When Ebola Shows Up At Your ED

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Tintinalli in Tyvek Suit 90x90Something looked amiss. Three guys from ID were standing at the front desk of our lower acuity area, serious-smiling at me as I walked in for my shift. “Hey Dr T! We’ve got an Ebola suspect in room 64 for you. Don’t worry, we’ll walk you through this.”

 


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Something looked amiss.


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Three guys from ID were standing at the front desk of our lower acuity area, serious-smiling at me as I walked in for my shift.

“Hey Dr T! We’ve got an Ebola suspect in room 64 for you. Don’t worry, we’ll walk you through this.” 

Gulp. And this wasn’t even supposed to be my shift.

They helped me put on a protective suit, big boots, two face masks, two sets of gloves, and hung a disposable stethoscope around my neck. I was shown a laminated sheet of paper with the clinical criteria for Ebola shown below (source):


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Ebola Facts:

  • Transmission: Direct contact with saliva, sweat, urine, feces, blood, semen of those suspected of having Ebola; or direct handling of bats, rodents, or primates from disease-endemic areas
  • Contagion: 3-21 days; not transmissible during incubation phase
  • Clinical Criteria: Recent travel to Ebola area and T≥38.6 and additional symptoms; severe headache, muscle pain, vomiting, diarrhea, abdominal pain; unexplained internal or external bleeding

Exposure Risk Level:

  • High Risk: Needle stick or mucous membrane exposure to blood/body fluids of Ebola patient; direct skin contact or exposure to blood or body fluids without appropriate PPE; processing blood or body fluids without PPE or biosafety precautions; direct contact with dead body without PPE in setting of Ebola outbreak
  • Low Risk: Household contact with Ebola patient; direct brief physical contact (handshaking, hugging) without PPE; being within three feet of an Ebola patient, or within the room or providing care without PPE (Brief exposure, such as walking by a person or moving through a hospital, is not close contact)
  • No Risk: No criteria for high or low risk

 “What about that cab driver who got sick?”

“Don’t worry,” they said, “he got the disease from somebody else, not from a passenger in his cab.”

“Listen, if I get sick will you fly me to Atlanta and give me Zmapp?”

“Sure,” they said.

“And, I’m going to throw away my favorite scrubs after this. Will you get me another set from the OR?”

“Sure,” they said, “anything you want.”

I took a deep breath, and went in to greet the patient who was still fully clothed, coughing and wearing an ear-loop face mask. The patient was scared to death. On exam, he wasn’t toxic, had no rash, had no active nausea or vomiting, and exam otherwise normal. AFEBRILE! NORMAL VS! I came out of the examining room. The ID guys stepped back about three feet away from me.

“Well?” they said. I reported back to them with exam findings and a detailed listing of the patient’s activities and contacts for the past two weeks. He had been to a hospital, walking through corridors to visit a colleague.

“Wait here, we have to call the local and state health departments. Don’t order any meds, IV’s, bloods, or xrays until we determine his risk level.”

I was sweating in my outfit. One of our favorite nurses was standing by, should she be needed. She volunteered because she was the only one on shift in our area who had no children and was single.

About 1.5 hours later, I received the final decision: No risk. ID left. I threw my garb into the hazardous materials containers. The patient got tearful with joy. I went back to see my backlog of patients.

 

Judith Tintinalli, MD, MS is the Editor-In-Chief of Emergency Physicians Monthly

 

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Tanneh, a Mental Health Counselor at ELWA 3, asks her colleagues on the other site of the fence for supplies. ELWA 3 is the Ebola Case Management Center run by Doctors Without Borders (MSF) in Monrovia, Liberia.

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New mattresses lie in an empty tent at ELWA 3 as the construction team prepares for new patients.

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Patients rejoice in song and dance praising God because they are feeling better.

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A colleague throws a bucket across the fence to Tenneh on the inside of the patient hot zone at ELWA 3.

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Photos courtesy of Morgana Wingard, for MSF

 

 

1 Comment

  1. Donald Kamens on

    Judith:
    Good that you brought this up, and clearly had you written this 7 days later (10/1), you would have had the opportunity to include the Dallas event in which a traveller from Liberia was sent home from an ED with antibiotics after being seen for fever. Whether the 4 days of exposure to others in Dallas, during his infective perod will result in spread is yet unknown. But for us in the ED, a high degree of suspicion is warranted whenever exposure is possible.
    DK

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