Ebola: first case hits the US

DesertMedic66

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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

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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.
 

jrm818

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@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.
 

samiam

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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.
 

CentralCalEMT

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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.
 

DesertMedic66

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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

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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.
 

Chimpie

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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/
 

Handsome Robb

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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

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gonefishing

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

adamNYC

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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.
 

gonefishing

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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.
 

Medic Tim

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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.
 

MonkeyArrow

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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)
 

gonefishing

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

MonkeyArrow

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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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