Omaha’s experience treating Ebola leads to federal funds, enhanced training opportunities

An Omaha Fire medical technician prepares for the simulation of an Ebola patient transfer. (Photo by Bill Kelly, NET News)
An architect's rendering of the future iEXCEL building containing the Center for Health Security. (Photo courtesy of UNMC)
Medical Center Chancellor Jeffrey Gold at the federal funding announcement. (Photo by David Koehn, NET)
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December 14, 2016 - 6:45am

Two years after Ebola patients arrived in Omaha for treatment, the University of Nebraska Medical Center continues to refine procedures for handling patients with dangerous diseases. The experience has paid off in significant ways.


 

Dr. Chris Kratochvil, associate vice chancellor for clinical research, UNMC, explains training center layout during a news media briefing. 

 

Biocontainment Unit team members explore a 3-D imagery demonstration similar to tools used for virtual reality training (Photos by David Koehn, NET)

 

In November, UNMC was selected by the U.S. Department of Health and Human Services (HHS) to host a multi-million dollar training facility on its campus for government workers responding to disease outbreaks anywhere in the world.

In addition, the hospital’s biocontainment unit recently conducted a major drill on behalf of the U. S. Department of State to practice evacuation of simulated Ebola patients from Africa.

The new training facility, scheduled to open in 2018, compliments on-going training underway at UNMC. It positions the school as “a worldwide leader in the fight against Ebola and other highly infectious diseases,” according to Congressman Brad Ashford of Omaha.

The $19 million in HHS funding is for development of what the university describes as “a training, simulation and quarantine center.” A curriculum will be developed to train people on procedures used to treat highly infectious diseases.

“The idea is these folks are going to have to be trained on how they're going to be able to keep themselves safe and keep their teams safe when they get out into that environment,” said Dr. Chris Kratochvil, associate vice chancellor for clinical research at UNMC.

The center will take advantage of a variety of new technologies to provide individuals with trained in lifelike simulations of situations they may face in the field.

Instructors standing in the facility in Omaha will guide trainees through realistic three-dimensional computer models where they will be sent to respond when a deadly disease breaks out. 

Speculating on the range of environments that could be created, Kratochvil said the computer simulations might render “a tent in West Africa, a street in Paris (or the) inside of a hospital room with a patient at a modern medical center.”

While adjusting to a variety of surroundings participants can also encounter digital replications of people suffering from the symptoms of the diseases they may encounter in the field.

Kratochvil says the technology allows instructors to “control that environment” and “recreate some of the scenarios that a health provider may face in this austere environment.

“It may be going into a family's home and helping to assess what's going on there and how are they going to safely interact with the patient in that setting,” Kratochvil said. 

Plans for the facility include a dedicated “quarantine center” designed to isolate and monitor persons who have received a high-risk exposure to dangerous diseases, but have not yet shown outward signs of infection. Like the UNMC Biocontainment Unit, the center will feature special air-handling and safety mechanisms to protect the public and hospital staff.

A spring groundbreaking is expected on the center. The university decided the Center for Health Security was a good addition to a new facility already planned for the campus. The iEXCEL program provides high-technology training for all aspects of health care, including the use of telemedicine, robotics, and virtual reality computer modeling.

Nebraska Medicine, the private hospital affiliated with UNMC welcomed the addition to the Omaha campus. "We saw during that crisis the importance of preparation. This grant helps us prepare for what's next,” said Dr. Daniel DeBehnke, Nebraska Medicine’s CEO in a prepared statement. “Nebraska will again be ready to lead the way in teaching others how to help."

At the news conference announcing the funding, Medical Center Chancellor Jeffrey Gold said the center addresses an important need in training for those responding to public health emergencies around the world.

“A day doesn’t go by that you can’t read about highly infectious agents breaking out in some part of the world,” Gold said. “With current transportation that problem can be in our neighborhood, in our homes, in our schools, in our churches literally overnight.”

The West Africa outbreak killed over 11,000 people in 2014, including dozens of health care providers and others attempting to deal with the pandemic.

 

Firefighters and doctors unload a "patient" from a 747 medical transport as part of a training exercise. 

an ambulance crew in full personal protective equipment tested during the drill. (Photos by Justin Cheney, NET)

 

After the American Ebola patients were sent to UNMC, the biocontainment unit staff developed a reputation as experts in handling patients suffering from dangerous diseases. These sorts of highly contagious pathogens can put entire communities at risk. Similar work was carried out by hospitals at Emory University in Atlanta and the National Institute of Health outside of Washington, D.C.

An exercise held late in November demonstrated how hands-on training needs to supplement.

In the simulation three “patients” were flown aboard 747 medical transport from Liberia in West Africa to the airport in Omaha. The patients (two human actors and a third training mannequin) were taken off the plane and transferred into a convoy of three ambulances in a carefully choreographed procedure used to handle patients with highly contagious diseases.

Crews from the Omaha Fire Department shuttled the original Ebola patients from their air transports to the hospital. To use three separate ambulances for this drill they enlisted crews and trucks from Bellevue and Papillion, Nebraska.

Discussing these types of exercises prior to the November event, John Lowe, the Med Center’s infection control specialist, said the university’s biocontainment unit regularly tests all of the procedures used to safely transport and handle difficult cases.

“That would allow us to test the full spectrum of protocols down to the minute detail and recognize things that we felt could be changed and done better,” Lowe said. “We'd make those changes and in the next year we would test those.”

The simulation was familiar territory for Lowe. Prior to the Med Center accepting the Ebola cases two years ago, he was assigned to develop safe methods to get infected patients from any location to the hospital where they would be isolated, secured and treated.

The three real-life American patients airlifted out of Africa in 2014 were delivered one at a time over the course of three months. Had all three fallen ill at the same time, they would not have been able to be simultaneously carried to the U.S. using the single Gulf Stream jet maintained by a private medical transport provider. After the Ebola pandemic receded the U.S. Department of State and the hospitals able to provide high-risk treatment talked through how they would evacuate multiple patients at one time.

The latest training simulation was a success according to Kratochvil.

“We really got this very close to what real-life would be and a huge number of learnings there in how do you coordinate transport and how do you coordinate the vehicles and getting them into the hospital,” Kratochvil said.

In the hours before they received the patients the emergency crews lined the back end of the ambulances with industrial-grade plastic sheeting to protect interior surfaces from fluids that could transmit the virus.

Some EMTs donning the full-protection biohazard suits and the breathing apparatus needed a little additional guidance from UNMC staff who treated actual Ebola patients.

The condition of each “patient” was relayed back to the exercise leaders in Omaha. As he would in an actual transport of an Ebola patient, the fire department’s chief medical officer warned the EMT’s “we don’t do IV’s. We don’t do crazy stuff. If (in a real situation) they were doing CPR, that person would be dead” and advised that should a patient be in trouble on the way to the hospital the crew should not put themselves at risk and simply advise the ambulance driver “to step on the gas.”

UNMC’s Lowe says it’s import crews get a sense in a drill what is at risk when faced with actual cases of a highly infectious disease.

“I think that that helps us, when we go out and ask someone to presumably put their own wellness at risk by entering this environment,” Lowe said. “They're able to make that decision in an informed manner based on science.”

The weather provided a real-life slap in the face that computer models can’t duplicate. Bitterly cold 40-mile-an-hour winds ripped the protective face masks off of the EMTs and rattled the elevator platform delivering patients from the plane to ambulances below.

As the convoy of ambulances prepared to head to the hospital, a team member in a biohazard suit walked down the airplane’s stairway, carefully wiping down the railing with disinfectant. In these drills, getting it right while pretending avoids mistakes when it’s real.

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