Part 6

2. Under most conditions a central clearing house, covering most if not all of the hospitals, is advisable for the admission of cases. Through this channel the severer cases may receive first consideration. Owing to constant changes in the hospital bed situation, the daily canvass of facilities may not be wholly depended upon; on the contrary, it may usually be necessary to telephone the hospital in order to make sure regarding the admission of a particular case. In any event the hospitals, if facilities are inadequate, should be impressed with the necessity for admitting only the most severe or needy cases, pay or free. Special hospital arrangements should be provided for pregnant women.

3. It is advisable to add wards or tents or new equipment to existing institutions rather than to establish entirely new emergency hospitals. If practicable, certain hospitals may be urged to handle influenza cases exclusively.

4. Non-emergency surgical and chronic medical cases amenable to home treatment should be de-hospitalized.

5. A convalescent home, if adjacent to the hospital, may serve for the care of mild and convalescent cases, thereby increasing the space in the hospital for acute cases, obviously involving an increase in the nursing facilities.

6. A canvass of ambulance facilities should be made, ambulances being requisitioned with payment, or hired by contract, if necessary. Automobiles and motor trucks should be potentially mobilized for this purpose. Frequently military equipment may be used if accessible.

V. Social and Relief Measures.

1. The central office should keep the family advised regarding the patient, thereby saving telephone calls, trolley fares and worry on the part of the family, and thereby increasing the willingness for hospitalization.

2. Volunteer workers such as Red Cross volunteers, teachers, relatives, etc., should be placed in care of families where the responsible members are dead or hospitalized, this service being under expert social supervision, and the families in touch with the supply system. Supervision of placed-out children is also necessary.

3. Homes should be investigated before patients are discharged into them, when destitution or other untoward circumstances are apparent.

4. Precaution should be taken that institutions and families too busy with the influenza situation to look after their own needs, are covered by the general relief measures.

5. Ordinary charitable relief should be handled through the routine agencies, the service co-ordinated with the other epidemiological measures. Churches, lodges, etc., should be urged to handle their own cases, in order to relieve the pressure on the central agency. Aid should be immediate, without protracted investigation.

6. Recreation facilities (motoring, etc.) should be provided for the physicians and nurses while off duty.

VI. Food.

1. Available central cooking facilities should be used so far as is necessary, such as the dietetic equipment in high schools, normal schools, colleges, etc., with a delivery system to families and institutions in need.

2. Individual families should be encouraged to cook additional amounts, the same to be delivered to central diet kitchens for distribution, a standard list of prepared foods needed being devised and advertised, with recognition of racial customs and preferences.

3. It may be necessary to establish canteens in sections of the city.

VII. Laundry.

1. A special collection and distribution system may be essential both for homes and institutions.

2. It may be necessary to take over a public laundry with compensation, or a private non-medical institution laundry.

VIII. Provision for Fatalities.

1. Death reporting should be prompt (24 hours) and a record kept so as to ensure prompt disposal of bodies.

2. A daily canvass of available coffins should be made, labor assured for construction, and possibly no coffins sold without the permit of the Influenza Administration Office.

3. If morgue facilities are inadequate a central place should be provided, with embalming facilities, for the temporary disposal of bodies.

4. A canvass of hearses should be made and regulations issued prohibiting unnecessarily long hauls, insisting on maximum capacity loads, etc. A central control will prevent unnecessary duplication as to routes, etc.

5. A reserve supply of trucks and automobiles should be at hand for use in various ways in connection with the handling of fatal cases.

6. The number of graves required should be estimated and labor released from public works or secured through other channels (possibly military) for digging. Possibly temporary trench interment may be necessary.

IX. Education, Instruction and Publicity.

Literature and special instructions will be necessary on many phases, including the following: