Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T08:44:22.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Preparing an Academic Medical Center to Manage Patients Infected With Ebola: Experiences of a University Hospital

Published online by Cambridge University Press:  25 September 2015

Carl H. Schultz ,
Kristi L. Koenig  and
Wajdan Alassaf
Carl H. Schultz*
Affiliation:
Center for Disaster Medical Sciences, Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, California.
Kristi L. Koenig
Affiliation:
Center for Disaster Medical Sciences, Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, California.
Wajdan Alassaf
Affiliation:
Center for Disaster Medical Sciences, Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, California.
*
Correspondence and reprint requests to Carl Schultz, MD, Center for Disaster Medical Sciences, Department of Emergency Medicine, University of California Irvine School of Medicine, 333 The City Boulevard West, Suite 640, Route 128-01, Irvine, CA 92868 (e-mail: schultzc@uci.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

As Ebola has spread beyond West Africa, the challenges confronting health care systems with no experience in managing such patients are enormous. Not only is Ebola a significant threat to a population’s health, it can infect the medical personnel trying to treat it. As such, it represents a major challenge to those in public health, emergency medical services (EMS), and acute care hospitals. Our academic medical center volunteered to become an Ebola Treatment Center as part of the US effort to manage the threat. We developed detailed policies and procedures for Ebola patient management at our university hospital. Both the EMS system and county public health made significant contributions during the development process. This article shares information about this process and the outcomes to inform other institutions facing similar challenges of preparing for an emerging threat with limited resources. The discussion includes information about management of (1) patients who arrive by ambulance with prior notification, (2) spontaneous walk-in patients, and (3) patients with confirmed Ebola who are interfacility transfers. Hospital management includes information about Ebola screening procedures, personal protective equipment selection and personnel training, erection of a tent outside the main facility, establishing an Ebola treatment unit inside the facility, and infectious waste and equipment management. Finally, several health policy considerations are presented. (Disaster Med Public Health Preparedness. 2015;9:558–567)

Keywords

disease outbreaksoccupational exposurepatient isolationpublic health practiceinfectious disease medicine
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 9 , Issue 5 , October 2015 , pp. 558 - 567
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Qureshi, K, Gershon, RR, Sherman, MF, et al. Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005;82(3):378-388.Google Scholar
2. Ebola virus disease fact sheet number 103. World Health Organization website. http://www.who.int/mediacentre/factsheets/fs103/en/. Accessed July 21, 2015.Google Scholar
3. Ebola situation report - 18 March 2015. World Health Organization website. http://apps.who.int/ebola/current-situation/ebola-situation-report-18-march-2015. Accessed July 21, 2015.Google Scholar
4. Risk of exposure. Centers for Disease Control and Prevention website.http://www.cdc.gov/vhf/ebola/exposure/?mobile=nocontent. Accessed July 21, 2015.Google Scholar
5. Althaus, CL. Estimating the reproduction number of Ebola virus (EBOV) during the 2014 outbreak in West Africa. PLoS Currents. doi:10.1371/currents.outbreaks.91afb5e0f279e7f29e7056095255b288. Published September 2, 2014. Accessed on April 15, 2015.Google Scholar
6. Milligan, GN, Barrett, ADT, eds. Vaccinology: An Essential Guide. Chichester, United Kingdom: John Wiley & Sons; 2015.Google Scholar
7. McCoy, CE, Lotfipour, S, Chakravarthy, B, et al. Emergency medical services public health implications and interim guidance for the Ebola virus in the United States. West J Emerg Med. 2014;15(7):723-727.Google Scholar
8. Sugalski, G, Murano, T, Fox, A, Rosania, A. Development and use of mobile containment units for the evaluation and treatment of potential Ebola virus disease patients in a United States hospital. Acad Emerg Med. 2015;22(5):616-622. http://dx.doi.org/10.1111/acem.12664.Google Scholar
9. Hospital preparedness: a tiered approach. Centers for Disease Control and Prevention website. http://www.cdc.gov/vhf/ebola/healthcare-us/preparing/current-treatment-centers.html. Accessed July 21, 2015.Google Scholar
10. Identify, isolate, inform: emergency medical services (EMS) systems and 9-1-1 public safety answering points (PSAPs) for management of patients who present with possible Ebola virus disease (Ebola) in the United States. Centers for Disease Control and Prevention website. http://www.cdc.gov/vhf/ebola/pdf/ems-911-patients-with-possible-ebola.pdf. Accessed on March 26, 2015.Google Scholar
11. Detailed emergency medical services (EMS) checklist for Ebola preparedness. Centers for Disease Control and Prevention website. http://www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf. Accessed March 26, 2015.Google Scholar
12. Ortega, R, Bhadelia, N, Obanor, O, et al. Putting on and removing personal protective equipment. N Engl J Med. 2015;372(12):e16. http://dx.doi.org/10.1056/NEJMvcm1412105.Google Scholar
13. Broadhurst, MJ, Kelly, JD, Miller, A, et al. ReEBOV Antigen Rapid Test kit for point-of-care and laboratory-based testing for Ebola virus disease: a field validation study. Lancet. 2015;386(9996):867-874. http://dx.doi.org/10.1016/S0140-6736(15)61042-X.Google Scholar
14. Ebola Virus Disease Waste Management in the Medical Treatment Facility. United States Army Institute of Public Health. http://phc.amedd.army.mil/PHC%20Resource%20Library/EVDWasteManagementonMTFSOP.docx. Published October 2014. Accessed April 23, 2015.Google Scholar
15. Ebola-associated waste management. Centers for Disease Control and Prevention website. http://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/waste-management.html. February 2015. Accessed on April 23, 2015.Google Scholar
16. Interim U.S. guidance for monitoring and movement of persons with potential Ebola virus exposure. Centers for Disease Control and Prevention website. http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html. December 2014. Accessed March 30, 2015.Google Scholar
17. Koenig, KL. Health care worker quarantine for Ebola: to eradicate the virus or alleviate fear? Ann Emerg Med. 2015;65(3):330-331. http://dx.doi.org/10.1016/j.annemergmed.2014.12.003.CrossRefGoogle ScholarPubMed