Stanislaus County health workers prepare in case Ebola arrives

American Medical Response paramedic Kristy Kuhn wears personal protective equipment, used when dealing with infectious patients, in Modesto, Calif., on Monday, Oct. 6, 2014.
American Medical Response paramedic Kristy Kuhn wears personal protective equipment, used when dealing with infectious patients, in Modesto, Calif., on Monday, Oct. 6, 2014. aalfaro@modbee.com

American Medical Response is advising its ambulance crews to ask two questions of patients they encounter.

Do you have a fever, chills, joint pain, vomiting or abdominal pain? And during the past 21 days, have you traveled to the West African countries of Guinea, Liberia, Sierra Leone, Nigeria or Senegal?

The ambulance company serving Stanislaus County and many other areas of the country said it began to prep for the possibility of Ebola more than a month ago, putting protocols in place for transporting infected patients while protecting ambulance crews.

Local hospitals, clinics and health agencies said they, too, are preparing for the possibility of an Ebola outbreak. Officials stress that there are no cases of the deadly disease in California. But a man who had traveled from Liberia was diagnosed with Ebola on Sept. 30 in Texas.

Dr. John Walker, county public health officer, said the first Ebola case to occur in the U.S. is more reason for health care providers to prepare. A joint meeting of the county’s contagious disease task force and emergency preparedness council will be held next week to discuss Ebola, he said. The two groups include officials from hospitals, infectious disease nurses, school nurses, emergency responders and members of the jail medical system.

In the past several months, county public health has received information from the Centers for Disease Control and Prevention, such as checklists for patients being evaluated for Ebola, and passed it to hospitals and clinics, Walker said.

The key message for health care providers is to ask about the recent travel history of patients and isolate them in the facility if it appears they may have Ebola, Walker said. He said Ebola symptoms are similar to other illnesses, so it’s essential to know their travel history.

The disease is a viral hemorrhagic fever. The symptoms, including fever, headaches, muscle aches, fatigue, vomiting and stomach pain, may occur two to 21 days after infection. Ebola is spread by contact with bodily fluids of an infected person or someone who has died from the illness. It is not transmitted through water, the air or food commonly eaten in the United States.

The recent outbreaks of Ebola in West Africa have killed more than 3,400 people.

Mistakes were made in handling the Ebola case in Dallas. The patient, Thomas Eric Duncan, first was sent home from a hospital with antibiotics, and his travel history given to a nurse was not passed to doctors. The CDC had to scramble to identify people who had been in contact with Duncan.

Training still lacking

National Nurses United has claimed that lack of preparedness is putting front-line nurses in jeopardy at hospitals across the country. The union said a survey found that 80 percent of nurses reported their hospital had not communicated guidelines for admitting patients infected with Ebola. Thirty percent said their hospital was short on supplies such as eye protection and protective gowns. The union said 1,400 nurses responded to the national survey.

Amy Glass, an intensive care nurse at Kaiser Modesto Medical Center, said she has not received face-to-face training on caring for patients with Ebola. She also does not know proper techniques for putting on the special clothing and eyewear or removing those items after they’ve been soiled by caring for an infected patient. “It does not matter what health system you are talking about, we are not prepared,” Glass said. “They have inadequate supplies because they like to do a just-in-time response.”

The nurses union plans an Oct. 26 town hall in Manteca on the training gaps, featuring a panel of nurses from health systems including Kaiser, Sutter Health, Tenet and Dignity Health.

Kaiser’s Modesto hospital has two rooms that are specially equipped for isolating and treating a patient with a deadly contagious disease such as Ebola. Those type of rooms also exist at Doctors Medical Center and Memorial Medical Center, both in Modesto.

Local hospitals mobilize

Most of the hospitals in Stanislaus County responded with emails when asked about planning and staff training for Ebola.

Kaiser said it’s fully prepared to evaluate and treat suspected cases of Ebola while protecting its health care teams. According to the statement, the staff at Kaiser’s south Sacramento hospital was well-trained and equipped to handle a suspected Ebola case in August. The patient was placed in a negative pressure room; tests determined the person did not have Ebola. Kaiser’s regional emergency team “is taking what we learned in South Sacramento” and will do additional training and simulation drills, the statement said.

A spokesman for Memorial Medical Center of Modesto wrote that a Sutter Health emergency planning team had developed workplace and patient-care guidelines for Ebola at hospitals and clinics in the past couple of months. Spokesman Craig Baize wrote that it included protocols for screening and care of patients, safety guidelines for staff, and practices such as isolation procedures, hand-washing and use of personal protective equipment.

His email said emergency rooms were screening and monitoring for the Ebola virus and following procedures of the CDC and California Department of Public Health. Sutter is affiliated with Memorial, Sutter Tracy Community Hospital and Memorial Hospital Los Banos.

Lani Dickinson, chief nursing officer of Doctors Medical Center, said the Modesto hospital has the recommended supplies for staff, such as face masks, eye protection and impermeable gowns. The hospital is starting to hold drills to reinforce staff education for identifying and isolating a patient with a deadly contagious disease and plans to participate in a countywide drill, Dickinson said Monday.

The director said the hospital has several rooms equipped for isolating any patients with Ebola. She noted that private rooms can be used for that purpose if procedures are followed. Dickinson said the hospital could handle the supportive treatment usually given to an Ebola patient.

Pennie Rorex, spokeswoman for Emanuel Medical Center of Turlock, wrote in a statement that “hospital staff are alert to identify patients with symptoms consistent with Ebola, especially if they have traveled to parts of Africa where many cases of Ebola have occurred.” The hospital was prepared to triage, evaluate and isolate any patient who appears to have Ebola symptoms, she added.

Response plans in works

Walker said a team consisting of county and state public health and the CDC would respond if there’s a suspected Ebola case here. “We have a responsibility to notify the state and the state has the responsibility to notify the CDC,” Walker said. “The CDC’s role would be to advise us.”

Local agencies have used Homeland Security funds to purchase emergency response equipment for disasters caused by biological agents, nuclear devices or terrorist acts. The county could also draw on additional resources from an 11-county mutual-aid region to deal with a larger disease outbreak.

Walker said contagious disease task force members still are discussing matters, such as whether a patient with Ebola would stay long in a local hospital or be transferred elsewhere. “It’s important the public knows we have been working to prepare and protect the residents of this county,” Walker said.