Nurses are speaking out re. CDC:
http://www.reuters.com/article/2014/10/13/us-health-ebola-usa-nurse-idUSKCN0I206820141013
http://www.reuters.com/article/2014/10/13/us-health-ebola-usa-nurse-idUSKCN0I206820141013
I'm willing to bet everything I own that those people in Dallas Presby were given crappy flimsy plastic shields, crappy masks, crappy gloves and gowns--and NOT the suits the CDC would use when working with Ebola or caring for a pt with Ebola.
In my probably idiotic opinion, that is, to you, I suppose, I think, in general, hospitals in the US can be vary careless and only do the bare minimum when it comes to infection control. I have worked in a ton of hospitals, and many of them "top of the line" medical centers. I have seen where ID decided to cut back on masks for kids on ventilators with contact isolation. I had a kid that was becoming hypoxic and bradying down. The RT and I were in there when I said "Let's suction him." I took the Mapleson and started to bag and then suction the child. ID decided contact isolation didn't require masks, so they stopped storing them in there. I guess inside the eyes, nose, and mouth don't count as mucus membrane areas. Anyway, this kid had known resistant bacteria in his mucus and trach. RT took the tubing off and turned it toward me too quickly for me to do a thing as I was bagging and preparing to suction him. We were in a hurry, and remember, ID and Cost Containment people decided to stop stocking masks in this isolation room. Guess who got hit with the junk from the kid's ventilator tubing b/c the RT wasn't paying attention? Me. It's surprising to me that the RRT didn't think what pointing a ventilator tubing from a sick child attached to a positive pressure ventilator could do to another person. It still blows my mind, and it was more than a few years ago now. I was sick as a dog for months and on multiple antibiotics, and my nurse manager and the institution could have cared less that I became infected there b/c of utter stupidity.
I will repeat myself, and it has NOTHING to do with playing MMQB. The right CDC staff should have been there and stayed there as soon as Duncan was tested positive--setting up protocols, instructing, and supervising, AND the people involved in Duncan's direct care should have had the same quality suits CDC would wear, period.
I have seen hospitals play Russian Roulette like this. It's ethically, and in my mind at least, legally wrong.
Again. How many people does it take to start an epidemic leading to a pandemic? ONLY ONE. It's not worth playing with this deadly infectious virus. There is NO excuse for this. It's time to get serious. Meanwhile, besides this nurse, there are about 50 + people that were involved in this person's care. It would not be improbable for more to test positive. And then there must be the consideration of all the people those people were in contact with. It's insane to get all hot and bothered over blame.
We should have and now need to seriously do better. If you know to do better and can do better, you must be held to accountability for not doing better. How much worse, then, is it if from this point on, if our CDC and health system and national leadership (which includes "We the people" and speaking out) don't get on the stick ASAP--I mean, like yesterday. No more excuses. No more idiotic worrying about blame. Let's get this crap under control now. Let's get the best PPE in and the best protocols and supervision and f/u in place NOW! That's all anyone with any sense cares about. Everything else is BS.
I have seen hospitals play Russian Roulette like this. It's ethically, and in my mind at least, legally wrong.
It wouldn't surprise me if true. Do you have a link?As a little medmal side note, you all know peter Rosen is now an expert witness for plaintiffs attorneys right?
Best post I've read in regards to Ebola in America thus far. The American PPE system is so flimsy it's a joke. People need to quit talking about protocol breaches because the protocol has failed. As I said in another thread, let's throw the kitchen sink at Ebola in America.I'm willing to bet everything I own that those people in Dallas Presby were given crappy flimsy plastic shields, crappy masks, crappy gloves and gowns--and NOT the suits the CDC would use when working with Ebola or caring for a pt with Ebola.
In my probably idiotic opinion, that is, to you, I suppose, I think, in general, hospitals in the US can be vary careless and only do the bare minimum when it comes to infection control. I have worked in a ton of hospitals, and many of them "top of the line" medical centers. I have seen where ID decided to cut back on masks for kids on ventilators with contact isolation. I had a kid that was becoming hypoxic and bradying down. The RT and I were in there when I said "Let's suction him." I took the Mapleson and started to bag and then suction the child. ID decided contact isolation didn't require masks, so they stopped storing them in there. I guess inside the eyes, nose, and mouth don't count as mucus membrane areas. Anyway, this kid had known resistant bacteria in his mucus and trach. RT took the tubing off and turned it toward me too quickly for me to do a thing as I was bagging and preparing to suction him. We were in a hurry, and remember, ID and Cost Containment people decided to stop stocking masks in this isolation room. Guess who got hit with the junk from the kid's ventilator tubing b/c the RT wasn't paying attention? Me. It's surprising to me that the RRT didn't think what pointing a ventilator tubing from a sick child attached to a positive pressure ventilator could do to another person. It still blows my mind, and it was more than a few years ago now. I was sick as a dog for months and on multiple antibiotics, and my nurse manager and the institution could have cared less that I became infected there b/c of utter stupidity.
I will repeat myself, and it has NOTHING to do with playing MMQB. The right CDC staff should have been there and stayed there as soon as Duncan was tested positive--setting up protocols, instructing, and supervising, AND the people involved in Duncan's direct care should have had the same quality suits CDC would wear, period.
I have seen hospitals play Russian Roulette like this. It's ethically, and in my mind at least, legally wrong.
Again. How many people does it take to start an epidemic leading to a pandemic? ONLY ONE. It's not worth playing with this deadly infectious virus. There is NO excuse for this. It's time to get serious. Meanwhile, besides this nurse, there are about 50 + people that were involved in this person's care. It would not be improbable for more to test positive. And then there must be the consideration of all the people those people were in contact with. It's insane to get all hot and bothered over blame.
We should have and now need to seriously do better. If you know to do better and can do better, you must be held to accountability for not doing better. How much worse, then, is it if from this point on, if our CDC and health system and national leadership (which includes "We the people" and speaking out) don't get on the stick ASAP--I mean, like yesterday. No more excuses. No more idiotic worrying about blame. Let's get this crap under control now. Let's get the best PPE in and the best protocols and supervision and f/u in place NOW! That's all anyone with any sense cares about. Everything else is BS.
Amen to that.... let's throw the kitchen sink at Ebola in America.
I agree that most hospitals could do a MUCH better job of exercising infection control precautions. However, it sounds like you're mixing up droplet precautions with contact precautions. They don't have the same indications or requirements, and just throwing everything you have at every patient on isolation will likely lead to precaution fatigue which will lead to protocol violations.
NB: I am not familiar enough with Ebola's transmissibility or the situation as Dallas Presby to speak specifically on that situation - the above statement is in no way meant as a judgement of the nurse in Dallas who contracted Ebola.
Best post I've read in regards to Ebola in America thus far. The American PPE system is so flimsy it's a joke. People need to quit talking about protocol breaches because the protocol has failed. As I said in another thread, let's throw the kitchen sink at Ebola in America.
I'll just leave this here.
http://thehealthcareblog.com/blog/2014/10/12/six-sigma-vs-ebola/
Sorry I didn't mean for it to be sarcastic, I'm agreeing with you. It's scary that a lot of doctors are playing this down. Us health care workers are on the front lines, especially emergency physicians. So to brush this off as an "African thing because they have worse PPE" is a serious mistake.I'm sorry if I'm wrong in this possible assumption; but is this sarcasm? I mean on one hand I think no, based on some things you have said.
Regardless, we need to learn and now get very serious with this; b/c we are kidding ourselves if we think it can't spin out of control here. People seem to have this magical thinking about America and American medicine. "This could never happen here. " Oh really? Sure about that? The relative easy of transmission, especially as patients with Ebola become increasingly sicker, seems to suggest otherwise.
Great post @Dr.McNinja
CNN, surprisingly, had a good post on where the CDC went wrong in its guidance. I know this is one of those situations no one, including the CDC, can ever 100% prepare for, but as an Epi student it did surprise me that some of these weren't being done.
Im not a fan of Monday morning quarter backing, but I think this is a good analysis and hopefully people are taking some of this into consideration as the situation develops.
http://www.cnn.com/2014/10/13/health/ebola-cdc/index.html
Standard PPE instead of Tyvek suits. Yes standard PPE should be sufficient if used properly, but it has more components to deal with and is probably harder to safely remove. So let's just get rid of the risk associated with that "if" as soon as they know its Ebola, the CDC should send those suits to be used.
Second, lack of disinfection of the suits on people when they exit before de-gowning. They do that in Africa if they have the supplies, and at the CDC labs, and they did it at Emory if the patient was vomiting, etc.
They also apparently didn't suggest the buddy system as is done in a lot of locations working with Ebola.
Third, the vast majority of hospitals haven't drilled for this much, if at all. But we have 4 really expensive biocontainment facilities where they do drill for this, were they have proper waste removal, and have small labs inside. So let's get our money's worth and put them through the paces. Let them work out the kinks, become the experts, and offer guidance to the rest of us for later use.
"This summer, the CDC produced a PowerPoint detailing how to put on and take off Personal Protective Equipment, or PPE. It has 49 slides."
http://www.vox.com/2014/10/13/6968775/ebola-nurse-united-states-texas-directions-protocol-breach
"This summer, the CDC produced a PowerPoint detailing how to put on and take off Personal Protective Equipment, or PPE. It has 49 slides."
http://www.vox.com/2014/10/13/6968775/ebola-nurse-united-states-texas-directions-protocol-breach
I just thought it was an interesting article.That's nice. Sorry. *shrug* That's not good enough. Being drilled and tested is a lot different than watching a PPT, don't you think?
I just thought it was an interesting article.
LOLyou aren't really disagreeing with my thoughts on PPE. I just didn't go into as much detail.
In someone who told the staff he traveled from Liberia and had a Liberian accent?
Yes, it should've been considered. The ball was dropped, and despite the objections to criticism by Sanjay Gupta, I feel like this was a big miss.
I always ask a travel history on anyone with viral type symptoms or fever. I've caught more than a handful of cases of malaria who were initially seen in outside ED's (one in my own ED) and who later returned. Nobody asked a travel history on them.
No matter what you say about the person who called the CDC to say things weren't being done appropriately, that person was ultimately right. It's hard to fault someone for being overly worried when they were right.
If people ultimately contract Ebola because the patient was sent home initially, the hospital and the ER physician may be held liable. Can you imagine if the paramedics/firefighters who helped the patient get Ebola?
It wouldn't surprise me if true. Do you have a link?
They're working on it.Somebody also needs to get to work on a vaccine, like yesterday.
We had a thread on this months ago, when William Sullivan wrote his article. I thought you were referring to something having to do with this Ebola situation, and lawsuits that might come out of it.I used to work with some aaem higher ups, and I asked them if this was THE Peter Rosen. They confirmed it.
http://www.epmonthly.com/features/c...-slippery-slope-for-dubious-expert-testimony/
The patient’s parents filed a medical malpractice lawsuit against the treating emergency physician and the emergency physician’s group. The trial court dismissed the case for failing to meet the “gross negligence” standard of proof. An appellate court then affirmed the trial court’s decision. The Georgia Supreme Court reviewed the case, including testimony from plaintiff experts Drs. Peter Rosen and Dr. Steven Gabaeff. According to the court opinions, Drs. Rosen and Gabaeff testified that the EKG showed “Q3T3” abnormalities and the chest x-ray demonstrated cardiomegaly – which were allegedly both suggestive of a pulmonary embolism. Dr. Rosen’s opinion was based on his experience diagnosing “hundreds if not thousands” of pulmonary emboli in his career. Rosen and Gabaeff opined that the patient’s symptoms “presented a classic case of pulmonary embolism” and that the diagnostic measures that the emergency physician took in response to those symptoms “did nothing to prove or disprove the presence” of a pulmonary embolism. While the treating physician believed that relief of pain from a pulmonary embolism would not occur with administration of Toradol, the experts called that reasoning “ridiculous.” Both experts stated that the standard of care required the treating physician to obtain a CT scan in order to rule out a pulmonary embolism in the patient, and that failure to do so was “grossly improper, egregious, and contrary to well-known and fundamental medical principles.” Given these expert opinions and other testimony in the case, the Georgia Supreme Court held that the treating physician’s treatment may have been grossly negligent and that a jury would have to decide the issue.
http://www.aaem.org/publications/co...elax-volunteers-medical-malpractice-liability
I found this funny, as Walker just dodged the question (he's not the guy I worked with, though)
Since when has the government placed the idea of closing borders to stop diseased or unvaccinated people from coming into this country unfettered, above political correctness and voter demographics?I'm going to be really blunt: everything regarding the government's management of this disease thus far has been political and driven by two things:
1. Try and minimize public concern
2. Don't institute a travel ban that would stigmatize African countries.
The first rational step in controlling the spread of a disease is to stop importing new cases.
I'm going to be really blunt: everything regarding the government's management of this disease thus far has been political and driven by two things:
1. Try and minimize public concern
2. Don't institute a travel ban that would stigmatize African countries.
The first rational step in controlling the spread of a disease is to stop importing new cases.
This is the key issue here in stopping an outbreak (and @Arcan57 made the same comment earlier). There are 4 specific locations (Emory, UNMC, NIH and some place in MT) with bio-containment units. Confirmed cases in the US need to be wrapped in plastic and shipped to one of these places as soon as the diagnosis is made. At the very least, they need to not be kept in whatever community hospital they wander into (or work in). I mean, when US healthcare workers have been infected in Africa, it's not like they're being sent to the hospital nearest their home for treatment, they're going to UNMC and Emory. Why should any other case in the US be different?Also, who's idea was this that any hospital can take care of ebola? Doesn't the CDC know that most hospitals take care of bull**** chest pain and confused old ladies with a creatinine of 2 all day? These cases need to be handled in designated centers with the appropriate equipment and training. Or else it gets transmitted to the healthcare workers.
we will stop ebola in its tracks... every hospital is capable... see training materials at cdc.gov... the nurses breached protocol.. its very hard to catch the virus... its ok to sit next to mr duncan for hours in the er ... don't have neck protection? use medical tape!!!
Now cdc says "hey don't look at us. We're not a regulatory agency..
The state health department is responsible! !!!!"
Freiden is a hack and should resign... he is a coach without a game plan... all hat and no cattle as they say in tx
There are 4 specific locations (Emory, UNMC, NIH and some place in MT) with bio-containment units. Confirmed cases in the US need to be wrapped in plastic and shipped to one of these places as soon as the diagnosis is made. At the very least, they need to not be kept in whatever community hospital they wander into (or work in). I mean, when US healthcare workers have been infected in Africa, it's not like they're being sent to the hospital nearest their home for treatment, they're going to UNMC and Emory. Why should any other case in the US be different?
Transferring every Ebola patient to Emory and 2 or 3 other hospitals will only work to the extent that's there's so few cases that all from a country of 300 million people can be handled by a handful of hospitals. Once, and if, the cases are into the hundreds or thousand, "Transfer all Ebola to one of 4 hospitals" as a strategy collapses like a house of cards. Also, transferring to Emory or wherever else, does nothing about possible transmission that can occur at the diagnosing hospital prior to transfer before and while the patient is being diagnosed, which is how it appears cases #2 and #3 occurred. So every hospital needs to be "next level" or their just going to create more cases before getting patients out, and the cycle will repeat.
One thing I know for sure, is that there is no shortage of people who though they were ready for Ebola, but turned out to be 100% wrong and now have egg on their faces. Unfortunately, we've seen that's there's a huge learning curve with this, and more people are likely to get sick in the process. This is a big enough national health and security issue, that the people at the top such as Obama and his CDC, need to be accountable.
Call it what it is,
"EBOLAGATE"
Transferring every Ebola patient to Emory and 2 or 3 other hospitals will only work to the extent that's there's so few cases that all from a country of 300 million people can be handled by a handful of hospitals. Once, and if, the cases are into the hundreds or thousand, "Transfer all Ebola to one of 4 hospitals" as a strategy collapses like a house of cards. Also, transferring to Emory or wherever else, does nothing about possible transmission that can occur at the diagnosing hospital prior to transfer before and while the patient is being diagnosed, which is how it appears cases #2 and #3 occurred. So every hospital needs to be "next level" or their just going to create more cases before getting patients out, and the cycle will repeat.
One thing I know for sure, is that there is no shortage of people who though they were ready for Ebola, but turned out to be 100% wrong and now have egg on their faces. Unfortunately, we've seen that's there's a huge learning curve with this, and more people are likely to get sick in the process. This is a big enough national health and security issue, that the people at the top such as Obama and his CDC, need to be accountable.
Call it what it is,
"EBOLAGATE"
it was probably some flow chart dial-a-nurse hotline kinda thingAll true. At this point, most of us can only hope and pray that it remains limited.
I love how everyone came down on the second nurse, when she contacted the CDC and they told her that 99.5F was beneath the threshold, so she could go ahead and get on the plane. If she was not coughing, vomiting, oozing, or spewing anything, those people on the plane are probably fine. But KNOWING that she was in very close contact with Mr. Duncan and his secretions, with substandard PPE, and then the nurse having a low grade fever, the CDC's advice was idiotic.
Seriously, what is up with the CDC?
unless you're 100% right. I know probably poor form to bring up a previous post. had to toss that in thereOne thing I know for sure, is that there is no shortage of people who though they were ready for Ebola, but turned out to be 100% wrong
it was probably some flow chart dial-a-nurse hotline kinda thing