Train, communicate to fight Ebola, doctor urges
YOUNGSTOWN
Proper training and communication among health care and emergency-response professionals are key to preventing the spread of Ebola should there be a case of it in the Mahoning Valley, a local forensic pathologist says.
“Training is going to be ongoing and evolving and is going to rely on the experiences from Dallas, as well as experiences from Africa,” said Dr. Joseph Ohr, forensic pathologist and Mahoning County deputy coroner.
That training will be “cumulative and continuous,” said Dr. Ohr, who attended a recent meeting of the Mahoning County Health Care Coalition, a local committee of health care and emergency- response professionals focused on emergency preparedness issues, including Ebola.
Mahoning County does not have a specific Ebola preparedness plan, but it has a general plan for all public health emergencies, said Patricia Sweeney, county health commissioner.
Training must be given to 911 dispatchers, who screen emergency calls, ambulance crews, police, fire, and Haz-Mat personnel; coroner’s office staff; funeral directors and embalmers; and hospital and home cleaning and disinfecting personnel, Dr. Ohr said.
The county emergency management agency already has provided the county’s 911 center with information on Ebola call screening, Sweeney said.
screening questions
Sweeney said the screening questions that dispatchers and emergency responders are being taught to ask are:
“Have you traveled to a country in West Africa where Ebola is widespread (Guinea, Liberia, or Sierra Leone)?”
“Do you have symptoms: diarrhea, fever, stomach aches?”
“Have you had contact with a patient that has Ebola (either in West Africa or the United States)?”
Joe Diorio, community health director at the county health department, educated local police chiefs about the deadly disease at a Wednesday meeting in Boardman.
“We urge all hospitals and health care workers to engage in comprehensive education and preparedness activities in order to ensure the safety of the public and health care professionals,” said Pamela F. Cipriano, president of the American Nurses’ Association.
She also said it’s essential that the U.S. Centers for Disease Control and Prevention “quickly investigate and fully share the findings surrounding the care of Thomas Eric Duncan (the Ebola patient who died Oct. 8 in Dallas) to help health care providers understand any further precautions needed to prevent transmission of the disease.”
Two health care workers, who cared for Duncan, including one who flew from Dallas to Cleveland and back to visit family in the Akron area, have been diagnosed with the deadly disease.
The U.S. is better prepared for Ebola than West Africa because it has better medical facilities and technology and better infection control precautions by emergency response and health care workers, Diorio said.
People here needn’t worry about having Ebola if they haven’t traveled to West Africa, haven’t been in contact with an Ebola patient, and don’t have symptoms, such as fever, diarrhea or abdominal pain, Sweeney said.
Youngstown Health Department officials said they have met with other area health departments, hospitals, emergency medical technicians and CDC personnel to improve coordination of services if the Ebola virus strikes here.
Dr. Ohr said the Valley is well-prepared because of the awareness and professional knowledge base here and the proximity of major medical centers in Cleveland, Pittsburgh and Columbus.
communication IS essential
“The central way to beat an epidemic like this is good communication,” among emergency responders and health care and coroner’s office professionals, Dr. Ohr said.
For example, he said coroner staff routinely use cellphones while they’re headed to a death scene to communicate with the police, fire or ambulance personnel.
Coroner’s personnel ask the emergency responders to take precautions to protect themselves against any contagious disease the deceased may have had.
Among the clues might be needles, drugs or HIV medications at the scene and whether the body is decomposing, swelling or spewing fluids, he explained.
“A dead body doesn’t tell you whether he’s been in Africa or not,” but the answer might lie in the surroundings of the deceased, Dr. Ohr said.
“Is there a suitcase in the corner with an Africa sticker on it? Are there plane tickets over here? Is there bloody diarrhea or vomit in the bathroom?” are questions that need to be asked, the pathologist said.
As first responders, police, fire and ambulance personnel “need to be trained first and foremost, and they’re the ones who need to be exquisitely protected,” Dr. Ohr said.
hospitals prepared?
As to whether Ebola patients should be treated in local hospital isolation units or moved to specialized units in large urban hospitals elsewhere, Dr. Ohr said federal guidelines discourage moving patients unnecessarily.
“If you don’t have to move the patient, then you don’t move the patient,” Dr. Ohr said.
Sweeney said she believes Mahoning Valley hospitals are prepared to treat an Ebola patient, if necessary.
She noted that St. Elizabeth Health Center and ValleyCare Northside Medical Center have the necessary negative air-pressure isolation rooms, which contain infectious diseases by letting air into those rooms, without sending that air out to the rest of the hospital.
“They all have trained and exercised. They are continuing to do so, so I’d say we are prepared,” she said.
ValleyCare hospitals have been following the CDC Ebola preparedness check list, conducting drills and working with state and local health authorities, said Trish Hrina, vice president of marketing and public relations there.
“Our primary focus is preparation to appropriately identify, isolate, test and transfer, if necessary,” she said.
Any patient with potential Ebola symptoms or risk factors will be placed in isolation, she said.
“Our hospitals have dedicated isolation rooms, and supplies of gowns, masks, face shields and gloves are already on site,” she added.
ValleyCare will “arrange for the transfer of any patient with a confirmed case of Ebola to a hospital that specializes in the care of such infectious conditions,” Hrina said.
A potential pediatric Ebola patient would be assessed in a containment room in Akron Children’s Hospital’s Boardman emergency department.
If that child had a positive screening and was symptomatic for Ebola, the child would be transported in a ground ambulance and lodged in a negative-pressure isolation room in a remote part of the main hospital in Akron, said Dr. Rob McGregor, the hospital’s chief medical officer.
That’s because the patient “could require intensive care services that are not present at the Boardman campus,” he said.
The only health care workers who have become ill with Ebola in the United States are those who cared for Duncan while his “viral load was as high as it could possibly be,” Sweeney noted.
CDC said it would dispatch a rapid-response team within a few hours to any hospital in the country that diagnoses an Ebola patient to assure that local health care workers can safely treat the patient.
Any hospital treating an Ebola patient should have someone devoted exclusively to ascertaining that proper cleaning of the facility, donning and doffing of personal protective equipment and hand-washing is universally performed by the staff, Dr. Ohr said.
The proper inside-out removal of a protective gown contaminated by the patient’s bodily fluids is critical, he said.
Any Mahoning County jail inmate with a high probability of having Ebola would be transported to St. Elizabeth Health Center with all guards and health care professionals wearing protective garb, he said.
don’t embalm
CDC recommends against autopsying or embalming people who have likely died from Ebola and calls for minimizing the transportation of their remains.
Dr. Ohr said he wouldn’t perform an autopsy if he had enough other information to ascertain Ebola as the cause of death.
In the unlikely event that an Ebola patient might be a homicide victim, Dr. Ohr said he’d seek CDC and National Association of Medical Examiners guidance before performing the autopsy.
Dr. Ohr said he agrees with CDC recommendations for direct cremation or for burial of Ebola victims in plastic bags in hermetically sealed caskets.
As to how the public should view the Ebola hazard, Dr. Ohr said: “Yes, it’s alarming. Yes, this is a very bad bug. No, it’s not something that is ‘The Walking Dead.’ It is not going to take over the Earth. We can beat an Ebola epidemic,” he said.
Contributor: Staff writer William K. Alcorn