As we will shortly be testing our own hospitals pandemic response capabilities, I thought it might be prudent to take a look at some basic guidelines for keeping you and your patients out of harms way during a pandemic.
And when it comes to the spread of influenza virus its the simple things that will separate an inconvenience from a catastrophe.

Guidelines for Triage Nurse during Pandemic Response.

Signage: As the possibility of a pandemic scenario emerges, prominent signage should be erected in the ED waiting room directing patients with flu-like or respiratory symptoms to identify themselves to the triage nurse immediately upon arrival.

Sort and separate: Identify any patient with respiratory symptoms (such as cough or SOB) AND history of travel in past 14 days to an area considered to be at high risk. These patients should be given high priority.
That is: they should be carefully assessed and if necessary isolated promptly. Assigning a triage score is done as usual, based on the triage nurses assessment. The important thing is to identify high risk presentations and separate them from other people.

Personal Protection: The triage nurse should Personal Protective Equipment (PPE).
That is: long sleeved fluid resistant gown (we call them the ‘yellow gown’), gloves, P2 (N95) mask face shield and disposable theatre cap.
As soon as possible the patient should be requested to wear a P2 (N95) mask.
Other staff who will have patient contact at the triage area (e.g.. clerical staff, wards men etc..) but who will NOT need to have close contact will only need to wear a P2 (N95) mask.
That is: Full PPE is only needed if coming into close contact (i.e. within 1 meter) of patient or exposure to droplets/secretions is likely.

Assess and isolate: If the patient has fever >/= 38C AND respiratory symptoms AND a plausible history of exposure consider a possible case of influenza.
Patient should be moved with high priority to an isolated environment.
That is: A negative pressure isolation room.
If no room is available: A single room.
If no room is available: an area designated for co-horting of pandemic influenza patients. This would be a dedicated area where pandemic patients are masked and separated by a distance of at least one meter.

Oxygen therapy. If oxygen therapy is required use nasal prongs covered with P2 mask, if high flow oxygen is required use non-rebreather mask.
Nebulizers are NOT to be used. Use spacers for delivering medication.

Assess and clear: If the patient is not at high risk they can be returned to the waiting room after some basic precautions. Educate them on cough etiquette. That is: coughing into tissues or Kleenex (rather than their hands or the face of somebody next to them). Disposing of the tissues in a bin and washing their hands afterwards.
All people in the waiting room should be separated by one meter if possible.

Family members: who accompany suspected influenza patients to the hospital are assumed to have been exposed to influenza and should be screened for signs and symptoms of influenza before being permitted entry into the ED. Once cleared they should wear a P2(N95) mask and be told not to approach within one meter of the patient. If closer contact is indicated (e.g. pparents of young children) full PPE must be worn.

Visitors: Visitors must be limited to persons necessary for the patients emotional well-being and care.
All visitors should be screened for signs and symptoms of influenza before entry into the ED and precautions used as for family members.

The life expectancy of Personal Protective Equipment:

P2(N95) Masks: Mask may be used until it becomes moist and then should be discarded.
They are not to be worn dangling around your neck.
Removing a contaminated mask is a high risk procedure. The front of the mask must not be touched. Grasp the elastic straps behind the head and carefully pull over and away from your face.
After touching or removing a mask immediately perform hand hygiene.
Gloves: Must be replaced with each patient contact.
Always perform hand hygiene after removing gloves.
Gowns: Disposable yellow gowns should be worn. If gowns are in short supply consider prioritising for use with patients where contact with secretions or body fluids is likely.
Goggles/ Face shield: probably only necessary if sprays or splatter of infectious material is anticipated. However, in the ED these events should always be anticipated without warning.
Always perform hand hygiene after removing.
Disposable theatre cap: Is recommended to prevent droplet contamination of the head and scalp.

Management guidelines for suspected pandemic influenza patients in Resuscitation.

Staffing: Staff assisting in resus should be limited to essential personal only. Intubation and airway suctioning are considered high risk aerosol generating procedures.
PPE: Staff attending to suspected influenza patients in resuscitation MUST wear full PPE.

Doors: into resuscitation are to be kept closed and signage posted to minimize traffic into this area. Not only does increased numbers of people increase the exposure risk, but air currents generated by constant opening and closing of doors MAY facilitate micro-droplet spread.

Some more thoughts on pandemic preparedness are here: Big Bird.