Ebola: first case hits the US

[SandpitMedic]

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.

 

[avdrummerboy]

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!!!!

 

[Akulahawk]

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.

 

[gonefishing]

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?

 

[Akulahawk]

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...

 

[gonefishing]

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

 

[Akulahawk]

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.

 

[SandpitMedic]

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.

 

[SandpitMedic]

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.

 

[MagicTyler]

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.

 

[Household6]

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.

 

[DesertMedic66]

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.

 

[Household6]

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..

 

[Handsome Robb]

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.

 

[Household6]

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

 

[Akulahawk]

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 mouths 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.

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.

 

[OnceAnEMT]

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.

 

[DesertMedic66]

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.

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.

 

[jrm818]

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.

 

[Handsome Robb]

@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.