Ebola: first case hits the US

OnceAnEMT · Oct 13, 2014

MonkeyArrow said:
We don't know how or why the nurse in Dallas got infected

We don't really know what level of protection is necessary for healthcare workers

Our guidelines aren't clear

We're (by our own admission) not training the hospitals enough (doubling-up on training)

As has been mentioned in this thread and the other, and by clear CDC guidelines to healthcare providers, the PPE is the same as with any other contact and airborne isolation. Ebola isn't a magical substance. It spreads like many other things, it just happens to suck more if you get it. The rise of a new illness should not have to prompt re-education of PPE. Is it nice? Sure. But you shouldn't have to be reminded when and how to use airborne and fluid isolation PPE.

vcuemt · Oct 14, 2014

Screening at the airport, much like current TSA screening, is political theater. There is no real added benefit to safety. Shutting down the airports for flights "from" West Africa (whatever that means) would be counterproductive because it would make us feel safer without actually making us safer. That is why it is a bad idea. The best thing we can do right now to stop the spread of ebola in the US is to stop the spread of ebola in the African nations that are woefully underprepared/staffed/trained/etc. to handle the outbreak that has been going on there since at least March. We could have gotten a jump on this months ago but we didn't and now we're playing catchup. So be it... let's at least try.

I have been a constant source recommending calm in the face of many who would advocate something other than calm. The reason for that is I am genuinely not worried about ebola. If you know anything about the disease you know transmission is difficult. So many people are infected in Africa because of a combination of cultural practices that bring family members in contact with dead bodies, poor sanitation in general, a lacking health care apparatus, misinformation about ebola, among other factors. None of those things are present in the US, and while it was almost inevitable that someone would travel here from West Africa carrying ebola the spread would almost certainly, and has been, arrested at the source. I'd like you, if you're concerned or skeptical, to read this Washington Post article.

http://www.washingtonpost.com/news/...es-good-news-in-the-texas-ebola-cases-really/

This group of neighbors, family members and first responders are being watched carefully by health authorities. They had some degree of close contact with Duncan during the four-day period when he was contagious – from when he started showing Ebola symptoms on Sept. 24 to when the hospital finally admitted him on Sept. 28. They didn’t take any Ebola-specific precautions. They didn’t know he was infected. Some stayed in the same apartment as Duncan as his condition worsened. Yet, so far, they have not gotten sick. And their 21-day Ebola incubation period started before Pham’s.

“That the casually exposed are not getting sick, it’s reassuring,” said Dr. Julie Fischer, an associate research professor of health policy at George Washington University. “What we’ve seen so far, it’s not surprising and it’s not shocking.”

That’s a good thing. This entire harrowing episode is playing out as health authorities predicted. Ebola is acting as portrayed in medical textbooks, based on nearly 40 years of research. Experts said the disease is hard to catch, that an infected person is not contagious until symptoms appear and that Ebola is spread by close contact with bodily fluids such as blood, sweat and saliva.

No evidence points to anything else.

“Ebola is not a terribly infectious disease,” said Dr. Joel Selanikio, a former U.S. Centers for Disease Control and Prevention (CDC) epidemiologist. “It’s quite difficult to get.”

There has never needed to be cause for too much concern over our standard PPE guidelines. Ebola is a scary disease once you have it. Luckily, getting it isn't easy.

VFlutter · Oct 15, 2014

https://www.facebook.com/CDC/posts/10152554196041026

A second healthcare worker has tested positive for Ebola. They also traveled on a plane the day before exhibiting symptoms...

Of course the CDC is blaming the nurses for breaching standard precautions but that seems like it is a scapegoat. However, people really are not that good at proper PPE donning/doffing.

We just got numerous emails about this and our update policies and procedures. I know that nursing has inherent risks however when it comes down to it this is just a job. Obviously people should not be risking exposure to others but our we expected to give up our lives and quarantine ourselves for a month?

MonkeyArrow · Oct 15, 2014

This topic actually came up at work the other day. Other than the fact that we found out how woefully underprepared we are to handle Ebola at our ER, we had a discussion about how to treat a potential patient. On the one hand, no nurse wants to get stuck with the patient. Then again, the nurse should not really be allowed to come and go as he pleases because of the inherent risks of constant donning/doffing/decon. I'd get pissed if I caught ebola from my partner who kept on leaving the isolation room and slipped up with their PPE. Why do we need to have a team of 70 people caring for the one guy. Whoever the nurse is in triage, since he is presumably already exposed, has to stay with the patient for the duration of the case. Why do doctors, techs, et al. need to be in the room with the patient. Examine the pt. through the glass/web cam and let the nurse already in the room with the patient handle all the med. admin. etc. Or at least have a shift of 3 nurses for the duration of the case. One nurse is in with the patient, the other two are in isolation somewhere. Therefore, there is really no chance for Ebola to spread to anyone outside of the 3 nurses already in isolation. No further spread at home, on a plane, to primary contacts, etc.

VFlutter · Oct 15, 2014

MonkeyArrow said:
Or at least have a shift of 3 nurses for the duration of the case. One nurse is in with the patient, the other two are in isolation somewhere. Therefore, there is really no chance for Ebola to spread to anyone outside of the 3 nurses already in isolation. No further spread at home, on a plane, to primary contacts, etc.

So the Nurses are supposed to just assume all of the risk and perform all care? What if they need procedures or scans? I better get paid hazard pay and overtime for entire time I have to be in isolation. 21days x 24hours x $30hr.....I'm going to Vegas.

Summit · Oct 17, 2014

Grimes said:
As has been mentioned in this thread and the other, and by clear CDC guidelines to healthcare providers, the PPE is the same as with any other contact and airborne isolation. Ebola isn't a magical substance. It spreads like many other things, it just happens to suck more if you get it. The rise of a new illness should not have to prompt re-education of PPE. Is it nice? Sure. But you shouldn't have to be reminded when and how to use airborne and fluid isolation PPE.

Why is it that CDC treats it as a BSL-4 agent with chemical showers of their fully contained suit followed by buddy team doffing and water showers? And that is for working with test tubes, not bleeding, projectile vomiting, bloody diarrhea patients.

WHO regards Ebola as one of the most virulent pathogens to affect humans.

Then CDC turns around lets some community hospital with no protocol treat Ebola "like many other" diseases with less precaution than Medicine Sans Frontiers is using in 3rd world countries??? Suddenly, some paper gowns, a surgical mask, tape and glasses are good to go? We are surprised nurses got sick?

That reeks of a do-what-you-can-with-what-you-have attitude. That is appropriate in an overwhelmed system, not when there was 1 active case in the entire country and 4 bio-containment units sitting empty. Someone at CDC should fall on their sword for that. But they won't.

At least they came to their senses and are moving all cases to the biocontainment hospitals.

Chase said:
So the Nurses are supposed to just assume all of the risk and perform all care? What if they need procedures or scans? I better get paid hazard pay and overtime for entire time I have to be in isolation. 21days x 24hours x $30hr.....I'm going to Vegas.

Hazard pay is typically small. The military pays <$1/hr. Federal scales for Ebola would be 8-12% (high hazard micro + maybe qualified as hot environment).
I hope that $30 figure is your base rate, not OT. Otherwise, I have a better ICU job for you.

Summit · Oct 17, 2014

When you are thinking about proper PPE, look at what MSF is doing in Liberia.

Guess who that is in the decon shower? Dr Tom Frieden, Director, CDC.

SandpitMedic · Oct 17, 2014

Hmmm... I hate to say I told you so.

Apologies and oops from CDC and big government, daily. A new Ebola czar being appointed.

They can't be trusted. Every other day it's something new or "oops lets do this instead."

Like I said... They have no idea. They are just making **** up as they go. Hoping to get lucky.

Chimpie · Oct 17, 2014

SandpitMedic said:
Hmmm... I hate to say I told you so.

Apologies and oops from CDC and big government, daily. A new Ebola czar being appointed.

They can't be trusted. Every other day it's something new or "oops lets do this instead."

Like I said... They have no idea. They are just making **** up as they go. Hoping to get lucky.

From CNN....
http://www.cnn.com/2014/10/17/politics/ebola-czar-ron-klain/index.html?hpt=hp_t1

President Barack Obama will appoint Ron Klain his "Ebola czar," knowledgeable sources tell CNN.
...
Klain is highly regarded at the White House as a good manager with excellent relationships both in the administration and on Capitol Hill. His supervision of the allocation of funds in the stimulus act -- at the time and incredible and complicated government undertaking -- is respected in Washington. He does not have any extensive background in health care but the job is regarded as a managerial challenge.

vcuemt · Oct 17, 2014

SandpitMedic said:
Hmmm... I hate to say I told you so.

Apologies and oops from CDC and big government, daily. A new Ebola czar being appointed.

They can't be trusted. Every other day it's something new or "oops lets do this instead."

Like I said... They have no idea. They are just making **** up as they go. Hoping to get lucky.

a picture is worth a thousand words, and a gif is worth a million

SandpitMedic · Oct 17, 2014

How many words is that worth?
In all seriousness... This thing is going to get a lot worse; it is just a matter of time before it spreads. So when it does, I hope that you can sideline your hubris for the sake of your patients and your loved ones. This virulent disease will gain a foothold if we do not act swiftly and cautiously.

I stand by my statement that this will not be the gateway to the zombie apocalypse, but it is going to get nasty out there.

Just be safe. Don't take risks. And don't pretend you are invincible to this thing.

vcuemt · Oct 17, 2014

SandpitMedic said:
In all seriousness... This thing is going to get a lot worse; it is just a matter of time before it spreads. So when it does, I hope that you can sideline your hubris for the sake of your patients and your loved ones. This virulent disease will gain a foothold if we do not act swiftly and cautiously.

I stand by my statement that this will not be the gateway to the zombie apocalypse, but it is going to get nasty out there.

Just be safe. Don't take risks. And don't pretend you are invincible to this thing.

I will bet you literally all the internet money that you're wrong. And what's more, it's fearmongering like this that will cause actual problems, not ebola.

Everything that is going on in Congress, with the President, etc. is politics. The President has to look like he's in control of the situation and the Republicans want to make it look like he's not in control. That's all optics though - with the midterms coming up, each party has an interest in looking good and making the other guy look bad. But that has nothing to do with the actual problem at hand, which is stopping the spread of ebola. It is really unfortunate that everything didn't go perfectly right off the bat, because if the hospital in Texas where Mr. Duncan went to after he developed symptoms had caught on, quarantined him, and had their nurses practice proper PPE we wouldn't have any of these issues. But of course that didn't happen, because this is reality. Hospitals are just as concerned about saving money wherever they can as they are patient care, and probably a little more than they are the safety of their workers. Of course we were going to be playing a game of catch-up for at least a little while.

But another reality is that in West Africa, where families habitually handle the dead bodies of their loved ones prior to burial, where the health care system is in shambles and governments are woefully underprepared to handle even a minor health crisis, less than 5,000 deaths have been reported. I'm sure the actual number is much larger, but they aren't losing millions of people over there, and that's in an environment much more conducive to the spread of the virus.

I don't think I'm going to convince you Sandpit to back off of your wildly overreactionary position. You do your thing. But do it in private... fear is much more catching than ebola.

SandpitMedic · Oct 17, 2014

At this point in the game until we fully understand the scope of this, I'd much rather be in the overreaction camp than the under reaction camp - the one that costs human lives.

It seems that you are also perceiving the cautiousness and preparedness I am preaching, in asking everyone to remain diligent, for fear mongering.

Others' mileage may vary.

Assumption is the mother of all **** ups.

I'm not saying its a frenzy, nor will it be. Just we now live in a post US Ebola world now, and it isn't going away. A non native virus has been introduced to a new environment, you have no idea what it will or will not do.

Are you a virologist? A public health official? CDC? Ever been to West Africa. You speak in certainties as if you have a crystal ball; knowledge is power.

This is an EMS forum, not a political forum. I am interested in sharing the latest updates and ensuring my colleagues stay safe.

I am not making this a personal debate with you.

gonefishing · Oct 17, 2014

This is interesting.

SandpitMedic · Oct 17, 2014

http://www.wusa9.com/story/news/local/arlington/2014/10/17/ebola-investigation-pentagon/17433031/

NEWS FLASH just in about 40 minutes ago. While some were discussing politics.

"Possible" Ebola situation at the Pentagon. Woman on tour bus, recently in West Africa, fell ill and vomited... They are treating it as potential Ebola for now.

Just look at this response! Look with you eyes at how they gear up like astronauts for a "possible" case.

Now tell me it's all good in the back of my poorly ventilated rig with my N95 and eye protection.

Sheesh. Again, be safe. Don't play with your Ebola.

Household6 · Oct 17, 2014

Ahhh, possible patient on a flight from JFK to MSP last week.. Funny that it just hit MN news today, we've known about it for a week.

To be honest, I'm mildly relieved that my service is not the one that has been selected to be responsible for the transport of suspected patients from MSP to County.. Allina Heath has taken that job, they'll go straight to Hennepin County MC.

MonkeyArrow · Oct 17, 2014

Chase said:
So the Nurses are supposed to just assume all of the risk and perform all care? What if they need procedures or scans? I better get paid hazard pay and overtime for entire time I have to be in isolation. 21days x 24hours x $30hr.....I'm going to Vegas.

I guarantee you that paying three nurses is MUCH cheaper than paying for the care of 1-X number of medical professionals for contracting ebola, plus the cost of monitoring all 50 people that has contact with the 1 patent and all the people that those 50 people have had contact with. Sterilizing their houses, fear mongering to see which bus they took home or what door handle they touched, etc.

And it's unfortunately part of the job. Sure, no one want to get stuck with an ebola patient. But, the triage nurse is already exposed to the ebola by virtue of triaging the patient so there is your first. I'm sure people with the right PPE, nurses will be willing to go in just as they have with the Atlanta and Nebraska patients. Hell if you can get 50 to go in, you can probably get 3 to go in again. Call your local hazmat team and treat it as a BSL-4, with full positive pressure ventilation/SCBA for the nurses while on duty in the room with the patient and bring the risk of contamination to nearly 0%.

Plus, the costs will most likely be offset by the government. The hospital is not going to want to, nor will they probably have to, pay all these "extra" expenditures. The CDC will send a team, they will provide hazmat suits, the county and state heath departments will provide resources, etc.

Summit · Oct 17, 2014

MonkeyArrow said:
I guarantee you that paying three nurses is MUCH cheaper than paying for the care of 1-X number of medical professionals for contracting ebola, plus the cost of monitoring all 50 people that has contact with the 1 patent and all the people that those 50 people have had contact with. Sterilizing their houses, fear mongering to see which bus they took home or what door handle they touched, etc.

And it's unfortunately part of the job. Sure, no one want to get stuck with an ebola patient. But, the triage nurse is already exposed to the ebola by virtue of triaging the patient so there is your first. I'm sure people with the right PPE, nurses will be willing to go in just as they have with the Atlanta and Nebraska patients. Hell if you can get 50 to go in, you can probably get 3 to go in again. Call your local hazmat team and treat it as a BSL-4, with full positive pressure ventilation/SCBA for the nurses while on duty in the room with the patient and bring the risk of contamination to nearly 0%.

Plus, the costs will most likely be offset by the government. The hospital is not going to want to, nor will they probably have to, pay all these "extra" expenditures. The CDC will send a team, they will provide hazmat suits, the county and state heath departments will provide resources, etc.

It's not 3 nurses.

To staff 3:1 working quarantined 8hr shifts 3 on 1 off is 12 RN dedicated per Ebola patient.

Let's say we don't use RT and don't use a dialysis tech or RN. You need housekeeping and lab to handle samples and waste. You still need an MD/NP/PA for lining and tubing. You might need xray and ecco techs. It's pretty easy to get 50 people is pretty through the room of a sick patient over the course of a month.

SandpitMedic · Jan 29, 2015

Ebola in Sacramento, CA.

http://fox40.com/2015/01/29/uc-davis-treating-possible-ebola-patient/

While it is not yet confirmed it seems legit. The first ER the OT visited has been closed down and the pt was transported to UCD, the regional level 1 and leading teaching hospital in the region.

SandpitMedic · Jan 30, 2015

Annnnnnd nobola.

Apparently the patient had recently returned from an Ebola hot zone and had symtoms similar to that. And thus, the alarm was raised, and protocols were followed.

Negative for Ebola.

Ebola: first case hits the US

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