Dallas (TX) Fire Department responds to Ebola patient
Emergency medical service (EMS) crews of the Dallas (TX) Fire Department responded to the first confirmed case of Ebola reported in the United States. The EMS providers are members of the International Association of Fire Fighters (IAFF) Local 58. They treated and transported the Ebola patient to the hospital at the end of September; he died in early October. According to the IAFF Web site, the EMS members were taken off duty with pay and were under continuous medical observation at their homes at press time.
The IAFF is urging every affiliate to conduct a “safety stand down” in the department to review all infectious exposure policies, procedures, and guidelines. The assessment should cover also whether the department is prepared to respond to and care for patients with possible symptoms of the Ebola virus: Is there enough equipment? Are the members trained to respond safely to worst-case scenarios involving potential Ebola exposures?
The IAFF recommends that departments follow all policies, procedures and guidelines, including “standard precautions, including fluid-resistant and or impermeable long-sleeved gowns, single or double gloves, eye protections, leg coverings, and disposable shoe covers, as well as N95 respirators for all patients with respiratory symptoms.” (See also “CDC Posts Ebola Guidelines for EMS”)
The IAFF stresses that crew members who think they may have been exposed to the Ebola virus should NOT return to the firehouse. They should, instead, do the following: After transport, remove the unit from service while at the hospital. If an engine and EMS unit both respond, they should stay together throughout the call to keep other firefighters from potential contamination. Exposure reporting should be activated from the hospital or while en route to the hospital with the patient.
The IAFF’s complete list of recommendations is at “Safety Stand Down for Ebola Preparedness http://bit.ly/1uAPBqO
Various other resources for guidance relative to Ebola are accessible at www.cdc.gov (Centers for Disease Control and Prevention). In addition, the CDC will hold a Webcast on the issue tomorrow between 3-4 p.m. EDT.
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Ebola Crisis in Spain Demonstrates the Need for Professional Crisis Management
Lessons Learned
The Ebola case in Dallas and its evolving consequences have yielded some valuable lessons learned for EMS responders and their departments. According to President of IAFF Dallas Local 58 Doug Dickerson, the Dallas paramedics were to have been under observation for at least three weeks (one week after press time) after contact with the infected patient. Dickerson stressed, however, that the paramedics say they were not in contact with the patient’s bodily fluids. He said family members met the responders outside the home and told them the patient may have had Ebola. The paramedics donned protective masks and gloves before entering the house, administered an IV, and transported him to the hospital. They alerted hospital officials of the patient’s symptoms and possible exposure to Ebola. After the hospital run was concluded, the EMS responders decontaminated the ambulance according to protocol.
The department instituted added precautions in response to this case: Fire department dispatchers now inquire whether the patient in need of medical assistance is running a fever. If so, responders wear their personal protective equipment, and paramedics advise the hospital so that its medical personnel can be prepared to receive a patient that may expose others to Ebola.
Dickerson cites two “important” lessons learned by the Dallas Fire Department: (1) EMS personnel/paramedics who believe that they may have been exposed to Ebola or other infectious disease must notify their fire department officials as well as the receiving hospital; and (2) Firefighters and paramedics must constantly be vigilant and follow universal precautions when tending to all patients. Dickerson’s complete comments are at client.prod.iaff.org/#contentid=4011
According to a report by Susan Schrock of the Star-Telegram, Arlington, Texas, firefighters have also been affected from the fallout of the possible exposure of EMS crews of the Dallas Fire Department to Ebola, the contracting of the Ebola infection by two nurses at Texas Health Presbyterian Hospital Dallas, and the potential for more exposures among individuals who have had connections with the hospital and the deceased victim. David Stapp, Arlington’s medical operations battalion chief, cites the need to prepare, even though at press time there were no individuals in the community who represented a high risk based on CDC criteria.
Some of the action’s Arlington’s 911 center has taken in response to the situation include the following:
- Ask if the person in need of medical assistance has a fever or specific symptoms associated with Ebola and if the patient had recently been in one of the areas where Ebola is prevalent or has been in contact with anyone who has contracted or is being monitored for Ebola. In cases where there may be some concern about the potential for being exposed to Ebola and if the patient’s condition is not immediately life-threatening, only one firefighter, dressed in protective clothing, would make contact with the patient to conduct an in-person assessment until the patient had been thoroughly screened.
- A specially prepared ambulance that can be easily decontaminated is now on standby. • Chief Don Crowson notes that the city’s medical director (or another appointed official in the case management team) will work with Tarrant County Public Health, the state health department, and the Centers for Disease Control and Prevention to determine to which area hospital the patient should be taken.
- Arlington and some other area departments have acquired or will be acquiring infrared thermometers, which can be used to measure body heat while a few inches away from the patient (usually the forehead) instead of having to be in contact with the body as traditional thermometers. Departments are also purchasing additional personal protective gear.
- Training is being provided on the proper method for donning and securing personal protective gear. To minimize the chance that firefighters could accidentally expose themselves to the Ebola virus, in Arlington, the hazardous materials team will be responsible for removing the protective gear from firefighters who come in contact with a patient suspected of having Ebola. • To protect patient privacy and not promote fear in the public, Arlington 911 dispatchers have been instructed not to mention “Ebola” when communicating over the radio with first responders. Schrock’s full report is at http://bit.ly/1w4ouda
On the National Front
The Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security’s Customs & Border Protection (CBP) introduced additional procedures for screening travelers entering the United States from Guinea, Liberia, and Sierra Leone, where the Ebola virus has been a serious health problem. The five airports were selected because they receive more than 90 percent of the passengers from these countries. The airports are New York’s JFK International Airport, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta international airports.
“CBP personnel will continue to observe all travelers entering the United States for general overt signs of illnesses at all U.S. ports of entry and these expanded screening measures will provide an additional layer of protection to help ensure the risk of Ebola in the United States is minimized,” said Secretary of Homeland Security Jeh Johnson. CDC is sending additional staff to each of the five airports.
These new measures complement the exit screening protocols used in the affected West African countries. Since the beginning of August, CDC has been working with airlines, airports, ministries of health, and other partners to develop exit screening and travel restrictions in Ebola-affected countries.
All outbound passengers are screened for Ebola symptoms in the affected countries. In the past two months since exit screening began in the three countries, of 36,000 people screened, 77 people were denied boarding a flight because of the screening results, but none of the 77 passengers were diagnosed, according to the CDC. Exit screening at airports remains the principal means of keeping travelers the affected countries from spreading Ebola to other nations. These nations have asked for, and continue to receive, assistance in strengthening exit screening, notes the CDC.
Additional and up-to-date information on Ebola is at http://www.cdc.gov/vhf/ebola/hcp/index.html
In October, President Obama announced that Ron Klain would be coordinating the administration’s Ebola response. Klain had served as chief of staff to Vice President Joe Biden and former Vice President Al Gore.
MARY JANE DITTMAR is senior associate editor of Fire Engineering and conference manager of FDIC. Before joining the magazine in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’ degree in English/journalism and a master’ degree in communication arts.
