Experience of Triage During an A/H1N1 Influenza Pandemic in After-Hours Emergency Centers

During the 2009 A/H1N1 influenza pandemic in Sendai, two primary emergency clinics, which are after-hours emergency centers managed by the Sendai Emergency Medical Service Foundation, were inundated with many influenza patients. In the course of the pandemic, from August 1, 2009 to March 31, 2010, a total of 47,831 internal medicine and pediatric patients visited the two clinics and rapid influenza tests were performed in 17,167 of patients, in which 6,697 patients tested A-positive. Consequently, 10,743 patients were diagnosed with influenza, which included 1,447 patients that tested negative, and 2,599 patients that were not tested. Prior to the physicians check up, nurses performed triage and divided the patients into two groups, isolated and non-isolated. We examined the effect of triage, using the results of the rapid influenza test and antiviral drug administration, in each of the early, middle and maximum pandemic phases. Triage was considered effective in the early and middle phases, where the average number of influenza patients that visited the clinic per day were 21.4 and 50.6, respectively. But in the maximum phase where the average number of influenza patients soared to 275.3 per day, one out of three patients in the non-isolated group was clinically diagnosed as influenza. We were unable to separate influenza patients effectively in the maximum phase of pandemic.