If the flu season hits hard this winter, hospitals in Cincinnati and Cleveland are proposing a never-tried plan to cope with the rush: opening temporary “treat and release” centers.

        Such centers would be in public or semi-public facilities such as Red Cross shelters, recreation centers or schools. They would be staf fed by nurses and doctors responding to public appeals and could include retirees and students working in supervised conditions.

        The idea is one step short of a full-blown disaster plan that communities might use to deal with a natural disaster, a big disease epidemic or a bioterrorism attack.

        Health planners say Ohio needs such a plan because hospitals are filling up months before the traditional peak of flu season (January-March).

        In Cincinnati, hospitals have been diverting patients at a record pace for the past three months. In Cleveland, hospitals are reporting near ly as many diversions in recent weeks as they did during the peak of last year's flu season.

        “We hope we'll never need these plans. But we're trying to brace the community that, with all the nursing shortages and recent hospital closings, we could have major problems with the flu,” said Richard Fox, senior vice president of Cleveland's Center for Health Affairs.

        Influenza has been a public health scourge for hundreds of years. For the elderly, people with lung disease, heart disease or other immune-system problems, the flu can be deadly, killing about 20,000 people a year.

        How bad this flu season will be remains hard to predict.

        Many have been concerned that months of delay in distributing flu vaccine would leave large numbers of people unprotected, but so far there are no signs of an epidemic.

        On the positive side, the flu hasn't hit in large numbers, the vaccine is getting out and high-risk people such as the elderly have been lining up to get shots.

        Public health departments in Ohio and Kentucky reported this week they have received long-awaited vaccine shipments.

        On the negative side, it appears that hospitals in Ohio may need to take special steps to deal with just a normal flu season.

        In Cincinnati, November set a third straight monthly record when eight hospitals went on diversion 57 times.

        A diversion means hospitals ask life squads to take all but the most unstable patients elsewhere. Di versions happen when a part of the hospital, such as an intensive care unit, fills up or runs short on staff.

        By law, a hospital ER cannot close or refuse to care for a patient. But without diversions, overcrowding would become a much bigger problem.

        “The patients who are waiting for a bed in the hospital are getting the nursing and medical care they need in the ER. But the public will feel the longer waits for minor injuries,” said Colleen O'Toole, vice president of the Greater Cincinnati Health Council.

        All year, hospitals have struggled to hire enough nurses and other medical personnel. Earlier this year, large hospitals closed in Cincinnati and Cleveland, which aggravated emergency department back-ups.

        To prepare for flu season, hospital executives, fire chiefs, and local and state health departments have been working on a three-level response plan, Mr. Fox said:

        • Stage I would be a declaration from public health officials that at least 10 flu cases have been confirmed in a community.

        • Stage II would be a flu or hospital capacity emergency. With a request from the Ohio Department of Health, and approval from the Health Care Financing Administration, hospitals statewide would be permitted to treat flu patients using beds normally reserved for rehabilitation, skilled nursing and psychiatric care.

        During last flu season, the state declared such a flu emergency on Jan. 6.

        • Stage III would be the new last resort, allowing hospitals to open “treat and release” centers.

        “Not every flu and pneumonia patient needs to be admitted to a hospital. Some can receive antibiotics and fluids in nonhospital settings,” Mr. Fox said.

        To reach this stage, hospitals would have to inform the state and HCFA that they are 100 percent full, and unable to meet demand. The centers would be allowed to stay open only for a few weeks.

        But if the hospitals are full and there aren't enough nurses, who will work at these temporary centers?

        In theory, nurses who are retired or not working would return. Nursing students might be allowed to work in limited ways. Nurses working in less urgent, nonhospital jobs might also be recruited.

        “This is new territory. A lot of details have not been decided,” Ms. O'Toole said. “But people have already started scouting for those folks.”

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