RoseAnn DeMoro, head of National Nurses United, is warning that hospitals in the U.S. “are not ready to confront” Ebola. But Thomas Frieden, MD, director of the Centers for Disease Control and Prevention insists they are. The string of errors in Dallas shows that the neither the CDC nor the local hospital was ready for the first American case of Ebola. New York and other cities can learn from what went wrong.
On September 25, Thomas Eric Duncan, a Liberian with an undiagnosed case of Ebola, went to the emergency room at Texas Health Presbyterian Hospital in Dallas. The medical team overlooked his recent arrival from Ebola-infested West Africa and discharged him with antibiotics. That was the first of several mistakes that have put at least 48 Dallas-area residents at enough risk of contracting Ebola that they’re being monitored twice daily, and in some cases quarantined.
Hospital officials initially blamed the electronic medical records system, instead of admitting staff had made an error. That allows deadly mistakes to be repeated.
After Duncan was discharged, his condition worsened, and two days later, as he huddled in a blanket, with vomiting, diarrhea, and reddened eyes, his girlfriend’s daughter called 911. But Dallas wasn’t screening 911 calls for Ebola, something that New York City is already doing.
When the ambulance arrived, paramedics got their first warning, thanks to the daughter, that Duncan had arrived from West Africa and could have a virus. So they grabbed masks and gloves before helping Duncan, who was vomiting profusely, into the ambulance. Those paramedics are now being monitored for symptoms.
After Duncan was brought back to the hospital, ambulance #37 remained in use for another 48 hours. Paramedics who staffed it during that time and the patients they picked up are also being monitored. Dallas health authorities spent much of Sunday looking for a homeless man who rode in the ambulance.
Dallas isn’t entirely to blame for missteps. The CDC had failed to alert officials that ambulances should be equipped for answering possible Ebola calls , and any ambulance used for that purpose should be taken out of use.
In fact, on August 5, the CDC held a conference call with hospital administrators and doctors and this very issue was raised. One questioner asked whether feverish patients who had traveled from West Africa should stay put or be brought into the hospital. A CDC epidemiologist, Barbara Knust said they should be bought in for evaluation. But neither Knust nor any other CDC expert on the call warned about ambulance use.
After all, the ambulance that the CDC used to bring two Ebola infected health care workers to Emory University hospital was lined with bio-containment sheets, and paramedics wore Tyvek suits and hoods with build-in respirators. Afterward, that ambulance was put through a two-and a half hour decontamination process. Not so in Dallas. Not until October 1, after the Dallas fiasco, did the CDC issue guidelines for ambulances.
Officials were also caught unprepared to dispose of Duncan’s contaminated bedding and clothes, as well as waste from the hospital, because two federal departments, Transportation and Health and Human Services, are still wrangling over rules for transporting virus-laden items on highways.
Dallas’s plight is a warning to get ready. That means equipping first responders and drilling ER and 911 personnel to pay attention to travel histories.
New York City is sending actors into public hospitals to test ER staff for readiness. Most importantly, hospitals need to double down on the infection control procedures doctors and nurses should be following every day.
Medical mistakes such as missed diagnoses, medication errors, and infections caused by lax hospital procedures lead to an astounding 400,000 deaths in the U.S. each year, according to the Journal of Patient Safety.
Lack of rigor is to blame.
Hurried cleaning staff overlook half the items in a hospital room when preparing it for the next patient. The germs are left to linger, causing an infection.
Stressed medical staff frequently fail to clean their hands in between patients, carrying germs from one bed to the next.
Preparing hospitals to cope with Ebola will encourage discipline and attention to correct procedures. That will save lives, even if we're lucky enough to be spared more cases of this deadly virus.