Any patient who enters an emergency room with an infectious disease poses a potential threat not only to him or herself, but also to the other patients, doctors and personnel in the hospital. These days, medical institutions across America are finding it necessary to prepare for one infectious disease in particular: Ebola.
In order to assist hospitals that may receive patients exhibiting symptoms of Ebola, the Centers for Disease Control and Prevention (CDC) commissioned Johns Hopkins Medicine to create web-based training tools. The results, newly posted on the CDC’s YouTube channel, are four video modules outlining preparatory steps recommended for emergency departments.
The first unanticipated case of Ebola appeared in the U.S. when Liberian Thomas Eric Duncan sought treatment for symptoms at the Texas Presbyterian Hospital in Dallas after travelling from his native West African country. Duncan died as a result of the disease and two of his nurses, Nina Pham and Amber Vinson, were infected, though they have recovered.
“The early cases of Ebola in Texas were certainly a wake-up call for all U.S. hospitals and, I believe, for the CDC,” Lisa Maragakis, director of the department of Hospital Epidemiology and Infection Control at Johns Hopkins Medicine, wrote in an email to The News-Letter. “Preparations to detect and care for patients with Ebola had begun well before then, but accelerated with an added sense of urgency after the first case in Dallas.”
Margakis says that communication with providers at other institutions who have had first-hand experience treating Ebola has been crucial in helping Hopkins build its own protocols.
“The Emergency Department is one of the places most likely to be a first point of contact for patients who have risk factors and symptoms that might be consistent with Ebola, so all of the staff in both the Pediatric and Adult ED have been training and conducting practice drills to prepare,” she said.
The videos themselves, titled “Ebola Preparedness: Emergency Department Guidelines,” were developed at the Johns Hopkins Armstrong Institute for Patient Safety and Quality along with other partners, though the content follows CDC guidelines.
The CDC advocates a three-step policy: first, to identify potential patients with Ebola based on their travel and exposure history and then by any symptoms they exhibit like fever; second, to immediately isolate patients who fulfill the first characteristics and avoid non-essential contact; and third, to inform the health department and coordinate the patient’s transfer to the hospital specifically designated for Ebola treatment in the region.
The videos show simulations of a hospital’s intended responses ranging from an administrative meeting regarding procedures and communication across all parties to the first steps when a potential patient walks through the door. Recommendations in the third segment, which is focused on isolation, include having a sign-in sheet on the door to the patient’s room to record contact and providing a cell phone to facilitate communication between providers and the patient without physical proximity.
Of course, there are always unforeseen circumstances that emerge when caring for any patient. Developers tried to account for such complexities by working within the Emergency Department and isolation center at Hopkins to try to identify potential areas of unpredictability.
Though publicized by the CDC, the videos produced by Hopkins are not mandatory viewing for hospital officials.
“Individual facilities might decide to recommend or require them for certain staff responsible for Ebola preparedness planning,” Margakis wrote. “The most important thing is that each facility utilize the available resources and convene a group of experts at their institution to plan for the many considerations that must be addressed to be prepared.”
Margakis notes that the likelihood of patients with Ebola arriving at hospitals unannounced is now rather unlikely given the 21-day screening process travellers from West Africa undergo.
“Significant strides have been made at controlling the outbreak in West Africa at its source which also reduces the current level of risk,” Margakis wrote. “However, we must maintain vigilance and a state of readiness until the outbreak has been entirely extinguished since international travel has the potential to facilitate the rapid dissemination of pathogens.”
Though these videos are intended for U.S. hospital preparations, Margakis reports that Hopkins experts have collaborated with organizations including the CDC, World Health Organization and the United Nations on similar preparedness training for providers in or going to West Africa. These videos follow a previously produced series from the Armstrong Institute on the personal protective equipment used for treating a patient with Ebola.