Dear Providers,

Fortunately, despite all of the Ebola preparations at VEP emergency departments over the past few months, only a couple of patients have had histories and symptoms suspicious for Ebola (so far).  Below is the experience of Justin Chatten-Brown, MD, our ED medical director at Woodland Memorial Hospital in Woodland, CA, who initially thought he was being summoned to the ED for an Ebola drill this week.  One lesson they learned at Woodland was that greater care is needed for PPE use.  The following link is for a one-week old CDC video on PPE, so hopefully it is still current!

http://www.medscape.com/viewarticle/833907?src=ppc_google_acq_bola_vid

Rob Wyman, MD
Vice President of Quality
925-482-2802
rwyman@vephealthcare.com

 

If your experience is anything like mine, you’ve received over 200 emails with constantly changing updates regarding Ebola. Knowing the very small chance that any of us will actually see a patient with Ebola, and the amount of time, energy, and resources which are going into Ebola preparedness, I’m sure that you, as I have, feel like we may be making a mountain out of a mole hill. While I’ve stayed positive and on point with my staff, I’ve felt at times like the degree of scrutiny we are under is absurd. I had an experience today which gave me new perspective on the issue.

I thought 6 AM was a little early for an Ebola drill, but dragged myself out of bed at 5. I walked into the emergency department thinking I would find us getting ready for a mock patient, but was instead met with a sense of urgency and seriousness I had not expected. I looked on the board and the patient in our isolation room had been in the department for an hour and a half. The administration and my colleagues told me it wasn’t a drill after all. I laughed it off, thinking they were pulling my leg. They told me to look through the window into the room, and it was only upon seeing the patient sitting in the bed, pale, diaphoretic, tachycardia in the 130s, that I realized this would have been a bit too hard to fake. The nurse sitting next to him at the computer in full PPE’s also appeared to be taking the situation very seriously.

It wasn’t much later that we were able to clear the patient for Ebola after obtaining more history, and in consultation with our public health department. It turns out our patient had very limited contact with a colleague who recently returned from Africa, but the symptoms were alarming. The patient had been in the emergency department for nearly 2 hours when we finally were able to run his laboratories and discover just how critically ill he was.

I imagine our extensive debriefing was much better than it would have been had this been a true “mock” patient. We were fortunate enough that this occurred early in the morning with a relatively empty department. We were also fortunate that the patient didn’t have Ebola, since at least two of our staff would likely have been exposed based upon improper donning and doffing of PPEs. Amongst numerous lessons learned from this experience, the standout is that while the Ebola scare may blow over soon, we are never as prepared as we would like to think. We all need to practice our preparedness, contingency plans, and how we will protect each other and our patients for whatever the next epidemic may be. As with our regular pediatric mock codes, we practice handling low incidence events knowing that if we don’t, lives will be lost. We should all consider our own biases and readjust our attitudes towards the current initiatives for Ebola preparedness.

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