H1N1: Hospital Emergency Room Overcrowding in Montreal

H1N1 guidelines set out by Quebec health officials are causing a huge increase in ER clients seen at both Montreal's children's hospitals. Because the provincial government's H1N1 self-care guide and decision making chart direct parents to bring a child up to age two to the hospital for a fever, many children are presenting at hospital with mild symptoms. As a result, both children's hospital emergency rooms are operating at 180 percent of their actual capacity to treat patients. ("ERs overcrowded because of swine flu") This, of course, is resulting in much longer waits for all children coming to the hospital for a health emergency.

H1N1 Self-Care Guide Inaccurate

Doctors at the children's hospitals feel the province's self-care guide, available online and going out to Quebec households by mail in the near future, gives inaccurate advice about when to bring children with a fever to the hospital. The guide advises parents that children under age two are in a risk group along with senior citizens, pregnant women and people suffering from chronic illness. The guide advises parents that children under age two who have a fever should be seen by a doctor the same day; with the current fear over H1N1 killing otherwise healthy young people and with so many families not having access to a primary care provider, it is not at all surprising to see so many going straight to the emergency room.

"Parents need only consult a doctor urgently if their newborn (three months and younger) has a fever of more than 38.3[ºC] (100.9º F ). For all other children, a doctor should only be consulted if the child has a fever and other complications associated with the flu as described in the guide." ("The ERs at CHU Sainte-Justine...")

Hospitals Not Testing for H1N1

With the current ER overcrowding, hospitals are unable to test children for H1N1 even if they do have a flu-like illness. Doctors also caution that if parents bring mildly ill children to hospital, it makes it more difficult for them to give timely and appropriate care to seriously ill children. The best course of action is to call the Info-Santé nurse at 811 for advice if parents are unsure whether their child needs to see a doctor. If the situation is not an emergency, parents are asked to take their child to a CLSC or local walk-in clinic. The Info-Santé nurse can help you find a clinic if you need assistance, or you can consult a listing on the Montreal health agency web site at http://www.santemontreal.qc.ca/En/portrait/clinique.html or check in your phone listings.

When to Go to the ER

Hospitals say children who truly need emergency care should be brought promptly to the emergency room. This includes children with signs of complications related to influenza, and also children with severe injuries or other signs of very poor health. Take your child to the ER if he or she shows any of the following symptoms:
* An injury that may be a broken bone or that may require stitches;
* Vomiting following an injury;
* Rash that does not turn white when touched;
* Changes in skin colour (e.g. pale skin; whitish or bluish lips) or difficulty breathing (e.g. breathing faster than normal; excessive coughing; choking or breathing irregularly);
* Signs of dehydration such as very dry mouth, no tears when crying, urinating much less than normal (should be at least twice over 24 hours); these signs often accompany diarrhea or vomiting.

The Montreal Children's Hospital points out that fever can generally be treated at home in older children. They recommend calling your doctor if the child is under six months old and has a fever, if the temperature goes above 39ºC (102ºF) or if fever lasts more than two days. "The degree of fever is not a reliable sign of how serious the illness is. A child's behaviour is usually a better indication of how sick they are." ("Should you come to the E.R.?")

Specific behaviours that are of concern are:
* Fussiness, irritability or restlessness;
* Extreme fatigue or a child who cannot be woken;
* Persistent wheezing or coughing;
* Any unusual behaviours that concern the parent - after all, you know your child best!

Dr. Harley Eisman, Medical Director of the emergency department at The Montreal Children's Hospital, encourages parents to remain calm even if they suspect their child has contracted H1N1 influenza. "H1N1 influenza is a relatively mild form of the flu," he says, "and is very similar in severity to the annual flu virus. The only difference is that flu season has started earlier and more people are being infected." ("The ERs at CHU Sainte-Justine...")

More H1N1-related articles by this author:
H1N1 Vaccine: Seniors in Canada | H1N1: What to Do If You Get Sick | Where to Find H1N1 Vaccination in Montreal

Please note the writer is not a health professional. This article is provided for information purposes only, and should not replace advice from a competent medical practitioner.

Sources:
"ERs overcrowded because of swine flu" CTV News
"Self-care guide - Influenza A(H1N1)" Pandémie-Québec
"Should you come to the E.R.?" Montreal Children's Hospital
"The ERs at CHU Sainte-Justine and The Montreal Children's Hospital are seeing a significant increase in number of children seeking care" CHU Sainte-Justine