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October 12 Update

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10.12.2014

Scott Bourn, Ed Racht

With the confirmation by the CDC that a nurse caring for Dallas Ebola patient Thomas Eric Duncan tested positive for Ebola, AMR’s medical leaders wanted to provide an update to our teams. We understand this new case heightens concerns among healthcare providers of whether current measures of protection adequately assure safety.

It is important that we remain focused on what we know and what we are doing to protect our colleagues, communities and patients.

What we know

  • Ebola is transmitted through DIRECT contact with blood or body fluids (blood, urine, feces, sweat, tears, semen) from a patient who is ACTIVELY sick with the disease
  • Symptoms include: fever or chills; weakness or fatigue; headache or muscle aches; stomachache, nausea, or vomiting; abnormal bleeding
  • Asymptomatic individuals cannot transmit the disease
  • Ebola has been most prevalent in three western Africa countries: Guinea, Liberia and Sierra Leone (8,376 total cases). Three additional cases have been reported in Spain, Senegal, and the US
  • Exit screening (for signs and symptoms of the disease) of all individuals leaving these high risk areas of the world has been enforced by the World Health Organization (WHO) and Centers for Disease Control and Prevent (CDC) since early in the outbreak
  • On Oct. 11, entrance screening (for fever and signs of the disease) began for all patients arriving from high-risk areas of the world at five major U.S. international airports (which encompass 94% of arriving passengers from these areas)

The most effective strategies for protecting healthcare workers from contracting the disease include:

  • Rapid identification of patients who have symptoms of Ebola AND a history of either travel in a high risk area OR confirmed close contact with a confirmed Ebola patient
  • Immediately accessing barrier protection for any patient who meets the criteria listed above, including:
    • Supervised donning of an impermeable gown and gloves to COVER ALL EXPOSED SKIN
    • Goggles/face shield and N95/N100 mask to protect the mucous membranes of the mouth, nose, and eyes from contact with blood or body fluids
    • Reducing the number of caregivers in proximity to the patient and eliminate any invasive procedures that are not critical to patient wellbeing, when possible without impacting patient care

What we have done to protect you, your patients and your communities:

  • We are following current CDC guidelines and will be making adjustments or updates if the CDC updates its recommendations
  • We created Screening questions(based on CDC criteria) for all patients with symptoms consistent with Ebola. These questions have been imbedded into the MEDS medical record platform
  • We developed detailed guidelines for the safe interfacility transport of a patient thought to be high risk for Ebola. These guidelines are based on CDC recommendations
  • We created a poster reminding caregivers when and how to apply barrier protection for blood and body fluids
  • We developed a recommended set of PPE (included here) to be used when caring for/transporting patients who are suspect or confirmed with Ebola. The PPE should be ordered through ProcuteIt. It eliminates the need to “build it yourself,” which can contribute stress and lead to errors
  • Established a 24/7 clinician hotline, 855-448-1742, for caregivers or leaders who have specific questions related to a potential care situation. Use this number first, rather than calling a variety of individuals when trying to plan a transport

Remain Focused: Remember we are fighting a battle. We must remain vigilant and focused on our clinical and public health principles. In the coming days:

  • We will continue our communications with the CDC and will modify our guidelines as necessary to protect our caregivers, patients and communities
  • We will evaluate any recommended changes to patient screening at the PSAP level
  • We will finalize and distribute training tools for field teams

If you need additional information, please contact Scott Bourn at Scott.Bourn@amr.net or Ed Racht at Ed.Racht@amr.net

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