Stanford Medicine Newsletter Updates For the Local Community

Ramping up for flu season

Stanford refines its drive-through triage approach

Emergency medical staff prepare to treat patients during an experimental drive-through assessment of the H1N1 virus.


Dozens of doctors, nurses and volunteers at Stanford Hospital tested out a singular drive-through approach this summer to handle the kind of patient surge that the novel H1N1 flu virus could produce this fall.

During the exercise — the first of its kind in the country — pretend patients remained in their cars, driving through a series of checkpoints in which they were examined by health care workers wearing protective gloves, masks and gowns. The goal was to do a quick and accurate diagnosis of large numbers of people and to control infection in a way that is not possible in a crowded emergency room. It’s part of the hospital’s overall plan to manage a potential H1N1 epidemic locally.

Though there is much yet to be learned about the virus, “What we do know is that it’s important to maintain social distancing among patients,” said Eric Weiss, MD, the hospital’s medical director for disaster planning. He noted that hospitals need alternatives to long patient waits in emergency rooms, where “rapid cross-infection can occur, particularly with airborne disease.”

Keeping track

In the post-drill analysis, the planners pinpointed important changes to be tested in the next practice session this fall. They will have paper forms on hand in case of computer failure, will add more lanes for cars, and will designate more workers to talk to waiting motorists about the process and to identify the sickest patients so that they can be triaged immediately, among other changes.

The hospital also has established a surge plan to free beds to accommodate more than 100 extra patients, if necessary, said Per Schenk, the hospital’s coordinator of disaster management. Voluntary surgeries, for example, would be delayed, which would open up some preoperative and recovery area spaces.

The hospital is now using a data observation system as an alert, with benchmarks that would trigger the opening of the novel H1N1 unit and the drive-through system, Weiss said. These benchmarks include weekly figures on the number of adults and children arriving with flulike illnesses at the Emergency Department and clinics. These figures can be compared with patient volumes during a normal week.

Simple measures

But infection control experts at the hospital say the best flu prevention tactics involve simple behaviors: hand-washing; coughing into a tissue or sleeve, rather than into the hand; and staying away from work for those who have flulike symptoms.

This year, without a novel H1N1 vaccine widely available, “We have to depend much more on the resolve of people to maintain hand hygiene and cough etiquette,” said Sasha Madison, manager of the hospital’s Infection Control and Epidemiology Department. “If you have a cough, don’t go into large groups of people. Don’t come to work if you have a fever and a cough, sore throat and runny nose.”

She noted that people may be contagious 24 hours before they exhibit symptoms. They should not return to work for seven days if they do develop the flu, according to guidelines of the federal Centers for Disease Control and Prevention.

Mask protection

To help prevent spread of infection, Madison said the hospital might ask patients to wear masks, both for their own protection and for the protection of others. Visitors will be offered masks as well, and treatment teams might wear gowns, gloves and masks.

“Masking doesn’t indicate any judgment or have a negative connotation,” she said. “It’s just part of the way in which we protect our patients and our visitors. Wearing a mask needs to become socially acceptable.”

For more information on Stanford’s programs in preparing for H1N1, visit You can also learn more about H1N1 and other types of flu at

Is it a cold or the flu?

You’re under the weather with a runny nose or fever, and the news is full of warnings about H1N1 “swine” flu. How do you know if you have the new flu or a garden-variety cold?

“If you wake up and feel like you don’t want to go to work, that’s a cold,” said Yvonne Maldonado, MD, a professor of pediatrics and chief of infectious disease at Packard Children’s Hospital. “If you wake up and feel like you’re going to die, that’s flu.”

Influenza infection causes a sudden-onset high fever (100° to 102° F or higher) with severe, all-over aches and pains; headache; severe exhaustion and weakness; and dry coughing and chest discomfort, Maldonado said. “It’s systemic — your whole body is involved.”

Influenza patients sometimes suffer from a sore throat, a stuffy or runny nose, or sneezing, but these symptoms are less common.

Colds, in contrast, tend to come on slowly, often starting with a day or two of sore throat. Colds typically cause nasal congestion and a hacking, productive cough, but not the fever or ex-treme exhaustion of influenza.

And since influenza vaccines don’t protect against colds, you can get a cold after receiving a flu vaccination, Maldonado said. Influenza is a high-priority vaccine target because it can cause serious complications or death, whereas colds are rarely dangerous. In addition, some cold- and flu-infected individuals may spread the viruses without showing symptoms themselves, which is why everyone should be vigilant about hand-washing and covering coughs and sneezes.

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