Nebraska Ebola cases continue to provide guidance to other hospitals

Ebola training drill in 2015. (Photo courtesy Offutt Air Force Base)
Biocontainment unit training. (Photo courtesy UNMC)
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April 17, 2017 - 5:26pm

The Nebraska Biocontainment Unit had just admitted only the second Ebola patient ever treated by its medical team. So little was known about how to safely treat the disease that they had become instant experts.

AFTER EBOLA is a special reporting project of NET News.

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Part 1: The Lessons Learned

Part 2: The Ebola Survivor

Part 3: How Families React

Part 4: Rural Hospitals Prepare

Michelle Schwedhelm, the manager of the unit, found her e-mail box full and her phone. Her phone rang almost non-stop with other hospitals frantically looking for answers.

“I think there was tremendous fear that somebody was going to show up in their place and they really didn’t have the understanding or knowledge to know what to do,” Schwedhelm recalled. “Everybody as very concerned and we had knowledge.”

The lessons learned by the team treating Ebola patients in 2014 continue to be shared with hospitals all over the world through articles published by leading medical journals.

In Nebraska, a series of training sessions for hospitals across the state encouraged hospitals of all sizes to make preparation for highly-infectious diseases part of disaster planning and routine staff education.

The experiences of a very few doctors, nurses and technicians at a handful of hospitals became invaluable when shared with the world’s medical professionals.

“It gives you sort of the evidence to say, ‘this is what we should do,’" said Dr. Ali Khan, dean of the College of Public Health at the University of Nebraska Medical Center. “It's no longer theoretical. It's here in the U.S., when you see patients this is what you need to do to protect your staff.”

In many instances Emory University in Atlanta and the University of Nebraska faced the first real-world tests for American hospitals dealing with a wide range of issues: the organizational challenges, the complexity of transporting Ebola patients by ambulance, and, in the event of the death of a patient, the dignified and safe removal of human remains.

This came at a time when thousands were dying of the highly-infectious virus in West Africa. Health care workers were at extreme risk. In August 2014, two American doctors were successfully treated in the isolation ward at Emory.

With more patients arriving, public health officials grew increasingly concerned with the lack of experience and training given to handling highly infectious diseases by hospitals in North America. Writing for the National Association of State Emergency Management Officials, Laura Stokowski, a registered nurse, found healthcare facilities “scrambling to put into place Ebola preparedness” without "making it up as we go along."

The third American patient, Dr. Richard Sacra, was sent to the University of Nebraska Medical Center. The biocontainment unit on campus had been training and doing research in how to respond to highly infectious diseases for nearly 10 years.

Creating a set of safety protocols covering dozens of ordinarily routine hospital practices is part of what gave the Nebraska team the confidence to care of an Ebola patient.

“That's one thing that makes our facility different than a regular hospital,” said Dr. Angela Hewlett, the medical director of the Nebraska biocontainment unit. “We had a lot of our protocols on waste disposal and caring for the patient and what we were going to wear into the patient care room. Things like that were already established.

Part of the mission of the unit is the make sure precautions are taken to keep people safe.

Hewlett explained that if members of the team got sick “there was a possibility that we could spread that disease in the community.”

“That was something that was always in our minds. We want to make sure and do everything that we can to try to protect not only ourselves but the community at large.”

After treating the Ebola patients, the Medical Center received hundreds of requests for training on how to best use the easily recognizable protective clothing worn by the team. In turn a group of doctors and nurses authored an article for the American Journal of Infection Control detailing the process for safely removing contaminated protective gear.

“We probably have hundreds of drafts of how we put on and take off our equipment,” said John Lowe, the biocontainment unit’s director of research. Using regular training and drills to test the procedures, Lowe and the team would routinely make changes, large and small.

“Every time we felt like our protocol was good, we would go through and reevaluate it and ultimately find ways that we felt we could make it better,” Lowe said.

The simple but essential safety step added by Nebraska was requiring that a helper, also in full protection, assist every person who had been inside the “hot zone” with safely removing their gear. When the unit was active the steps were handwritten on poster-sized sheets of paper to guide the team and alert them to any changes in the protocol.

Angela Vasa, a nurse who worked on all three of the Ebola cases, said having “a doffing partner whose sole job at that moment is to safely get your gear off of you makes it that much more successful.” She and others credit the strict policy for keeping more than 40 members of the medical team safe despite the high-pressure environment of treating Ebola patients.

Other published medical journal articles included how to screen and assess whether a patient is infected with Ebola, safely handling laboratory samples containing the virus, and the behavioral health of the health care working under high stress levels when the biocontainment unit was active.

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