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.


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

Bad:
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?

Ugly:
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.

11 comments:

CATP said...

Aesop,

Can you post a list of basic supplies that will be needed to treat ebola if you do it on your own? I have gathered from previous posts that you need the standard protective gear head to toe, goggles, masks,etc. How about for victim survival? What does a layman need in terms of iv supplies to be able to give a family member an iv drip, how much solution on hand to get someone through the virus assuming they can survive with rudimentary care? I have given up thinking that we will stop this, I am into planning to overcome in pandemic scenario where we get to the point where we have to provide family members care by ourselves. Please put out a practical guide or list of what we need. You are the only voice I have found that is providing useful guidance from a medical viewpoint. I am also researching supplements that might help.

Thank you!

CATP said...

I think we have a window to get prepared right now before the entire world goes into full panic mode and getting supplies becomes impossible. I feel that if things keep going as we see unfolding in the media and in online unrestricted news sources that we have about a month before it is going to be a daily occurrence to hear about new ebola cases in the tens on airline flights and throughout the globe. Right now we are hearing about them on a onesey twosey basis. Then about a month after that we are going to be into 100s per day, and then a month after that 1000s per day. Maybe that rate is too fast or too slow. But, in any case I think we have a few months to get ready in our communities and at the home level. On the travel scene I think we only have a weeks or maybe a month until ebola is going to be dominating awareness. At that point I think you are going to see everyone wearing masks when they fly, etc. Here is what I am coming with as a basic plan for myself and family.

Have 2-3 months food on hand.

Have adequate firewood/heating options to get through the winter with minimal regular heat at least for part of it.

Have a local water source and water treatment capability

Have self-defense capability. People are going to be desperate to get everything to survive once this gets rolling in earnest. You will need to be able to prevent sick and infected folks from forcing entry into your home.

Have medical supplies to assist family members through the virus. I am hoping Aesop gives us guidance here.

Have PPE (personal protective equipment) to allow 3 levels of protection. One a tertiary level for remote exposure defense. A medium level of protection in areas that are not enclosed. A high level full hazmat protection level for caring for loved ones that get sick. Aesop please fill out the needed items for each level.

I fully believe that if a family is prepared adequately it is possible to overcome this with at least odds that are better than 50/50, maybe 25% or better. I have seen a story of a girl in Africa caring for 4 family members and only one died. She survived by using basic methods of protection.

I think we have to resign ourselves to that being the best case once this goes full pandemic mode. I am planning to survive and there will be a world and hope afterwards. It is time to get ready, imho.

Thanks Aesop for your great blog!



Christine said...

https://petitions.whitehouse.gov/petition/have-faa-ban-all-incoming-and-outgoing-flights-ebola-stricken-countries-until-ebola-outbreak/FFJHH9yX

Anonymous said...

I'd like to also point out the idiocy in the airport scanner plan.

No scanners for Dallas, the ONE ABSOLUTE PROVEN airport with an ebola traveler! Not getting scanners. None for Houston either, despite Houston's importance in the oil industry and all the companies there that have ties to West African oil.

Proven point of entry, not getting scanners. And we know that copy-cats tend to copy everything so....more refugees fleeing to Dallas.

The time to stock up is NOW. Prices are already going up, and it will only get worse.

good luck,

nick

CATP said...

Aesop, what is you interpretation of the date presented at the link below:

"As seen in Table 4, diphenoxylate and dipivefrin were active against MARV, EBOV and LASV. Since diphenoxylate is a Schedule-II drug and is medically utilized with severe restrictions, its verification by animal efficacy was not possible. Unexpectedly, two antibiotics, dirithromycin and erythromycin, were potently active against MARV and EBOV, with erythromycin exhibiting 60% protection against LASV. Dirithromycin had no activity against LASV in vitro."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618516/

Erythromycin is a pretty common antibiotic, could this work? I found another link where a nurse told someone in Africa to get it also.
http://allafrica.com/stories/201409051721.html

"On the scene, a female Police officer's name withheld assigned with the Ebola Task Force instructed and escorted Bendu to a pharmacy opposite the hospital to buy some drugs for Bendu's husband.

Medications she bought included erythromycin and metronidazole. The officer instructed Madam Sonii to keep their patients home and apply this medication instead of bringing them to the hospital to suffer and die. Bendu says she is concerned about how the patients are being treated at the hospital. "My husband them can sleep outside, they say they don't even have beds for them, only the ones that are very weak they can give a bed to".

CATP said...

"The ability of erythromycin to inhibit filoviruses as well as bacteria is intriguing and suggests that this drug can act not only by impacting bacterial growth but also on the cell itself, possibly by altering uptake of the pathogen. "

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3618516/

Aesop said...

I find it hard to believe that something as simple as erythromycin hasn't been tested or tried with regard to EBV.

Not saying they have or haven't, but this would be like not saving the Titanic because no one closed the portholes to keep the water out.

E-mycin is also dirt cheap; if it was efficacious, the airlines and hotels worldwide would be handing the stuff out like after dinner mints to travelers and aircrew.

So I suspect that it's about as likely and legit as Nigerian e-mail request for your bank account and PIN number.

I'd love to be wrong on that, too.

CATP said...

http://drsircus.com/medicine/ebola-saving-lives-natural-allopathic-medicine

Interesting points here

ASM826 said...

Everyone needs to add in the fact that rodents (mice, rats, squirrels, etc) and dogs get ebola. So do some other kinds of mammals, but doncha think mice and dogs would be enough to make an extra special mess of things?

As a bonus, dogs don't get sick, they just carry the virus for some period of time and then clear it.

Anonymous said...

Thanks for all of this great information, Racanteur Report. One question for you: central heating and air conditioning systems. Should we turn off these system or would it be better to keep the heat on at a specific temp? I'm concerned that if Ebola, TB, etc go airborne on a significant scale, these systems could pull it into the house. Any insights on the best thing to do for this? Thanks again

Aesop said...

If Ebola or TB go airborne on a scale significant eough for your A/C's intake to be a problem, we're far beyond screwed.

If I had a window A/C next the front door in an apartment building full of neighbors, I'd be concerned somewhat.

A unit in your side yard or on the roof should be fine.
If you're a belt and suspenders kind of person, construct a frame cage that would let you drop in HEPA filters on the sides to pre-filter the intake air.

And set the unit to recirc inside air, rather than draw air in from outside common areas if other people can walk right up to it outside without crossing your property line limits.

If that was me, I'd probably build up a plywood window insert, rehang the thing safely in a room with an outside window away from passersby, and block the hole where it used to be with plywood and expanding sealing foam until further notice.

And making sure that my home was still secure, my A/C wasn't going to fall out and land on someone's head, and the new wiring option wasn't going to burn my house down, all of which are not irrelevant risks too.
Everything is a tradeoff. Plan wisely.