A couple of months ago, Stanford Hospital had a preview of what a real pandemic might look like: hundreds of people, fearing they might be sick with the H1N1 virus, showed up at the emergency department looking for help. Hospital officials scrambled fast, converting some space over night into an infection-controlled triage area.

On Friday morning, Stanford Hospital tested something that might one day be the standard for how all hospitals respond when thousands might need care at the height of pandemic-a car drive-through triage and care system to keep people from infecting each other and to care for them as quickly and efficiently as possible.

"It's a fantastic idea," said emergency medicine physician Milana Boukhman, as she waited for another volunteer "sick" person to arrive at her treatment station, one of several set up in a parking garage near the Hospital. "One of the biggest issues in a pandemic is cross-contamination. Cars are self-contained contamination units. And this works if you have limited resources, too."

The system tested Friday, with 40 patients and 50 health care providers, was simple. Physicians, nurses, pharmacists, evaluators and observers hovered around a series of tables where patients were first registered, then evaluated, then treated and then discharged The observers-health care and emergency preparedness professionals-gathered data that will be sent on to the U.S. Centers for Disease Prevention and Control for evaluation and review.

"We know this way is more cost efficient and safer," said Eric Weiss, MD, Medical Director for both Stanford Hospital and Lucile Packard Children's Hospital. "This doesn't take any more staff that would be required to see patients in the emergency department."

Weiss and Gregory Gilbert, another Stanford Hospital emergency medicine physician, share credit for the approach, which does have its similarities to a famous chain of hamburger sellers. In fact, not too long after Gilbert mentioned the drive-through idea to Weiss, Weiss had a personal, real-life glimpse of it. He and his family were in Montana and pulled into a McDonalds. The interior, Weiss and his wife could clearly see, was packed with coughing and sick-looking people. They chose to get their food at the drive-through window.

Weiss' wife, Amy, was one of the volunteer patients Friday. She's a former hospital emergency department administrator and an industrial engineer who saw the logic of translating hamburger delivery to healthcare delivery. "You don't want people walking five blocks in the middle of winter," she said. "You have to have something like this."

Hospital officials got on the spot feedback from observers that included physicians, nurses and disaster relief experts like American Red Cross volunteer Karl Matze. He's seen triage and treatment in tents, but using cars as self-contained infection control units "takes things to another level."

For Stanford and Palo Alto police officials, one of the main challenges is traffic control. In a dry run a couple of years ago, city emergency officials used the Mitchell Park Library as a medical evaluation center, "but we concluded it was not efficient. Parking is a significant issue," said Dennis Burns, the city's interim police chief. Keeping people in their cars is a great idea, he said.

Margarita Casanova, a Palo Alto neighborhood emergency preparedness coordinator, brought her one-month-old Friday to be a "sick" person. "I grew up in Mexico City and lived through a bad earthquake there in 1985," she said. "It made a big impression on me. We need to be prepared." When she returned to the beginning of the route to give her feedback about the process, she was ready. "It took three steps to get to a doctor. You need to explain to people as they go through that they're being prepared to see a doctor."

Stanford Hospital's emergency preparedness coordinator Per Schenk was there, too, observing with the recent H1N1 experience still very fresh in his mind. "We almost did this a few weeks ago," he said. "It can be done within 24 hours notice and it's a model that could be used almost anywhere."

About Stanford Hospital & Clinics

Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiovascular care, cancer treatment, neurosciences, surgery, and organ transplants. Consistently ranked among the top institutions in the U.S. News & World Report annual list of "America's Best Hospitals," Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. It is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children's Hospital at Stanford. For more information, visit stanfordmedicine.

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