Ebola: Texas Style

WHO Photo, in Sierra Leone

WHO Photo, in Sierra Leone

Oct. 3, 2014 (San Diego) I know people are scared of Ebola. It is a disease with 50 percent lethality rates. In places like Liberia the rates are even higher. The reasons for that are a lack of a mature medical system, with a lack of things as simple as IV solutions and kits to administer them. There is also a lack of trust in the medical system.

Ebola is a scary disease, but quite frankly, Entenovirus 68 is easier to catch than Ebola. Yet, there are things that are indeed scary from the management of the first Ebola case in Texas.

What do I mean? A triage nurse wrote notes in a medical chart system that the patient came from Liberia but the Emergency Room doctor never saw this when the patient first presented? I used to work in a medical system without all the fancy gear and trust me, we did not have parallel notes systems. My EMS chart followed the patient to discharge, and was included in the nurse and doctor’s file. Why? It was the same file.

Yes, technology is great, and it is supposed to make life easier, but somebody comes into the ER, with high fever, diarrhea, body aches, and a history of recent presence in Liberia? What is wrong with a verbal communication between the nurse and the doctor? What happened to paper? What happened to the protocol?

Then we have the family of this patient kept in isolation in the apartment with infected and soiled mattresses, and clothes and towels. I might not be the sharpest tool in the shed, but that sounds like a sure way to get people infected. Now we learn that they are going to be transported to a private residence that a good Samaritan is offering. I know they are not sick and generally speaking we do not put people in hospital beds unless they are sick, but we used to have special isolation wards during epidemics in the past, not house confinement.

Oh and yes, the Centers for Disease Control do have the authority to order this.

 Quarantine is used to separate and restrict the movement of well persons who may have been exposed to a communicable disease to see if they become ill.

Then I watched the HAZMAT procedures to remove the soiled linens. OK, fine and dandy the Texas Fire Department HAZMAT decided to use higher-level isolation suits. Sure, perhaps that is what they had, but we had a civilian crossing all barriers in civilian clothes up and down the apartment. Why bother with the HAZMAT suits and three layers of isolation?

Containing a contagious disease is not that hard. Ebola is not that contagious, just extremely scary. What we have seen so far makes me wonder if we really are ready for it though. Perhaps the errors are coming because this is the first case. Queens Medical in Hawaii followed protocol to the T, even though it was just a suspicion. So far a medical center in Washington DC is doing that as well.

So we must ask, what led to this series of errors in the management of this. The errors could get somebody sick, and perhaps even dead. If you are going to contain something like Ebola you need to pay attention to small details, like patient history, and disinfection of the place where they live, and tracking people. It is not complicated just personnel intensive. It is intrusive as hell, but when you do it well, and procedures are in the books, none is inventing them, you will stop it before we can say outbreak.

These rookie mistakes will lead to mistrust in the medical system. These are the kind of errors that can lead to more infections than necessary and perhaps an actual outbreak. If nothing else, this is showing that we need to invest in government and public health. After all, trust is golden, and just saying that we have the best system in the world does not make it so…not when we see mistakes like these.


Nadin Abbott is a former First Responder with the Mexican Red Cross in Tijuana, where she served as a volunteer emergency medical technician. Paramedic.

Categories: analysis, Ebola, Health

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