# Ebola: first case hits the US



## SandpitMedic (Oct 1, 2014)

http://www.cnn.com/2014/10/01/health/ebola-us/index.html?c=homepage-t


A man infected with Ebola who flew from Liberia to the US is now in isolation days after being in public in Texas.

He had visited the ER feeling ill, but was released because no one bothered to ask if he had recently traveled. He returned 2 days later and then they realized... WHOOPS! 

Let's see if this guy becomes Americas patient zero.

Be safe out there guys.


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## avdrummerboy (Oct 1, 2014)

Great, and cold/ flu season is here, so everyone with a sniffle or flu like symptoms is going to be calling saying that they have ebola!!!!


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## Akulahawk (Oct 2, 2014)

From a report I saw earlier today, during his _first_ ER visit, he _was_ asked if he'd had any recent travel. His primary nurse asked him and he said (apparently) that he recently came from Western Africa. It is unknown if this info had been passed on or if the "Western Africa" wasn't connected with the areas currently experiencing that large Ebola outbreak. He probably didn't feel any better after 2 days of antibiotics so he returned by 911... and the rest is history.


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## gonefishing (Oct 2, 2014)

Akulahawk said:


> From a report I saw earlier today, during his _first_ ER visit, he _was_ asked if he'd had any recent travel. His primary nurse asked him and he said (apparently) that he recently came from Western Africa. It is unknown if this info had been passed on or if the "Western Africa" wasn't connected with the areas currently experiencing that large Ebola outbreak. He probably didn't feel any better after 2 days of antibiotics so he returned by 911... and the rest is history.


LOL! Maybe the nurse lives under a rock?


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## Akulahawk (Oct 2, 2014)

If someone simply told _me_ they came from "Western Africa" I might not have made the connection to Sierra Leone, Guinea, Liberia, or Nigeria. I know those are all countries on the African Continent, but without looking at a map, I couldn't tell you where they are. Now if he'd said he came from Nigeria, then _that_ little bit of info might have made people pay attention...


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## gonefishing (Oct 2, 2014)

Akulahawk said:


> If someone simply told _me_ they came from "Western Africa" I might not have made the connection to Sierra Leone, Guinea, Liberia, or Nigeria. I know those are all countries on the African Continent, but without looking at a map, I couldn't tell you where they are. Now if he'd said he came from Nigeria, then _that_ little bit of info might have made people pay attention...


Anything with AFRICA in it would make me pay attention.lol. kind of like the bird flu and Asia lol


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## Akulahawk (Oct 2, 2014)

I would suggest that any patient that presents to you with flu-like symptoms should bring on the question of recent travel, and if from Africa, should have a follow-on question of "any countries where there currently is an outbreak of infectious disease?" 

One other issue is that from watching a news conference was that early on in the disease process is the viral load is pretty low, and can be so low that it's not detectible by currently used tests. On a side note, I heard of a new test that's much more sensitive than our currently used exams. Unfortunately the new test tech is very experimental right now and has yet to be developed.


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## SandpitMedic (Oct 2, 2014)

He checked in to the ER with a Liberian passport. All providers/staff involved were not punched in that day, clearly.

The recent travel or contact with recent travelers is ingrained in my assessment fortunately. However, that is due to where I work and the high percentage of tourists I encounter.


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## SandpitMedic (Oct 3, 2014)

http://www.cdc.gov/vhf/ebola/hcp/in...suspected-united-states.html?mobile=nocontent


CDC Guidelines for EMS for contact with suspected Ebola patients above.

While I'm not real big on panic and frenzy, especially among health officials, I believe that this Ebola thing is not being taken as seriously as it should.

Bird flu= mass hysteria.
SARS=mass hysteria and main stream media panic.
Swine flu= mass hysteria, N95 shortages, main stream media convinced everyone they will die.
MERS-V=  Mainstream media says OMG, everyone run for the hills, the Arabs are attacking! Everyone will be infected.
Ebola= eh, don't worry about it. "We can contain it 100%"

While we (the U.S.) are light years ahead of West Africa in healthcare, technology, and the simple notion of hand washing, I do believe it is prudent to be on heightened alert. The latter of those listed above is the only real threat out of all of those infectious diseases. And no one seems to care.

Like I said, panic is unnecessary, but my locale has yet to even brief EMS on the issue. While I understand there is only (as of 10/3/14) one confirmed patient in the US, the way this situation is being publicly handled concerns me.

They have Media in West Africa. If masses of potentially knowingly infected people believe they can hop a flight to and/or illegally immigrate to America and be cured we may see a sharp influx in cases here at home.

Not only that, but lest we forget that we are at war. What a strategic tactical advantage Mother Nature has given those who might exploit this and take advantage of a disease with a 3 week incubation period. An infected enemy host could easily purposefully contract the disease and immigrate here to spread it around.

While some of you may not share my concern I must not bury my head in the sand. This is an actual potential outcome, unlike everyone dying of H1N1.

I'm simply advising to be on guard. No one wants to be the first provider to catch this because you think it's another BS N/V/D or FLS call. Everyone does not and will not have Ebola, but it should be in the back of your mind, especially if this spreads out of TX. Even if we could receive treatment, I would be quite content without earning an "I survived Ebola" t-shirt.


Be safe folks. Complacency kills.


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## MagicTyler (Oct 3, 2014)

Amr has set up amr.net/ebola for ems providers updates on ebola. They are currently recommending using the ebola screening tool on every patient encounter.


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## Household6 (Oct 3, 2014)

So... The three person ambulance crew that picked him up are in isolation as well.. SUPPOSEDLY, they pulled up and found him vomiting on the sidewalk, transported him, and kept the rig in service for another 48 hours before doing a decon with bleach? 

I don't think I'm an overreact-er, but anytime I have a vomiting pt (or anyone with sepsis or MRSA) I do a complete wipe down of everything before I leave the hospital garage.. Like, everything. Restraints, Stryker top to bottom, LP, and anything I've touched when I had my gloves on. I switch gloves a few times too. I hate germs.


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## DesertMedic66 (Oct 3, 2014)

We are being asked to ask patient who appear with flu like symptoms of they have been to Africa in the last 21 days. If yes we have to alert the hospital. We are having our ePCR software incorporate those types of questions (you know because that's not something we can put in a narrative *rollseyes). 

If the patient answers yes to our questions we are to avoid IVs, suctioning, and nebulized medications if possible. 

We are also placing additional pieces of PPE and more PPEs in our unit.


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## Household6 (Oct 3, 2014)

DesertEMT66 said:


> We are being asked to ask patient who appear with flu like symptoms of they have been to Africa in the last 21 days. If yes we have to alert the hospital. We are having our ePCR software incorporate those types of questions (you know because that's not something we can put in a narrative *rollseyes).
> 
> If the patient answers yes to our questions *we are to avoid IVs, suctioning, and nebulized medications if possible. *
> 
> We are also placing additional pieces of PPE and more PPEs in our unit.



Ohhh, that's a good idea..


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## Handsome Robb (Oct 3, 2014)

We got an email about it.

Basically said you will be advised if they meet criteria through ProQA in dispatch about universal precautions and to notify the hospital if they've been to Africa in the last month. Also emphasized the point that we're more likely to get the Flu than Ebola if we were to come into contact with a patient that tested positive for EBOV. Gloves, N95 mask and eye-pro. No directions to avoid treating the patient as that could bring up issues of providing substandard care and discriminating against the patient.

I disagree with you @Household6 about it being a good idea. Do you avoid IVs or other treatments in patients with HIV/AIDs or Hepatitis? Same concept. If they need a line and fluid resuscitation they will get it. If they need a breathing treatment they will get it. If they need suctioning they will get it. Our job is inherently dangerous and exposes us to diseases with the potential for human to human transmission through multiple routes, it's part of healthcare. If you're providing substandard care because there's a risk you *might* contract what they have you may need to rethink your field of employment. *I'm using you as a general term, not directed solely at you Household.* As long as you're using your PPE, it's sized and worn appropriately you don't have anything to worry about despite what the news and Facebook-certified epidemiology heroes say.

The outbreak in africa is due to cultural practices, lack of healthcare resources, a fear of western medicine and lack of hygienic practices. They don't have the education to understand the importance of hand washing, covering their mouthes when they cough or sneeze, ect, ect... They consistently care for their sick relatives at home without any sort of protection, come into direct contact with their deceased as part of burial rituals, have community sources of drinking water, food and what not. Many eat bush meat as a primary source of sustenance which is a huge carrier and source of transmission for EBOV.


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## Household6 (Oct 3, 2014)

No worries Robb.. Those are great counter-points you make.


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## Akulahawk (Oct 3, 2014)

Handsome Robb said:


> We got an email about it.
> 
> Basically said you will be advised if they meet criteria through ProQA in dispatch about universal precautions and to notify the hospital if they've been to Africa in the last month. Also emphasized the point that we're more likely to get the Flu than Ebola if we were to come into contact with a patient that tested positive for EBOV. Gloves, N95 mask and eye-pro. No directions to avoid treating the patient as that could bring up issues of providing substandard care and discriminating against the patient.
> 
> ...


I cannot stress the above more. The airborne route of human to human transmission of EBOV doesn't occur. There is some evidence of a potential transmission of EBOV from pigs to primates (human and non-human) and/or from splatter that causes droplet transmission, but it doesn't appear to aerosolize (and require a HEPA filter) like TB does. In short, this stuff is spread much like HIV or any other bloodborne disease and not like the flu. If your patient vomits, that's highly infectious and the splatter can cause infection, but you have to be within splatter range for this to occur. Glove and gown up like you would for CDiff and goggle up / mask up like you would for the flu (to prevent splatter transmission) and you'll reduce your chances of catching EBOV by a HUGE percentage.


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## OnceAnEMT (Oct 3, 2014)

I agree with Robb that this technically shouldn't be treated different than any other transmittable illness. It is just another to add to the list. That said, ATCEMS sent out an e-mail emphasizing specific protocols and provided an abundance of background and s/s information of Ebola. No change in protocol, because there is no need for change (note that hospital notification of onboard/suspected on board infectious disease is already in protocol). The e-mail did suggest extra caution when performing skills that involve bodily fluids (intubation, suctioning, etc), and to consider safer methods, such as getting the IV before moving the truck. The ED I'm at emphasized the importance of a travel history (which we have done anyway, because its not like Ebola is a first). They did however implement a new section in the triage note for recording such information, but that is just a documentation difference, not a change in practice.


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## DesertMedic66 (Oct 4, 2014)

Handsome Robb said:


> We got an email about it.
> 
> Basically said you will be advised if they meet criteria through ProQA in dispatch about universal precautions and to notify the hospital if they've been to Africa in the last month. Also emphasized the point that we're more likely to get the Flu than Ebola if we were to come into contact with a patient that tested positive for EBOV. Gloves, N95 mask and eye-pro. No directions to avoid treating the patient as that could bring up issues of providing substandard care and discriminating against the patient.
> 
> ...


For some of our medics they will start a line on every patient because they will get a line in the hospital. So now we are asked to only start IVs on those patients if they actually need it for meds or fluids.


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## jrm818 (Oct 4, 2014)

Saying ebola is similar to HIV or Hepatitis may be a bit of a stretch....and based on the objective evidence that multiple healthcare professionals equipped with proper PPE have still managed to contract ebola, I'm not sure that  "nothing to worry about" is really a proper phrase.

The CDC told us during the swine flu nuttiness (and I agree that the hype was a bit overblown) that surgical masks would protect us, later revised to advising n95 masks.  I used proper PPE and still caught that bugger.  SARS never established itself but several healthcare workers in Toronto died. No need for paranoia, but no need to downplay a pretty nasty disease about really very little is known.  I do know that many initial predictions about the outbreak in Africa proved to be false.

There is a difference between discriminating because of unfounded fear and the rational avoidance of procedures that may spread a deadly contagion unless absolutely necessary.  Be smart, the back of an ambulance is a confined space that moves around and has poor ventilation (and lots of nooks and crannies). 

Ebola may well be present in all bodily fluids including sweat, unlike HIV or hepatitis.  HIV and hepatitis do not generally cause a person to begin spreading their fluids, whereas ebola causes diarrhea, vomiting, and bleeding.  Its fatality rate in the US has yet to be established convincingly, but may still be quite high. It doesn't seem like anyone is truly certain about its potential to be transmitted as an aerosol, but the CDC is advocating avoiding aerosol producing procedures: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html

This disease may not establish itself in this country, but if it explodes in africa as some of the epidemiologists are saying, the potential for multiple imported cases is certainly there.


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## Handsome Robb (Oct 4, 2014)

@jrm818 I definitely agree that the potential is there and that yes, it is transmitted through more bodily fluids than either of the diseases I mentioned. With that said the reaction to this is absolutely absurd. Should we be careful? Absolutely! Should we freak out like the zombie apocalypse is coming? Definitely not.

I don't see them saying avoiding aerosol producing procedures, I see them advocating for full precautions during such procedures. 

Tall stay safe out there.


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## DesertMedic66 (Oct 4, 2014)

Handsome Robb said:


> Jrm I definitely agree that the potential is there and that yes, it is transmitted through more bodily fluids than either of the diseases I mentioned. With that said the reaction to this is absolutely absurd. Should we be careful? Absolutely! Should we freak out like the zombie apocalypse is coming? Definitely not.
> 
> Tall stay safe out there.


I'll just leave this here... http://m.nydailynews.com/news/national/dead-victims-ebola-claimed-risen-dead-article-1.1952958


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## SandpitMedic (Oct 4, 2014)

Robb, did you read the guidelines sent out by the CDC?

"An EMS agency managing a suspected Ebola patient should follow these CDC recommendations:


Limit activities, especially during transport, that can increase the risk of exposure to infectious material (e.g., airway management, cardiopulmonary resuscitation, use of needles).
Limit the use of needles and other sharps as much as possible. All needles and sharps should be handled with extreme care and disposed in puncture-proof, sealed containers.
Phlebotomy, procedures, and laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and medical care."
Also in regards to PPE:

"
During pre-hospital resuscitation procedures (intubation, open suctioning of airways, cardiopulmonary resuscitation):


In addition to recommended PPE, respiratory protection that is at least as protective as a NIOSH-certified fit-tested N95 filtering facepiece respirator or higher should be worn (instead of a facemask).
Additional PPE must be considered for these situations due to the potential increased risk for contact with blood and body fluids including, but not limited to, double gloving, disposable shoe covers, and leg coverings.
If blood, body fluids, secretions, or excretions from a patient with suspected Ebola come into direct contact with the EMS provider’s skin or mucous membranes, then the EMS provider should immediately stop working. They should wash the affected skin surfaces with soap and water and report exposure to an occupational health provider or supervisor for follow-up."


That's all fancy for this is more than HIV & Hep C. I also read that you should not be giving breathing treatments. Ebola can be carried in aerosol- until proven otherwise.


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## jrm818 (Oct 4, 2014)

Handsome Robb said:


> @jrm818 I definitely agree that the potential is there and that yes, it is transmitted through more bodily fluids than either of the diseases I mentioned. With that said the reaction to this is absolutely absurd. Should we be careful? Absolutely! Should we freak out like the zombie apocalypse is coming? Definitely not.
> 
> I don't see them saying avoiding aerosol producing procedures, I see them advocating for full precautions during such procedures.
> 
> Tall stay safe out there.



Sorry, I don't want to turn this into a back and forth, but a clarification - if you follow the link I posted, which is for in the hospital even, the first bullet under "aerosol generating procedures" says:
 "

Avoid AGPs for Ebola HF patients."
Sandpit Medic has posted the stuff specific to EMS. Also, "full precautions" they suggest includes a PAPR, which I never had access to in EMS.  


I agree that there is no freaking out needed, and I don't watch the news but I am sure they are in full freak out mode.  That said,  for better (for most people) or for worse (for us in healthcare) the primary threat ebola poses to the US at this point is really to healthcare professionals.  With the high infectiveness of the body fluids of ebola patients, its reasonable to use extra precautions, even if that means avoiding procedures which could cause harm to other patients or providers.


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## samiam (Oct 4, 2014)

All of the guidelines I have seen recommend PPAR/Scuba for any droplet inducing procedures. Many of the healthcare workers who have caught ebola in africa were taking "appropriate" precautions and applying the same practices recommended by the CDC and many of them have still contracted the disease. We absolutely have the responsibility and duty to provide quality appropriate care but only if it can be done safely. While there is some inherent risk to treating any patient with an infectious disease remember that unlike AIDS/HIV, SARS, etc ANY fluid from the patient can cause an infection. Scary Scary Stuff. Period.


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## CentralCalEMT (Oct 6, 2014)

Does anyone else wonder if there is some confusion even in the medical community about how ebola is actually spread? On one hand the CDC and other health officials are on TV saying do not worry, the virus is not an airborne virus and it is comparatively hard to catch. On the other hand, they are telling EMS to not administer breathing treatments unless "absolutely necessary" which seems strange if the virus is not airborne. I think confusion like this can increase the anxiety level of healthcare providers.


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## DesertMedic66 (Oct 6, 2014)

CentralCalEMT said:


> Does anyone else wonder if there is some confusion even in the medical community about how ebola is actually spread? On one hand the CDC and other health officials are on TV saying do not worry, the virus is not an airborne virus and it is comparatively hard to catch. On the other hand, they are telling EMS to not administer breathing treatments unless "absolutely necessary" which seems strange if the virus is not airborne. I think confusion like this can increase the anxiety level of healthcare providers.


My guess would be because breathing treatments often cause patients to cough


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## SandpitMedic (Oct 7, 2014)

Listen, the gov't cannot be trusted with this. I'm not some conspiracy wacknut, but they have absolutely no idea. They are making **** up as they go while trying to prevent mass hysteria. They have medical personnell, virologists, scientists, epidemiologists, and all manner of brainy folks trying to get a handle on this behind the scenes. Working hard on this one. You can be one of the sheeple and listen to the propaganda, or you can use your eyes and see what is happening.

Exhibit A.) When they brought the American doctor with confirmed Ebola back via airplane and ambulance, all the personnell involved were wearing full on self contained level C HAZMAT suits. Including the patient. It was on national TV.
http://media4.s-nbcnews.com/i/newsc...ts-1244p_ae40b6803cd608f6e6c166462b8dce31.jpg

Exhibit B.) A full scale manhunt was launched this week to track down a homeless man who rode in the Dallas ambulance who may have been exposed to Ebola before the ambulance was decontaminated after transporting the guy from Liberia who was confirmed to have it. He was found after the full weight and resources of the government was utilized to find him.
http://www.wfaa.com/story/news/health/2014/10/05/ebola-patient-ambulance-dallas-search/16764107/

Exhibit C.) Whenever the government starts coming out strong in droves telling you there is nothing to worry about, that is the time to start worrying. No need to worry, nothing to see here, we're telling you one thing and doing another because -- well, we're the government, trust us. 

They have no idea. LUCK will play a huge role in preventing this bugger from spreading. While I don't think it will be the end-all-be-all that sends us into the zomie apocalypse, I do believe it has the potential to sicken a lot of people who are healthy. The usual suspects (i.e. flus and stuff) generally are subjects of Darwin. They thrive by infecting the young, old, weak, and immunocompromised. However, Ebola is merciless. Young, old, athletes, doctors, nurses aids, otherwise healthy folks are easily susceptible. No one is immune. All of the doctors/medical providers claim to have been utilizing proper PPE, given their guidleines, and still got it. 

Also, on an aside, Nebulizer txs produce aerosol particles that contain whatever your pt may or may not have in their respiratory tract/oro/nasopharynx. The concern is not that it makes them cough... They're already putting out all of that aerosol "mist" that is contaminating the air and every surface, nook, and cranny of the small space in your ambulance. Which is why N95 masks are to be worn when you give a tx to a sick person.


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## vcuemt (Oct 7, 2014)

SandpitMedic said:


> I'm not some conspiracy wacknut.





SandpitMedic said:


> You can be one of the sheeple and listen to the propaganda, or you can use your eyes and see what is happening.


Do with this what you like.

Listen. One person has ebola in the entire United States, and he contracted it in Africa.


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## Chimpie (Oct 8, 2014)

This just in....



> DALLAS — The first Ebola patient diagnosed in the United States died Wednesday morning in a Dallas hospital, according to a hospital spokesman.
> 
> Thomas Eric Duncan was pronounced dead at 7:51 a.m. at Texas Health Presbyterian Hospital Dallas, where he was admitted Sept. 28 and has been kept in isolation, according to spokesman Wendell Watson.
> 
> Duncan carried the deadly virus with him from his home in Liberia, though he showed no signs when he left for the United States. He arrived in Dallas Sept. 20 and fell sick a few days later. His condition was downgraded during the weekend from serious to critical.



http://www.ems1.com/public-safety/articles/2000779-Dallas-Ebola-patient-has-died/


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## Handsome Robb (Oct 9, 2014)

Supposedly a SO Deputy who was in the apartment of "Dallas patient zero" has been transported with "ebola-like symptoms" after he was in the apartment Duncan was staying in.

http://www.wfaa.com/story/news/health/2014/10/08/patient-frisco-ebola-suspect/16922477/

Apparently he lied on his exit paperwork when leaving Liberia saying he had not been in contact with anyone showing symptoms of Ebola, he was potentially facing charges her in the U.S. and in Liberia if he survived. 



@SandpitMedic we usually agree but I do not agree with you on this one. There is the potential for it to come to the U.S. There's no arguing it already has, however I stand by what I said. Unless we and other healthcare providers are complete morons, as it sounds like may have happened when he originally presented to the ED in Dallas saying he had come from Liberia when he was sent home the first time. 

Some may not agree but I personally think that we shouldn't shut down incoming flights from West Africa, but I think a quarantine should be in place. It's not difficult to track someone's travel even if they take an indirect route.

Also, I don't know how I feel about emergency services, both prehospital and hospital settings are being briefed on what questions should be asked and what we should be doing although one would think it would be common sense but maybe I'm giving too much credit where it isn't warranted.

Does anyone know anything at all about ZMapp? Is there any scholarly articles out there about it, who produced(es) it and what it takes to produce it out there?


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## SandpitMedic (Oct 12, 2014)

http://www.cnn.com/2014/10/12/health/ebola/index.html?c=homepage-t

A nurse who cared for Duncan (patient zero) at the Dallas ER has contracted Ebola. 

Reportedly, that nurse had proper PPE including gloves, gown, mask at all times when caring for him.


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## gonefishing (Oct 12, 2014)

Now heres what I find interesting is hazmat is cleaning up common areas when supposedly this is not airborne and really hard to catch........


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## adamNYC (Oct 12, 2014)

As a precaution should N95s and eye protection at a minimum be worn for anyone with ebola-like symptoms? Had someone with vomiting yesterday and we didn't wear any masks or anything. At least pt wasn't out of the country recently.


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## Medic Tim (Oct 12, 2014)

If it was airborne there would be ALOT more people coming down with it.


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## gonefishing (Oct 12, 2014)

Medic Tim said:


> If it was airborne there would be ALOT more people coming down with it.


What about the Winnipeg studys in Canada where a monkey with ebola and a healthy pig were placed in cages next to eachother and the pig contacted ebola? thats whats scary to me.


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## Medic Tim (Oct 12, 2014)

gonefishing said:


> What about the Winnipeg studys in Canada where a monkey with ebola and a healthy pig were placed in cages next to eachother and the pig contacted ebola? thats whats scary to me.


I may be wrong but I believe the conclusion of that study that they were not sure how it was spread. They suspected airborne, droplet, or fomites transmission. The study was not ideal at all to determine if it was airborne.... Though they couldn't rule it out.

An unless you are talking about a different study... The pigs were infected with ebola and it was passed to the monkeys. The only thing separating them was a cage wall.


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## joshrunkle35 (Oct 13, 2014)

gonefishing said:


> Now heres what I find interesting is hazmat is cleaning up common areas when supposedly this is not airborne and really hard to catch........



But droplets can still be aerosolized.


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## MonkeyArrow (Oct 13, 2014)

I just realized how little the CDC actually knows... Reading some of the news articles on the latest press conference with the director of the CDC, we can gather this:

We don't know how or why the nurse in Dallas got infected
We don't know what to do with Ebola patents once they are identified (stay in hospital, move to special hospital, etc.)
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)
We won't consider shutting down flights from West Africa or actually implementing effective screening at the CBP and ICE checkpoints (asking someone whether they have been to Africa in the last 21 days is not effective...you can lie, like Duncan did on his customs declaration about not touching an ebola-ridden patient)


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## gonefishing (Oct 13, 2014)

MonkeyArrow said:


> I just realized how little the CDC actually knows... Reading some of the news articles on the latest press conference with the director of the CDC, we can gather this:
> 
> We don't know how or why the nurse in Dallas got infected
> We don't know what to do with Ebola patents once they are identified (stay in hospital, move to special hospital, etc.)
> ...


Why not shut down flights!?! LOL pure and simple. Stop the spread at the source.


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## MonkeyArrow (Oct 13, 2014)

gonefishing said:


> Why not shut down flights!?! LOL pure and simple. Stop the spread at the source.


I think that the problem is two-fold. First, most flights are not direct from Africa-US. Therefore, it will be hard to track which connections came from where and where each person originated from. With 8 hour lay-overs and flights from Amsterdam to the US, how do you know which people on that flight are from Europe or from Africa on a connection? Therefore, you would theoretically have to shut down the borders to all international flight or quarantine all people trying to come into the country for 21 days...

Second, there is the whole legal issue. Sure, maybe the Texas county can force quarantine on the close family members of the first Ebola case in the country but can you legally shut down the borders to American citizens who are showing no symptoms. I don't think that you legally can. Also, what about all the people who rely on tourism as their main income/livelihood? Etc, etc, etc., the list can go on and on.


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## 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.


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## 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.”
> 
> ...



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.


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## 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?


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## 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.


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## 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.


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## 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.


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## 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.*


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## 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.


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## 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.
> 
> ...



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.


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## 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.
> 
> ...


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


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## 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.


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## 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.


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## 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.


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## gonefishing (Oct 17, 2014)

This is interesting.


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## 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.


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## 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.


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## 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.


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## 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.


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## 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.


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## 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.


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## Akulahawk (Jan 30, 2015)

That patient tested negative... however another patient was admitted to Kaiser South Sacramento for suspicion of Ebola today.


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## SandpitMedic (Feb 2, 2015)

Also negative for Ebola.


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