Saturday, October 11, 2014

Still Not Ready For Prime Time

Forum post this morning:
My [relative] is a senior ER nurse at a major hospital in [redacted major city]. Nurse reports... well, I'll let [him/her] tell it:                               
The ER had a call from the head office of the ambulance company saying they were delivering a patient - a driver from [somewhere in Texas] who was complaining of fever, headache, nausea, stomach pains. The hospital heads came down and told Nurse he/she would be the one seeing the patient, and they garbed  Nurse head to foot in protective gear. They would bring the patient in one room, and then the patient and nurse would stay in there until a diagnosis was made. After one-half hour of examination and discussions with the patient, seems like driver ate a bad hamburger in Dallas and that was the reason for the symptoms.

1) They made up a not-entirely-horrible plan on spur of the moment.
2) Nobody died.
3) Nobody got exposed to Ebola.

1) Clearly, no one thought of this before the last second, still.
2) "Tag, you're it" is a pretty shitty way to select staff for this kind of thing.
3) WTF happened with the ambulance folks?
4) No airlock.
5) No decon area to remove contaminated PPE.
6) No way to get the nurse out, or additional supplies in, without exposing additional staff, and/or contaminating the entire ER.
7) De facto 1:1 nursing assignment cuts back on the ability to care for other patients.
8) What happens if the patient needs imaging, like an Xray, CT, etc.?
9) What was the plan doing for blood work, which for Ebola requires BL4 handling and packaging precautions, and a lab staff prepared to deal with that?

1) What if patient had been a legit risk Ebola case?
2) What if patient had deteriorated, and they needed additional nursing staff or doctors in the room, STAT?
3) What if the patient gets hostile, and the nurse has to chose between getting jacked, or running outside and contaminating the entire ER?

So clearly, they've done zero prior planning, have zero infrastructure to support such a plan, have done zero training of staff or any personnel, not doctors, nurses, techs, lab, imaging, or anyone else.
They have no support available to care for even one such patient.

In other words, everything I've only been saying for some weeks is true, even after one Ebola patient has been to a US ER twice, been treated, and died from Ebola, despite the CDC and 5-10 networks using a bullhorn about this for 3 solid weeks 24/7.

Color me shocked. Not.

And that continues to be the case as hospitals stumble to find their way in all this, from coast to coast:

   The missteps in Dallas's handling of the first Ebola case diagnosed in the United States have revealed an uncomfortable reality: state and city plans for handling the deadly virus are based on generic recommendations for everything from measles to floods, to hurricanes and dirty bombs.
Officials acknowledge they need to do more.
    Checks with health departments in six states and cities that have large West African communities, Philadelphia, Boston, New York City, Minnesota, New Jersey, Maryland and Rhode Island, show that they are scrambling to adapt those generic plans to Ebola. Even top hospitals are learning that a plan for dealing with infectious disease outbreaks may still leave them exposed to Ebola.
    Vanderbilt University Medical Center recently ran an Ebola drill with a pretend patient arriving at the emergency room, being admitted and placed in an isolation unit.
    During the drill, when doctors and nurses removed gowns, masks and other protective equipment "they wanted to get out of that stuff and do it quickly," Dr. William Schaffner, chairman of the Department of Preventive Medicine, told an audience at the Woodrow Wilson International Center for Scholars on Tuesday.
    Moving quickly raised the risk of accidentally touching fluids on clothes, a likely reason for infection of healthcare workers in West Africa and possibly Spain, Schaffner said. All staffers have since been instructed to remove protective gear with a partner, "to count to 10" during each step "and do it slowly."
    According to National Nurses United, 76 percent of nurses surveyed say their hospital has not communicated to them any policy regarding potential admission of Ebola patients, 85 percent say their hospital has not provided education sessions where nurses can ask questions, and just over one-third say their hospital has insufficient supplies of face shields and impermeable gowns.
    Dr. Leon Yeh, director of emergency medicine at Saint Francis Medical Center in Peoria, Illinois, said, "It's happened so fast we haven't drilled specifically on Ebola."   

I feel ya, Doc.
Two solid weeks while the warning alarms have been ringing non-stop is hardly time to even think about this, let alone actually do anything. 
Maybe another month or two would be long enough...?

I'm sure Ebola will wait outside the door patiently during that time while everyone puts their thinking caps - and five layers of protective gear - on.

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