A nurse at an emergency room or a neighborhood quick clinic has probably asked you, “Have you been outside of the United States in the last 21 days?” The inquiry became common practice after the Ebola outbreak killed thousands in West Africa.
AFTER EBOLA is a special reporting project of NET News.
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Part 4: Rural Hospitals Prepare
For hospitals across America, the epidemic and the prospect of receiving such high-risk patients alarmed many in the business of health care. In Nebraska, awareness peaked when the University of Nebraska Medical Center was selected to care for three of those stricken with the virus.
“Ebola changed everything due to fear,” recalled Jolisa Reisland, a registered nurse and the infection prevention specialist at Good Samaritan Hospital in Kearney, Nebraska. “Everyone was afraid. Everyone was scared. Everyone thought they were going to get Ebola.”
For hospitals thousands of miles away from the outbreak, there were essential lessons learned about the importance of planning ahead and understanding highly contagious diseases could show up in any medical facility.
“We may be the first ones that would see (a dangerous virus) in the United States. We know that it's going someplace first,” said Dr. Brady Beecham, a family medicine physician with Lexington Regional Health Center. “I think it could just as easily be here in central Nebraska as any place in the country.”
At the Nebraska Biocontainment Unit (BCU), the medical team knew days in advance an Ebola patient was on the way. The executive director of emergency preparedness at Nebraska Medicine, Michelle Schwedhelm, recognizes community health care facilities may not know anything about an arriving patient when they walk through the door.
“Every health care facility needs to know how to screen at the front doors,” Schwedhelm said. “Asking the right questions about patient symptoms and travel history’s critically important these days because with the speed of travel. We need to be mindful.”
As Ebola fears spread in 2014, The U.S. Centers for Disease Control (CDC) issued guidelines recommending patients be asked at intake about visits to West Africa and whether their symptoms were consistent with Ebola.
The CDC recently dropped requirements for Ebola-specific screening, but still advises facilities obtain a patient’s travel history.
The Nebraska state epidemiologist, Dr. Tom Safranak, says it’s necessary because a patient’s virus could sicken an entire emergency room staff overnight.
“When your hospital work force at the facilities is decimated, then you're really straining your care provision resources,” Safranak said. “It's a major problem.”
Kearney’s Good Samaritan has “a rigorous screening process” according to Reisland, relying on what they call a “Yes-Yes” system.
If an incoming patient reports traveling to a country known to have a contagious disease outbreak, that is the first “yes.” Having matching symptoms is the second.
“If we would get a “yes-yes” they would get a mask, sometimes gloves, depending on what illness, and we would have a nurse come out and escort them to a room right away,” keeping them at a safe distance from others in the hospital.
“Prior to all this, if someone had presented with some of those symptoms at where we check into our emergency room, they would have gone back to the emergency room,” said Sue Hunter, the house supervisor at Good Samaritan. That would have risked a lock down of the emergency room, and that, Hunter said, “would create quite a problem.”
The risk of emerging and as of yet unidentified viruses popping up in the smallest communities in the country causes public health officials like Safranak to ask if they have “fully connected with the emergency departments to keep tuned into the potential for the really unusual illnesses.”
Emphasizing awareness about what new viruses have been reported combined with ongoing training remains a high priority for Hunter at Good Samaritan.
“The best thing we can do is get out in front of it with the education and provide the protective equipment that they need,” she said.
Equipment and planning ahead became the other lesson learned from the Ebola outbreak.
Much research at the Nebraska biocontainment unit went into refining and selecting equipment which provided the greatest protection for the staff treating the Ebola patients.
Schwedhelm said equipment for smaller hospitals doesn’t have to have “all the bells and whistles” found in their personal protective equipment (PPE).
“It can be as basic as a gown and a mask and your gloves, but making sure that those things are available for people in entry areas in health care whether that’s a clinic or in the ERs or wherever,” when the unexpected case arrives.
In 2014, with fresh fears Ebola could travel to America, federal health officials advised hospitals to stock up on protective gear. It was part of Reisland’s job to order supplies for the hospital, including PPE and personal respirators used to safely filter air.
“When Ebola was here, there were several supplies that we just could not get,” Reisland recalled. “They went on back-order almost immediately, even though we tried very early on in the process to obtain some of those supplies.”
Today, Good Samaritan routinely refreshes its supplies of disposable protective suits and suitable footwear.
Because an Ebola scare can sustain itself only so long, public health officials worry medical professionals may get complacent. As veteran employees with an institutional memory move on, new people move in without the same level of caution or knowledge of protocols and procedures.
Reisland believes it’s important for hospitals to develop “at a minimum a general level of preparedness at all times; being prepared for anything that may come through.”