Lifespan to date has seen roughly nine patients who came into ERs fearing that they had contracted Ebola after traveling to West Africa, Murphy said. If someone is suspected by physicians to have Ebola, Murphy said providers are instructed to treat that person as dangerously contagious until “we are 100% certain that they don't have Ebola.”
If Lifespan providers can't rule out that a patient has Ebola after evaluating them against criteria established by the Centers for Disease Control and Prevention, then the patient is immediately transferred to Lifespan's Rhode Island Hospital, regardless of which of the system's four hospitals they initially visited. The system decided that at-risk patients would only be treated at a single hospital to cut down on the amount of staff who would need to undergo training, as well as to limit the amount of briefing locations that would be needed for the expected overwhelming media attention a case would garner there, Murphy said.
Staff training in infectious disease protocols and the use of personal protective equipment has played a major rule in reducing anxiety brought on by news coverage, Murphy said. Exercises go beyond just doctors and nurses, Murphy said. Employees in housekeeping and radiology technicians have also been involved in discussions, he said.
Dr. Michael Guttenberg, medical director for emergency medical services for the North Shore-Long Island Jewish Health System, Great Neck, N.Y., said a patient recently was isolated after presenting Ebola-like symptoms, but was ultimately diagnosed with malaria, a noncontagious disease common in West Africa.
“Malaria is the mimic of Ebola, and until proven otherwise it's Ebola,” Guttenberg said, noting that the similar disease presents a challenge to triage staff.
Hospital staff run drills three to four times a day on all shifts to drive home the seriousness of the epidemic, Guttenberg says. It's been important to remind staff that they shouldn't be afraid to raise the flag when a patient appears at-risk.
“We've developed appropriate protocols to reinforce to the staff that it's OK to escalate and that it's appropriate to ask for help,” Guttenberg said. “Without pressing the panic button, there's room to reach out for help.”
The Detroit Medical Center health system in early August prepared and issued screening guidelines for its emergency departments and frontline personnel, according to an e-mail sent last week to DMC leaders and staff by Dr. Suzanne White, the organization's chief academic and medical officer.
“While we need to be vigilant when caring for patients with fever, we also need to remember the facts,” White wrote, reminding her colleagues that the virus is not spread through casual contact and that individuals are not contagious after exposure unless they develop symptoms.
Dr. Teena Chopra, an infectious disease physician at DMC, said the system hasn't changed any of its policies for dealing with infectious disease patients, and hasn't received any patients who traveled to West Africa and were concerned that they might have the virus.
While hospitals work on staff training, the CDC and the Department of Homeland Security's Customs & Border Protection announced Wednesday that they will begin enhanced Ebola screening at five major U.S. airports that receive nearly all travelers to the U.S. from Guinea, Liberia and Sierra Leone, the three most affected countries. The airports include JFK International Airport in New York; Washington-Dulles in Washington, D.C.; O'Hare International Airport in Chicago; Hartsfield-Jackson Atlanta International Airport; and Newark (N.J.) Liberty International Airport in New Jersey.
After Customs & Border Protection officers review their passports, travelers from Guinea, Liberia and Sierra Leone will be escorted to a separate area for screening. Customs & Border Protection staff will observe travelers for signs of illness and ask them questions to determine whether they may have been exposed. Medical staff will take each individual's temperature with a noncontact thermometer.
Passengers who present possible Ebola symptoms or who are suspected of exposure following the questionnaire will be evaluated by a CDC quarantine-station public health officer, who will make a public health assessment and take appropriate action. The CDC has sent additional staff to the five airports to assist in this process.
All travelers from the region will be asked to self-monitor, and provide a daily temperature log and contact information. Exit screening has been underway in the three countries for the last two months. JFK, which received nearly half of all travelers from the three affected countries between July 2013 and July 2014, will launch the enhanced screening Monday, while the other four airports will implement the procedures next week.
Follow Adam Rubenfire on Twitter: @arubenfire
