Physicians who are treating patients with the Ebola virus at Emory University Hospital and the University of Nebraska Medical Center shared their advice and protocols with worried hospitals and health care providers over a phone conference on Tuesday. Whether the conference really quelled these fears, however, was not exactly clear.
The intent of the conference, which was organized by the Centers for Disease Control and Prevention (CDC), was to answer health care questions related to admitting and treating a patient with Ebola. There’s growing concern among health officials that hospitals without specialized isolation units and with little experience treating serious communicable diseases may not be fully prepared to treat the disease. “We don’t want to have to face another person or family that ends up getting infected because we are not as good as we should be in treating patients,” Karen Higgins, co-president of National Nurses United (NNU) told TIME.
“Every clinic in the United States needs to be prepared to manage a patient who has just returned from an Ebola-affected country and has fever,” said Dr. Alexander Isakov, the director of prehospital and disaster medicine at Emory. That’s become increasingly clear since Thomas Duncan walked into a Dallas hospital with the disease having traveled from Liberia, only to be turned away initially. The hospital wasn’t able to save the patient after he was eventually admitted, and a nurse who helped treat him has since become infected.
Emory, on the other hand, has successfully treated missionaries Dr. Kent Brantly and Nancy Writebol, and is currently treating an unnamed patient. No one on their medical team has become ill. Nebraska has successfully treated Dr. Richard A Sacra, and is currently treating NBC freelancer Ashoka Mukpo, who appears to be recovering.
But here’s the thing. Emory, for one, has been preparing for a situation like this for a decade, drilling all their processes multiple times a year. And their procedures are unique. If they’re transferring an Ebola patient, they use a specially equipped ambulance that’s completely protected and then sanitized meticulously. The patient is moved into a specialized isolation center where they are treated with doctors who are incredibly well-versed in infectious diseases. “Because the [patients] are so ill, we only use intensive care nurses,” said Dr. Ribner, the head of Emory’s serious communicable disease unit. “Some of our patients have gone on to require dialysis or ventilation on a respirator, and these are skills that really floor nurses are not confident to do.”
The team uses full-body protection because its nurses may be in the room with a patient for three to four hours a day and they are dealing with patients with a lot of vomit and diarrhea. They’ve created a lab within their unit so that no Ebola-contaminated specimens could spill and cause a contamination “disaster.” All of their waste, garments, sheets, etc, are autoclaved on site—a process that uses a pressure chamber to sterilize equipment. Nebraska has a similar set-up. They also autoclave their waste, use a hospital-grade disinfectant that’s poured into the toilet for 10 minutes prior to flushing, and have a video-conferencing system that patients use to talk to their family members. They even have a specific individual on staff to go about securing experimental drugs.
It’s plain to see why patients with Ebola in countries like Liberia have been evacuated to these two hospitals. But for hospitals without these kinds of resources — that is, the vast majority of them—the lessons bear little relevance. “I really appreciate this helpful information, but practically speaking, I think what you just described would probably bankrupt our hospital,” said a health care professional from Southern California during the call. “Should we try to duplicate some kind of containment unit in order to adequately take care of the patients but also protect our staff?”
Both Emory and Nebraska agreed that they think any hospital could take in a patient with Ebola—frankly, they have to be prepared to. And that the most important thing is to develop a way to identify and quickly isolate a patient with Ebola within their facility. Missing symptoms or travel history is not acceptable. Dr. Isakov even suggested that perhaps communities prepare by identifying which hospitals had the resources to successfully treat patients, and perhaps set up a transfer system.
“It may be that a community prepares so that every hospital be able to screen for these patients, initially manage these patients…and communities may choose one or two out of 30 hospitals that are best prepared to manage a patient should they become critically ill,” he suggested.
To that, an unidentified conference caller who may not have realized her phone was not muted, said exasperatedly: “Who is going to volunteer? Without any money? Nobody.”
That brought the conference to a quick close.
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