A recent article in the British Medical Journal, titled “Post-Ebola Reforms: Ample Analysis, Inadequate Action[1]” concluded that the world is not prepared for the next infectious disease outbreak.
Using studies conducted in the aftermath of the 2014 Ebola outbreak, the researchers concluded that there are three categories of improvement needed to combat the next outbreak more effectively: better compliance with International Health Regulations, Reforming the World Health Organization, and improving research and knowledge sharing.
While those are surely important steps in global response, what does that mean to our local healthcare facilities? The Ebola response in the United States during the fall of 2014 was a perfect storm; widespread 24/7 coverage by the media, an overabundance of opinions about proper response, and endless committee meetings that resulted in some healthcare facilities never having a final plan by the time the event had concluded.
We saw similar responses during the 2002 Severe Acute Respiratory Syndrome (SARS) outbreak and the 2009 H1N1 Influenza Pandemic. In both events, a “seat of the pants’ response emerged, with initial over-reaction by healthcare organizations (closing schools, ineffective quarantine, misdiagnosis, confusion on proper personal protective equipment), that gradually transformed into an optimal response, due to the number of cases being seen and the need to be more efficient in the care of patients and protection of healthcare providers. Unfortunately, the United States never saw enough cases of Ebola to get to an optimal response, and so issues linger.
Ebola was first discovered in 1976. Since then, we have been collecting information on the transmission, treatment, and personal protective gear needed for someone suspected of and diagnosed with the disease, yet it all seemed to disappear when the first case diagnosed in the United States occurred in Dallas, Texas in September of 2014.
The reason is clear: while we had 41 years’ worth of research on Ebola outbreaks overseas we did not have 41 years of research on Ebola in the United States. With our modern healthcare facilities, advanced equipment, and infectious disease leadership, it would seem we should have had an easier time of diagnosing and treating the disease, but we didn’t.
What can your facility do to better respond to the next outbreak, whether it’s local to your community or widespread? Here are some tips:
- Lead with your emergency management team: Infectious disease response is a multi-disciplinary effort; an emergency management team’s strength is the ability to bring together experts, coordinate a response, and develop plans of action. These specialized skills are normally not part of a clinician’s practice. Your EM team is also skilled at communicating across disciplines to keep people informed.
- Trade your committees for a team of experts: Navigating a response through various committees can delay the proper response (Ask yourself how are your standing committees at accomplishing tasks quickly during normal operations?) Assemble a team of experts, prepare guidance and communication, and use that team as the source of information for your organization. The team members can also ask as liaisons to their peers to get messaging out and feedback in.
- Pick a source: Everyone has an opinion, and it was interesting to see the various guidance issued by the World Health Organization, the Centers for Disease Control and Prevention, and other organizations and experts. Pick one and follow-through. Copy and paste among agencies and experts will lead to confusion to your field teams.
- Communicate early, often, and honestly: One of the first messages that should have been communicated to healthcare staff is “most of you will not care for a confirmed Ebola patient.” Yet we were training food service staff on wearing PPE. Keep everyone informed, keep the designated caregivers trained, and don’t let cable TV be your information source.
- Work with your local public safety providers and public health departments: Healthcare providers understand infectious disease, standard, droplet, and airborne precautions. Prehospital providers understand level A, B, C, and D protection primarily for chemical emergencies. Ebola is not a chemical, and the miscommunication resulted in improper gear being used not only by the healthcare facility but by the prehospital providers as well. Be not only the infectious disease expert for your facility but your community.
- Have a distinctive end to the event: Eventually, the event will end. Plan for it, acknowledge it, and notify everyone that the event is over. It gives people a reference point for returning their lives to normal. Use the lessons learned in your facility and community to make improvements and plan for the next outbreak.
About the Author
Scott Cormier is the Vice President of Emergency Management, Environment of Care (EOC) and Safety at Medxcel Facilities Management, specializing in facilities management, safety, environment of care and emergency management and provides healthcare service support products and drives in-house capabilities, saving and efficiencies for healthcare organizations that, in turn, improve the overall healing environment for patients and staff. Cormier leads the development and implementation of emergency management, general safety, security, fire protection, life safety and accident-prevention programs for a national network of hospitals that Medxcel Facilities Management serves.
Resources
[1] Moon Suerie, Leigh Jennifer, Woskie Liana, Checchi Francesco, Dzau Victor, Fallah Mosoka et al. Post-Ebola reforms: ample analysis, inadequate action BMJ 2017; 356 :j280
