. 

Pregnant women and their babies shouldn't be hit this hard to where we lose both. 

There have been a lot more than just a "couple" of flu deaths among the young.

The statistics are there. Check them out for yourself.


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## bunkie (Oct 26, 2009)

VentMedic said:


> How many who thought they had the H1N1 got a confirmation from a reliable lab?   Is it possible you had the seasonal flu instead?  How many live or work with children?  What if you gave it to one of them and they got very ill or died?



I had h1n1. It was confirmed by the CDC. And yes, I do have 3 young children at home. Youngest is only 14 months. I get scared in general for my kids to get sick. I was even more concerned for my 3 year old who has seizures. And all three of my kids went in to be seen as soon as I heard a cough. The doctors were more freaked out at my having it in combination with my problems then the my kids.



Sasha said:


> Whoa whoa whoa! There is nothing wrong with getting a little humor out of something that doesn't mean you're getting pleasure from the flu killing children. Jeez, how did you make that jump? It was sarcasm, my dear! I understand that the swine flu is serious, but I also understand that it has been seriously sensationalized while the media works people up bordering on hysteria!
> 
> Do you never get any humor from your job???
> 
> I find it kind of funny that you specifically use children to make your poiint, are the elderly not being hit hard and dying from it too? Wasn't there a couple young adults as well?



Yes there were, as well as a pregnant woman in Texas I believe. I was under the impression that h1n1 was having more casualties in the young adult population.


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## Sasha (Oct 26, 2009)

VentMedic said:


> Your statements are fueling the swine flu to be one big joke for some here to believe that the media is doing their articles for no reason.



The media does their articles mostly for shock value. I saw an article about ONE person in the tons of people who've gotten it,  experiencing a certain adverse side effect to the vaccine, yet their whole headline was "Is the swine flu vaccine safe?"  You don't think that the media is going for the shock value or fear value? Perhaps I'm a little bitter, bad media experience when I was younger, but they don't care to accurately report anything if by skewing it, it will boost their ratings.




> Not when I am working at the bedside of a child dying from H1N1.  This thread is not about work place humor.  It is about the swine flu.



I'm sorry, I wasn't aware that we were at the bedside of a dying child.



> And I am NOT your dear.  If you were trying to present a valid argument you lost it with your obvious disrespectful use of those words.



Actually, I wasn't trying to use 'dear' as disrespectful, and I'm very sorry if it offended you. It's often a form of endearment and a word (along with sweetie, sweetheart and hun.. I'm Southern  ), I use very often. You're a very smart lady, I like you and generally agree with your posts, but I found you jumping to very outlandish accusations to be a bit ridiculous.


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## VentMedic (Oct 26, 2009)

Is everyone here in belief that there have only be "a couple" of deaths due to H1N1?

Last week alone 11 children died of the flu with 9 of those confirmed to be H1N1.  There have been close to 100 so far within in the past few months.  That may not seem like a lot but the season is just starting.    These are also children that may not have died from just the seasonal flu.

There have been almost 30 pregnant women that have died from confirmed cases of H1N1.  Again, they may not have died from the seasonal flu.

Read last week's stats. 
http://www.cdc.gov/flu/weekly/


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## VentMedic (Oct 26, 2009)

Sasha said:


> The media does their articles mostly for shock value. I saw an article about ONE person in the tons of people who've gotten it, experiencing a certain adverse side effect to the vaccine, yet their whole headline was "Is the swine flu vaccine safe?" You don't think that the media is going for the shock value or fear value? Perhaps I'm a little bitter, bad media experience when I was younger, but they don't care to accurately report anything if by skewing it, it will boost their ratings.


 
Read the CDC weekly publications before you jump to conclusions. The hospitals are right now also caught in the middle with trying to answer the "Is the flu vaccine safe?" before making it mandatory for all employees. This is not hype. Most of it is based on very real reality.




Sasha said:


> I'm sorry, I wasn't aware that we were at the bedside of a dying child.


The thread is about swine flu. Children are affected and some are dying. 




Sasha said:


> Actually, I wasn't trying to use 'dear' as disrespectful, and I'm very sorry if it offended you. It's often a form of endearment and a word (along with sweetie, sweetheart and hun.. I'm Southern  ), I use very often. You're a very smart lady, I like you and generally agree with your posts, but I found you jumping to very outlandish accusations to be a bit ridiculous.


 
I'm Southern also which is why I find that very offensive and especially since you are about 30 years younger than me. Have your parents never taught you manners about calling your elders honey, sweetie and dearie. That is one of the first lessons of respect Southern children do learn. 

Again, if you work in a hospital around the EDs and critical care units you will see patient very ill and dying from the flu of whatever type. You may take it as a joke when on the ambulance and find it ridiculous that someone would even call you for a "ride to the hospital". However, for some, if you follow up a few hours later you may find that patient is on a ventilator. 

I don't have to accuse as your posts and others speak for themselves.

I guess the biggest mistake some hospital staff and patients have made is "assuming" that EMT(P)s have enough understanding of the flu to protect themselves and the patients but I believe now that is a very incorrect assumption.


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## Sasha (Oct 26, 2009)

VentMedic said:


> The thread is about swine flu. Children are affected and some are dying.



But the comments are not being made at the beside of a dying child, nor even on the clock. It's on a lesiure EMS forum.



> I'm Southern also which is why I find that very offensive and especially since you are about 30 years younger than me. Have your parents never taught you manners about calling your elders honey, sweetie and dearie. That is one of the first lessons of respect Southern children do learn.



I don't take your age into consideration while posting, I don't see you as "Vent the Elder", just Vent. 



> Again, if you work in a hospital around the EDs and critical care units you will see patient very ill and dying from the flu of whatever type. You may take it as a joke when on the ambulance and find it ridiculous that someone would even call you for a "ride to the hospital". However, for some, if you follow up a few hours later you may find that patient is on a ventilator.
> 
> I guess the biggest mistake some hospital staff and patients have made is "assuming" that EMT(P)s have enough understanding of the flu to protect themselves and the patients but I believe now that is a very incorrect assumption.



Never have I taken it as a joke, and neither I have underestimated that things that may not affect me can affect my patients. I am very agressive with disinfection and using BSI percautions for that reason, not for my protection but for my patients. It's also why I'm getting both flu vaccines this year.

I'm referring to your accusation that we are laughing in the face of dying patients by finding a little humor in it. You have got to find humor a little humor in your job, or it will drive you crazy.


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## VentMedic (Oct 26, 2009)

Sasha said:


> But the comments are not being made at the beside of a dying child, nor even on the clock. It's on a lesiure EMS forum.
> 
> 
> 
> ...


 
I reread the thread and found absolutely nothing funny about it either in or out of the work place. 

If some here actually knew the consequences and reality of the disease, the tone might be a little different but most here have yet to even see a dead person or even one that is intubated. Thus, they have no idea about what they are laughing about either on duty or off. 

We do not even know the full extent of what this flu season will be like because we are just starting. The H1N1 started way ahead of the regular flu season. 

I can find humor in many other things and don't feel compelled to laugh about the swine flu which I have seen for myself what it can do. 

It is in the BLS section and for those to believe that the swine flu is a leisure activity also shows a great need for more education.


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## Sasha (Oct 26, 2009)

VentMedic said:


> I reread the thread and found absolutely nothing funny about it either in or out of the work place.
> 
> If some here actually knew the consequences and reality of the disease, the tone might be a little different but most here have yet to even see a dead person or even one that is intubated.   Thus, they have no idea about what they are laughing about either on duty or off.
> 
> ...



Swine Flu, of course, is not a leisure activity, I'm sorry if my post came off that I was calling it such, however we are discussing it ON a leisure EMS forum. Something that many people access during their spare time. 

I've transported a couple swine flu patients myself, I understand that it is a serious illness. But so is cancer, HIV/AIDS and many STDs. Have jokes been made about 'oh I'm going to go smoke my cancer sticks, I'll get cancer anyway' 'gotta die somehow' 'Getting herpes means you get to go white water rafting, and mountain climbing!' or 'he's got the hiv' or the like? Yes! Does it downplay the seriousness of it all? No. I doubt anyone would call those illnesses a joke, even though you may talk about it in a light manner. 

There's a running poll at my place of employment over which animal next year's flu strain will come from. We've already had avian and now swine flu. Does that mean we laugh when we transport swine flu patients? No. Does that mean we don't understand swine flu is very serious? No. Does that mean we are all ignorant morons who don't understand the need to protect ourselves and our patients from it? No.

Like I said, I understand it's serious and can be very deadly. I'm getting both flu shots this year, not only for my patient's protection but so I don't bring it home to my adorable little nephew who has seen enough of the NICUs and PICUs for his lifetime. I sincerely apologize that you've found any comments of mine offensive, I will keep that in mind next time I post. I seriously meant no disrespect to you or to anyone suffering from the swine flu.


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## silver (Oct 26, 2009)

Finally someone else is backing up my original statement, and it is not just me being "fearful."


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## VentMedic (Oct 26, 2009)

Sasha said:


> I've transported a couple swine flu patients myself, I understand that it is a serious illness. But so is cancer, HIV/AIDS and many STDs. Have jokes been made about 'oh I'm going to go smoke my cancer sticks, I'll get cancer anyway' 'gotta die somehow' 'Getting herpes means you get to go white water rafting, and mountain climbing!' or 'he's got the hiv' or the like? Yes! Does it downplay the seriousness of it all? No. I doubt anyone would call those illnesses a joke, even though you may talk about it in a light manner.


 
HIV/AIDS and STDs can be avoided with protection. 

Smoking cigarettes is your choice and you should know what risks you take. It is only a joke until you are dragging at oxygen tank around at the age of 35.

However, many of these will be lengthing illness if you do contract one as most can be managed for awhile. 

But with the H1N1 flu, you may feel a little sick one day and be on a ventilator the next. One of the following days could bring death. You will not be given a chance to joke about your disease and neither with your family.


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## VentMedic (Oct 26, 2009)

silver said:


> Finally someone else is backing up my original statement, and it is not just me being "fearful."


 
Fearful? No. It is respect for what some diseases can do. Being fearful could make one an ineffective health care provider. But, having an understanding of the diseases and how to protect yourself and the patients can overcome whatever fears you might have. 

Of course there are some days you do go home and give your family an extra hug...after you have thoroughly showered.


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## Sasha (Oct 26, 2009)

VentMedic said:


> HIV/AIDS and STDs can be avoided with protection.
> 
> Smoking cigarettes is your choice and you should know what risks you take. It is only a joke until you are dragging at oxygen tank around at the age of 35.
> 
> ...



And HIV/AIDS isn't necessarily avoidable in children who got it from their parents at birth.

I think you missed the point. My point was, they are all serious illnesses, a little humor about the origin does not debase the fact that they are serious illnesses. I don't feel that a little sarcasm about the source of a future strain of influenza disrespects the fact that swine flu is a serious illness.


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## VentMedic (Oct 26, 2009)

Sasha said:


> I don't feel that a little sarcasm about the source of a future strain of influenza disrespects the fact that swine flu is a serious illness.


 
Unfortunately, after the CDC named the flu for its source they realized that it was a distractor and some would see it as a joke.  For that reason it is now referred to as H1N1.   Of course, they thought the jokes would be coming from the lay persons and not health care providers who should have some education about the significance of the strains.   I guess the CDC has never read this forum.


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## VentMedic (Oct 26, 2009)

Sasha said:


> And HIV/AIDS isn't necessarily avoidable in children who got it from their parents at birth.


 
Which is why we now test pregnant women and measures can be taken to reduce the risk of that baby converting to positive.


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## Sasha (Oct 26, 2009)

VentMedic said:


> Unfortunately, after the CDC named the flu for its source they realized that it was a distractor and some would see it as a joke.  For that reason it is now referred to as H1N1.   Of course, they thought the jokes would be coming from the lay persons and not health care providers who should have some education about the significance of the strains.   I guess the CDC has never read this forum.



I guess a little humor is inexcuseable, and that educated people are above it. Again, my apologies.


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## VentMedic (Oct 26, 2009)

Sasha said:


> I guess a little humor is inexcuseable, and that educated people are above it. Again, my apologies.


 
Sometimes just a reality check is needed.

There is a time and place for humor but only if one fully understands the source of their laughter.    As well, this goes for the reason some are laughing as it pertains to their own personal feelings and securities or insecurities.


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## silver (Oct 26, 2009)

VentMedic said:


> Fearful? No. It is respect for what some diseases can do. Being fearful could make one an ineffective health care provider. But, having an understanding of the diseases and how to protect yourself and the patients can overcome whatever fears you might have.
> 
> Of course there are some days you do go home and give your family an extra hug...after you have thoroughly showered.



Thats why I put it in quotes. I have no fear of it; people were responding to my post like I did. I just have an understanding and respect for what viruses do, which I assume you do too.


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## guardian528 (Oct 26, 2009)

NJnewbie said:


> Correct me if I'm wrong, but from reading through the threads on here, I don't get the impression any of you are too concerned about contracting the swine flu.  I've been wanting to join my local volunteer squad, but with all the talk in the news about the swine flu, I admit I'm getting cold feet.  Is it all just hype?  I'm thinking maybe I should wait until it all blows over, but I don't know.  :unsure:



seriously? i am more worried about getting swine flu going to school than i am going to work. at school i sit in a crowded lecture hall with 400 students right next to each other coughing all day long. at work i sit with a partner and a patient. seems school has the greater odds.

and yes, swine flu is all hype. its bs


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## VentMedic (Oct 26, 2009)

guardian528 said:


> and yes, swine flu is all hype. its bs


 
Obviously you don't live in CA or you would know what is happening around you unless you totally could care less.    You also probably do not work in any form of EMS or have any type of medical job or you would also be aware of a few facts in California.   You might try learning what H1N1  is since that is the name you will now hear the Swine Flu called.   Stay informed.


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## guardian528 (Oct 26, 2009)

VentMedic said:


> Obviously you don't live in CA or you would know what is happening around you unless you totally could care less.    You also probably do not work in any form of EMS or have any type of medical job or you would also be aware of a few facts in California.   You might try learning what H1N1  is since that is the name you will now hear the Swine Flu called.   Stay informed.



i wasn't aware there were prerequisites to living in california. i would voice my opinion, but i've already watched you argue with sasha on the subject, so i'll just stay out of it. its seasonal flu x1.5, get over it. if you haven't already, read the article from this thread


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## VentMedic (Oct 26, 2009)

guardian528 said:


> i wasn't aware there were prerequisites to living in california. i would voice my opinion, but i've already watched you argue with sasha on the subject, so i'll just stay out of it. its seasonal flu x1.5, get over it. if you haven't already, read the article from this thread


 
You need to read the links to the CDC and get your facts straight. You spout off stuff that you have no clue about what you are even talking even though it is taking place all around you. From what great experience are you speaking from if you are not even in a health care occupation? Can you tell me that the deaths to the children in CA this past month is just BS? Is that the only "disease" some EMTs know? Why don't you give the parents a call and tell them to just suck it up? 

Prove that those deaths were not caused by H1N1 and the parents are just stupid for over reacting to the death of their children. Provide links that prove those parents are contributing to the hype. 

Then you can start calling the families of some of the 20 somethings that have died. Let's not forget about the families of the pregnant women. I'm sure they would like to hear that they should just suck it up as well. 

You don't even begin to know what this is all about and you probably don't care. I seriously doubt if you even understand the article that you linked to either. 

I don't want someone, especially a child, sick with the H1N1 or whatever to get blown off by an EMT who believes everything is BS and they should just suck it up.


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## VentMedic (Oct 26, 2009)

There are some really sad statements on this thread concerning the understanding of H1N1. 

Other EMS forums are seriously discussing the safest way to deliver O2 therapy, CPAP, ventilators and nebulizers in close spaces. Dr. Bledsoe and a few other ED physicians have joined the discussions. Healthcare professionals on their forums are discussing isolation rooms, triage space, ED tents, new therapy protocols, technology, treatment, resistance to drugs therapy, testing issues and employees health coverage. 

Meanwhile, here at EMTLife, some EMTs have decided the patients being treated, as well as some that are dying, in the hospitals right now for H1N1 are just BS and they should just suck it up.


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## guardian528 (Oct 26, 2009)

you reply to me the same as you replied to sasha, with an overreaction. you take what people say and blow it out of proportion. i am indeed in healthcare, and it seems a little strange to think that you discredit people the second they aren't as passionate about something as you are. i'm sure there are issues that i care deeply about that you would shrug off without thinking twice about, and thats fine. on this particular issue, i happen to think that it has been overhyped by the media and by a lot of people. just because i think that in the big picture, this disease is overhyped, does not mean that my everyday patient care would be anything less than usual. somehow because of that, you think i should start calling sick people and telling them to suck it up, and that i "believe everything is BS." i don't impose my will onto my patients. it is absurd to think that I would refuse to help a patient or tell them to "suck it up" just because I believe the hype surrounding what they have has been a little too worked up. in the future, maybe take a minute to listen to other sides of the story, instead of grabbing for their throat and demanding they feel the same way as you.


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## VentMedic (Oct 26, 2009)

guardian528 said:


> you reply to me the same as you replied to sasha, with an overreaction. you take what people say and blow it out of proportion. i am indeed in healthcare, and it seems a little strange to think that you discredit people the second they aren't as passionate about something as you are. i'm sure there are issues that i care deeply about that you would shrug off without thinking twice about, and thats fine. on this particular issue, i happen to think that it has been overhyped by the media and by a lot of people. just because i think that in the big picture, this disease is overhyped, does not mean that my everyday patient care would be anything less than usual. somehow because of that, you think i should start calling sick people and telling them to suck it up, and that i "believe everything is BS." i don't impose my will onto my patients. it is absurd to think that I would refuse to help a patient or tell them to "suck it up" just because I believe the hype surrounding what they have has been a little too worked up. in the future, maybe take a minute to listen to other sides of the story, instead of grabbing for their throat and demanding they feel the same way as you.


 
But yet you linked to an article entitled "Suck it up" when engaged in a discussion about H1N1.

And with this little comment from you:


> and yes, swine flu is all hype. its bs


 
Your comments have stated your side of the story. 

I again ask you to prove that the deaths in your area are not real and just media hype. Go to any hospital in the area and see how many patients they have admitted for H1N1. Find out how many are on life support right now and haven't made the death list yet to become a statistic. 

You seriously have not seen the true picture. 

I don't give a crap about what you think about me. I am just trying to get some to do their own legitimate research from well published sources before they take the word of an EMT such as yourself that the flu is just hype and BS. I am very passionate about some issues especially when it comes to dying and dead children or young adults and pregnant women are thought of as just media hype and BS. Your opinion will hopefully not be considered as the standard for all EMTs because there are some who are intelligent enough to do their homework and have a good understanding of the issues so they can protect themselves, their families and provide good care for their patients.

The rest of this forum holds little interest to me because I don't care what light bar you put on your POV or what stethoscope is your passion. I do care when there are important patient care issues that need to be addressed.


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## guardian528 (Oct 26, 2009)

VentMedic said:


> But yet you linked to an article entitled "Suck it up" when engaged in a discussion about H1N1.



cmon bud, you know as well i as do that that article is primarily about how things get overhyped and that people fear they have some ungodly illness the second they sneeze. yes, towards the end of the article it states:

"A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it's time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what's really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores."

but that does not mean they suggest going out and telling everyone to suck it up. i'm not going to continue arguing this, you see only what you want to see, and read only what you want to read. I said "swine flu is bs" because i just quoted the OP, and didn't read the rest of the thread. it was lighthearted, intending to imply the hype surrounding the flu. had i previously read the little debate going on between you and sasha, i probably would have been more clear. you just keep telling me to "prove that the deaths are all hype." wanna hear something crazy? those deaths were caused by H1N1. oh my goodness, i said it! i haven't ever said otherwise. i have simply stated that the media has overhyped this to a ridiculous degree. if it were as bad as the media has said, we would have people dropping like flies all around us. by all means, continue beating this dead horse if you'd like, or go out shout "H1N1 KILLS!!!" from the rooftops, or do whatever it is you do, but i'm out.


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## VentMedic (Oct 26, 2009)

guardian528 said:


> but that does not mean they suggest going out and telling everyone to suck it up. i'm not going to continue arguing this, you see only what you want to see, and read only what you want to read. I said "swine flu is bs" because i just quoted the OP, and didn't read the rest of the thread. it was lighthearted, intending to imply the hype surrounding the flu. had i previously read the little debate going on between you and sasha, i probably would have been more clear. you just keep telling me to "prove that the deaths are all hype." wanna hear something crazy? those deaths were caused by H1N1. oh my goodness, i said it! i haven't ever said otherwise. *i have simply stated that the media has overhyped this to a ridiculous degree.* if it were as bad as the media has said, we would have people dropping like flies all around us. by all means, continue beating this dead horse if you'd like, or go out shout "H1N1 KILLS!!!" from the rooftops, or do whatever it is you do, but i'm out.


 
You again keep saying over hyped. 

Prove your point.  *Post stats* that disprove those that are posted by the CDC and the state of California.   Don't just say it is all hype if you can not say the CDC is lying about the numbers just for H1N1.


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## Sasha (Oct 26, 2009)

Came across, figured I'd post here as opposed to starting a seperate thread for it.

*CDC: H1N1 Flu Still Hits the Young Hardest*
Full Article: http://www.medpagetoday.com/CriticalCare/Pneumonia/16535


> ATLANTA -- The pandemic H1N1 influenza virus continues to disproportionately attack the young, the CDC warned today.
> 
> Children and adults under age 25 have accounted for 53% of hospitalizations for laboratory-confirmed H1N1 and 23.6% of related deaths since Sept. 1, the agency reported at a press briefing.
> 
> ...





> Pregnancy, in particular, has been a risk factor for which the CDC said it has met resistance in its recommendation to treat with antivirals.
> 
> "Completely healthy pregnant women have been coming down with horrible, horrible illnesses [with the pandemic H1N1, including the need for] intensive care unit courses, and, tragically, more deaths that we've been hearing about recently," Schuchat said.
> 
> ...





> The age breakdown was:
> 
> 
> 3.1% ages 4 and under
> ...


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## 51 RESCUE EMT-B (Oct 27, 2009)

Got my H1N1 vaccination yesterday, all is good.B)


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## Sasha (Oct 29, 2009)

Interesting article.

*CDC Confirms Sickest H1N1 Patients Have Comorbidities*
Full Article: http://www.medpagetoday.com/Pulmonary/URIstheFlu/16417


> A preliminary CDC analysis has confirmed that most patients hospitalized with the pandemic H1N1 influenza virus have underlying conditions that increase the risk for complications.
> 
> In more than 500 hospitalized children evaluated, the most common conditions included asthma, chronic lung disease, neurologic and neuromuscular disorders, and sickle-cell anemia and other blood disorders, Anne Schuchat, MD, of the CDC's National Center for Immunization and Respiratory Diseases, said on a conference call with reporters.
> 
> Among about 1,400 hospitalized adults, the most common conditions were asthma, diabetes, chronic lung disease, chronic heart disease, and immunosuppression.





> In addition to the underlying chronic medical conditions, pregnancy remained notable among the hospitalized adults; 6.1% were pregnant.
> 
> Schuchat said pregnancy increases the risk of flu-related complications because a mother's immune system is suppressed so the body does not have a reaction to the fetus, increasing vulnerability to all infections.
> 
> In addition, she said, as the baby grows, the mother's airways can become restricted, making it harder to fight off a lung infection.


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## dragonjbynight (Oct 30, 2009)

Ok, Just getting over the H1N1 virus myself. It sucks, fever off and on, constriction on the chest and coughing, Some muscle aches. I was lucky enough to skip the headache. Comparative to a minor case of mono...

There is no more testing for this unless you get admitted to the hospital. Dr's office's, urgent care facilities are now told that if you have the symptpoms, you have the bug. GO home, don't go back to work till 24 hours fever free without medication. In the case of children, 48 hours fever free until they can go back to school. 

That being said, I agree with both Sasha and Vent on this topic. The media HAS sensationalized certain cases. My case in Point: FFA girl dies of H1N1 in Indianapolis. 

1. Yes the girl passed away.
2. The Girl had a pre-existing heart condition. 
3. The heart condition was the cause of death, H1N1 exacerbated what was already there, the same way pnemonia, the regular Flu, or half a dozen other viruses could have done.

But this has been the top story on the news for 3 days now. Not girl dies of heart problem due to exposure to H1N1, its girl dies of H1N1. Now the average layperson is NOT going to make that connection and freak out when they hear a cough because all they have heard on the news in days is about the deaths that H1N1 has caused, which is leading to the swamping of emergency rooms nation wide. (not saying parents shouldn't be worried)

Secondly: Vent is accurate in that this is a virus that has some potential to kill and shouldn't be treated Lightly. It is not BS, it is a true medical issue. It also does have the potential for mutation, as every flu does. The regular flu does it every so many years, however, with a "new" flu, it has a higher chance of doing so in a shorter amount of time if I am not mistaken ( which I may Be). 

---Bunkie, glad to hear you made it through alright, speedy recovery.


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## SES4 (Oct 30, 2009)

Got the vaccine on 10/28/2009.  So not anymore.


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## CountryEMT-bGurl (Oct 30, 2009)

So got my H1N1 vacc. the other day. I work at a local hospital in the Nursery; to tell you the truth I am very fearful of the shot. I am not one to take med.'s unless I am dying. But I did it for MY children an my patients! Both my children have Hirschsprungs disease, an they easliy contract viruses, bugs, etc... BUt I am still fearful of what this shot is going to do to me long term...(or possible short; who knows :unsure. I also have SVT, an ever since I have gotten the shot, my SVT has acted up twice;an the last couple of days I feel like my SVT could start up at in sec (tightness in my chest, my throat feeling like it is closed, etc) I am freaking out!!! But I know I did it for the right reasons at least; if I DIE!!!!!    :unsure::unsure::unsure::unsure:


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## Foxbat (Oct 31, 2009)

VentMedic said:


> Other EMS forums are seriously discussing the safest way to deliver O2 therapy, CPAP, ventilators and nebulizers in close spaces.


Other than a risk of O2 finding an ignition source, what are the dangers in it?


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## VentMedic (Oct 31, 2009)

Foxbat said:


> Other than a risk of O2 finding an ignition source, what are the dangers in it?


 
Think about it a little bit unless you  are just trying to be funny about something that is serious.  

The same infection control principles apply for many types of bacteria and viruses, not just the Swine flu, when using these devices.


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## Shishkabob (Oct 31, 2009)

Oops... please delete.


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## VentMedic (Oct 31, 2009)

Linuss said:


> Oops... please delete.


 
I saw your post Linuss.

I would be curious to know what happens to that patient with a PaO2 of 31 mmHg. The patient I just placed on the High Frequency Ventilator yesterday  had a PaO2 of 50 mmHg on a NRBM.


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## Shishkabob (Oct 31, 2009)

Yea when the nurse said he had a Pa02 in the 30s my first thought was "Did she say that right?"

They had him tubed and on a ventilator (obviously).  They said it was ARDS complicated/caused(dont remember which one) by H1N1




Also got to see my first person on BiPAP today.


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## VentMedic (Oct 31, 2009)

Linuss said:


> Yea when the nurse said he had a Pa02 in the 30s my first thought was "Did she say that right?"
> 
> They had him tubed and on a ventilator (obviously). They said it was ARDS complicated/caused(dont remember which one) by H1N1
> 
> Also got to see my first person on BiPAP today.


 
If the patient is at a progressive hospital, there is a good chance he will be on a high frequency ventilator (HFOV). If you get the opportunity to followup, the HFOV is even more awesome to see in action than a BiPAP machine. It will be oscillating the breaths given to the patient at around 180 to 420 times per minute.

ARDS is a complication of H1N1 or now known as Flu Associated Acute Respiratory Distress  Syndrome.


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## Foxbat (Oct 31, 2009)

VentMedic said:


> Think about it a little bit unless you  are just trying to be funny about something that is serious.
> 
> The same infection control principles apply for many types of bacteria and viruses, not just the Swine flu, when using these devices.


Are you talking about somehow filtering the air pt. exhales when he breathes through CPAP/autovent/NRB?
(And no, I don't think it's funny).


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## VentMedic (Oct 31, 2009)

Foxbat said:


> Are you talking about somehow filtering the air pt. exhales when he breathes through CPAP/autovent/NRB?
> (And no, I don't think it's funny).


 
It is the expired air that will be distributed t/o the ambulance and the ED to anyone nearby and that is the concern with the higher flow of gas. Unless the CPAP device is a closed system, it is difficult to filter. Right now the only closed system that provides CPAP is through the ventilators and that is usually not the simple portable single limb ones. 

The U.S. government has initially started stock piling CPAP devices for just this type of emergency but then had to back pedal after the SARS outbreak to which O2 devices were blamed for some of the spread.

If these devices are used on a suspected flu patient, everyone near should have an N95 mask and the ED should be forewarned to have an isolation bed ready or their staff protected and bystanders/patients out of the way of the exhalation particles.

Don't forget to put a filter between the ETT and  BVM for intubated patients when various diseases are suspectd such as the flu, meningitis and TB.


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## FF2EMT (Nov 3, 2009)

Its all one big joke if you ask me people just need to suck it up


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## sbp7993 (Nov 3, 2009)

I am not worried about it at all. The regular seasonal flu is a more important thing to be worried about. I had it a while ago, and it wasn't fun.


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## Simusid (Nov 5, 2009)

FF2EMT said:


> Its all one big joke if you ask me people just need to suck it up



Disagree completely.   Yes people die every year from the seasonal flu, that is a fact and a reality.  Maybe I'm just a little hypersensitive because a co-workers daughter died today of H1N1, and a 12 year old girl in a neighboring town died last week.  

I take it as a given that there are people trained extensively in this field and they are telling me that this is important and different.

Don't you hate it when you get a patient refusal from an MVA when your extensive training and experience tells you that there is a real possibility that they need medical attention?


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