Ebola….Is your community ready?

on December 3, 2014 in News

CPSM and ICMA meet with various groups and government organizations to provide you with the latest information to prepare.

UPDATE: AS OF 12/3/2014 there are no new cases/active cases of Ebola in the United States.

By Thomas Wieczorek
Director

My annual physical was due this past week and, as directed, I arrived 15 minutes early to the Johns Hopkins Physician practice in downtown Washington.

As I stepped off the elevator, a receptionist greeted me but stood about four feet away. She took only a couple of seconds to fire off questions: “How are you today? How are you feeling? Have you done any international travel recently? Where?”

When I answered “only to London, England,” she smiled, knowing that I did not fit the profile of someone who may have contracted the Ebola virus.

The topic that managers need to discuss with their police, fire, EMS, and dispatch is whether they have adjusted protocols for call takers to include the same questions. If not; why not?

When someone calls 9-1-1 and reports that they have been ill, suffering from flu-like symptoms, or the other characteristics of the Ebola virus, it takes but a few seconds to quickly eliminate that diagnosis although you might have a patient with the flu or Enterovirus. ICMA and the Center for Public Safety Management (CPSM) have been meeting with officials from the Centers for Disease Control (CDC), White House, National Institute of Health, American Public Works Association, National Emergency Management Association, and others to identify steps that communities can take before another case.

The outcome depends largely on steps taken to prepare before a case presents itself.

  1. Dispatch. When the CPSM team begins studies of police, fire, EMS, or emergency management, we begin by looking at the performance of dispatch. Similarly, success or failure will begin with your dispatch center. It is critical that protocols be changed to answer the simple questions that I was asked and that information is quickly relayed to responders. Dispatch will be the first link that can fail in response to Ebola or other viral outbreak.
  2. Responders. In many communities, EMS first response and transport are fire-based and become the job of the fire department. However, in other communities volunteers operate the transport service or it may be contracted to a private provider. In any case, the information from dispatch must be communicated quickly to the first responder and transport personnel so they may enact protocols that have only recently been updated by the CDC for handling suspected Ebola cases.Among the protocol changes are new types of Personal Protective Equipment (PPE) that eliminate the possibility of exposed surfaces. As was found in Dallas, the inability of personnel to access proper PPE equipment may have led to the spread of the virus to two health care workers.Many may not remember the days after September 11 when the United States faced threats from Anthrax and a deadly flu virus that health officials thought could jump from animal to humans. In order to respond, PPE was purchased for fire departments and health providers along with stockpiles of narcotics that would be useful in response treatment.Managers need to discuss with their fire and response personnel whether they have trained with the health providers in their community. Have they updated their PPE and most importantly, have they EXERCISED how to put on and take off that equipment? One of the most likely times to spread a virus like Ebola is when taking off the protective gear. Simply issuing an order or updating a protocol is not sufficient; personnel must practice putting the equipment on and off and demonstrate competence to do so.All cases should utilize a “buddy” system where one person watches another to ensure they are not inadvertently exposed to the patient’s fluids. If you followed the 24/7 news coverage, when patients were transported to secure, specially-designed treatment facilities, a “safety officer” was present to ensure that no contact was made between patient and care giver.

    While the CDC issued new protocols, it has no authority to mandate usage; violations would likely be covered under OSHA or worker’s protection statutes. One frustration for responders is educating the public that states are in charge under the Robert C. Stafford Act that enables response in disasters and emergencies. Cities request assistance when their resources are exhausted – from the state. The state then requests assistance from the federal government. Ultimately all disasters and emergencies are local, meaning they begin and end with you and your staff. What the outcome will be is dependent on what you do prior to the event and during the event.

  3. Wastes. Much discussion has taken place on the threat to public works employees and those handling waste collection. The Ebola virus quickly dissipates when it is outside the host body. Ultraviolet and chlorine easily kill the virus. Any materials that have come in contact with the patient should be handled as a hazardous material situation and properly packaged and disposed. Managers should discuss with their team where such items should go; can an agreement be made between the community’s health care provider/facility and the city to handle all materials associated with the incident? There have been reports that some landfills and states have refused to handle waste generated in the Texas incident; have you established protocols and contracts ahead of a call for service?
  4. Isolation. If your staff respond to a suspected patient, what steps are in place for unit decontamination? What steps are in place for isolation and monitoring of employees responding to the call? Will you place the responders on home-isolation or will you monitor and allow continued work? Again, these issues are covered in protocols that are easily downloadable but the decisions and policy should be adjusted now; before an incident occurs.
  5. Public Information. Have you met with staff and decided who will speak for the community if an incident occurs? The information will have already been “Tweeted” and on “Facebook” before you are able to develop a press release or even get the patient into care but you will likely face an onslaught of reporters and news services if another case is confirmed. You do not want to create panic (like has ensued with the one case in the United States that resulted in two additional patients from exposure during treatment) but will become “ground zero” for the 24 hour news outlets. Consistent, confident, confirmed, and vetted information should regularly be presented to attempt to head off rumors, innuendos, and unsupported reports.

Yesterday brought news that the cameraman infected with Ebola has been declared free of the disease and today, the second nurse that became infected from the one patient who entered the US tested negative. She will need to undergo two additional tests for confirmation which would leave the first nurse that encountered the original patient.

The CDC and governmental agencies have issued new travel guidelines and restrictions for all persons who would leave the three western Africa countries that have been the center of the most recent outbreak. While there are no direct flights, the 150 people who connect and then fly to the US on an average day will only do so through five airports. Health providers in the immediate vicinity of those airports are being trained and prepared if another case or suspected case enters the US.

Two vaccines are in Phase I trials in the US and are likely to be ramped up for distribution in the infected areas of Africa as soon as January. Drugs that have looked promising, including ZMapp, are also being rushed into increased production.

When dealing with this emergency:

  • PREPARE. Develop and update your protocols, training, and equipment.
  • EXERCISE and ensure that your staff is competent and skills at putting on and taking off the PPE..
  • ASK when calls are received at your dispatch center.
  • COMMUNICATE with your citizens and media to minimize panic.
  • INNOCULATE your staff against the flu. For comparative purposes, Ebola has killed one person in the US; the flu kills 36,000 to 50,000 per year; and the Enterovirus is believed to be the cause of at least four deaths.

Current Information and Links for Ebola Resources (As of October 23, 2014):

Transporting Infectious Substances

Transporting Infectious Substances Safely

Ebola Communications Information