Ebola V - What It Means for U.S. Hospitals

In the past few blogs, I've talked about Ebola in West Africa. Nevertheless, most of us aren't going to West Africa, even if we recognize how important that is. For the less daring, less courageous of us, we focus on preparations at home. Now that there are several cases of Ebola in the U.S., it is no longer a possibility or threat; it's real. Fortunately, we have the resources here to take care of it. What does this look like? What does this mean?

I've been privy to some of the discussions and preparations at Stanford Hospital for managing new and emerging infectious diseases like Ebola. It is a process that involves a lot of people and departments. The physicians likely to encounter Ebola are emergency doctors, infectious disease specialists, and critical care physicians. But those at greatest risk will be those who have the most contact with Ebola patients, our nurses. We also have to involve administration, facilities management (how do you dispose of all the Ebola-contaminated gowns?), respiratory therapy, and the county public health office. We have to figure out our processes and policies. For example, what do you do if a potential Ebola patient has a cardiac arrest? If health care workers swarm into the room, they are likely to get exposed, even if they try to put on personal protective equipment. Do we send these patients to the MRI or CT scanner? How do we prevent potential infected persons from sitting in a waiting room? And though we all expect patients to enter the health care system through the emergency department or urgent care, it's entirely possible that they can show up to an unrelated clinic or satellite center.

Although these decisions are still undergoing review, we're using technology to our advantage. For example, to limit the health care workers directly in contact with a patient, we're considering putting cameras in patient rooms so physicians can talk to patients without going into the room. That way, specialists like infectious disease doctors can do most of their job without endangering themselves. We're coming up with the exact route a patient will take from the emergency department to the ICU room and how security will facilitate that transport. We're determining the appropriate number of nurses, the length of nursing shifts, and the appropriate level of evaluation - for example, with the biohazard suits, we cannot listen to the heart or lungs with a stethoscope. We have gotten chemicals that solidify waste to make it more manageable. Our office of emergency response and disasters has already put dozens of health care workers through the training for putting on the biohazard equipment.

Image of researcher in biosafety level 4 hazmat suit is in the public domain, from Wikipedia.