yup

nurses to strike over lack of proper equipment to care for ebola patients at Kaiser Permanente

18,000 nurses who work for Kaiser Permanente in California will strike on November 12 to protect lack of training and proper isolation gear for caring for patients with ebola. Cities across the country will have demonstrations on the same day.

We are expected to use the isolation gear that doesn't cover everything at my hospital, although there have been promises to get better gear. Nothing has happened yet. No mandatory training either.

Have you been trained?  Do you have adequate equipment?

Kaci Hickox responsible for end of world

So that damn defiant Kaci Hickox is at it again. She and her boyfriend are right now riding their bike. The world will probably end during the ride. This is it people.

shitty poltiicians play games with ebola

Political opportunists are using the ebola situation to further their ambitions. They try to act like their quarantine policies are for the good of the public, but they are a cynical attempt to keep themselves in the press.

No one with any sense thinks that healthcare workers who have worked with ebola patients shouldn't be closely monitored.  Obviously. We have already seen two nurses caring for an ebola patient become positive.

Do nurses need to be placed in tents? Of course not.  They can be monitored at home. That whole debacle was ridiculous and I admire Kaci Hickox for standing up for herself.

Now more and more states are imposing these quarantine rules on health care workers.  Here is my problem with it: Why are just the people coming back from Africa being quarantined?  Why aren't all the healthcare workers who have worked with ebola patients, including those in NYC not being quarantined. Therein lies the blatant political side of this. If these politicians were concerned about public safety this would apply to all workers, not just those from Africa.

A terrible situation in Africa gets worse every day. These games being played will only discourage HCWs from going there to help.  It will also discourage nurses here from being willing to care for the patients who may come to their door.

the brave nurses who cared for Thomas Duncan

If you want to hear what it was really like to treat Thomas Duncan, read this story about the brave nurses volunteered to care for him.

nurses: take a look at your future if you care for patients with ebola

This ebola thing just gets better and better...**

Kaci Hickok, the nurse who is now quarantined in a tent outside a New Jersey hospital has hired a civil rights lawyer.  Here's the thing: She is going to get herself out of the quarantine.

You can't single out a group of individuals who decided to go to Africa to help with ebola, but let the ones caring for ebola patients here just go home every night.  If you are going to put Kaci in a tent, then you have to put them all in tents.  How long do you think those nurses will continue to care for ebola patients if they are told they are spending the next 3 weeks in a tent?  Not very long.

What if they are single parents?  Who is going to take care of their children?  Who is going to pay them when they are in quarantine? Obviously this has not been thought through.

I got an idea...anybody who had anything to do with or will have anything to do with  any ebola patient should be put in a mandatory quarantine.  If you were on the same bus, quaratine, live in the apartment building quarantine.  You walked on the same street?  Quarantine.  I don't know if you picked something up along the way.

Lets have thousands in quarantine now.  It makes sense.  It makes about as much sense as grabbing Kaci at the airport and putting her in a tent with a portapotty.

**this is the actually tent she is staying in.

nurses become pariahs after taking care of ebola patients

OK let me get this straight, the nurse who landed in Newark friday from West Africa, where she worked for a month caring for ebola patients, is currently being held in a tent outside the hospital? Is this a joke?

Wow. She has shown no symptoms of ebola.  She sat at the airport for 7 hours, then was taken lights and sirens with people wearing the full isolation equipment to the hospital where she has tested negative twice. She is now being held against her will in this tent with a porta potty, no shower facilities. So this is how we are going to treat people who have the courage to go to Africa to help?

The people who are caring for the doctor at the hospital, WHO ACTUALLY HAS EBOLA, are going home to their families at the end of their shifts and going about their normal business of life.  How does this make sense? It doesn't.

This is craziness. Isn't there some kind of happy medium?  This is what happens when politicians start being in charge of medical problems they know little about.  Makes me wonder what would happen if there was a real epidemic in the country.

Not only will this discourage people from going to Africa, but it sends a message to nurses who care for ebola patients in hospitals: you will become a pariah. That's why a lot of nurses are going to say, hell no, I'm not taking care of that patient.

man candy 2fer

I'm tired

Done this month:

1) 8 hour de-escalation/how to deal with violent patients class.

2) ACLS

3) PALS

4) Ebola baloney

5) Brand new drug dispensing system starting.

6) My regular hours

How was your month?

After you have done acls, pals, tncc, bls 20,000 times shouldn't you be able to be grandfathered in for cripes sake?

doctor has ebola

So here comes news that a doctor in NYC has ebola.  He treated patients with doctors without borders in Africa.. Doctors Without Borders is at the forefront of ebola treatment.  In other words they know what they are doing when it comes to isolation procedures and equipment.  This proves, that despite all of that, you can get ebola. Yet they keep telling healthcare workers the chances are so, so low... As of about september 1st, 240 healthcare workers in Africa developed ebola, 120 died.

Today I asked someone from infection control if, after we cared for a patient with ebola, we would keep working and taking care of other patients.  Answer: yes.

BTW,  if you would like to donate to Doctors Without Borders, a truly awesome organization, go here.    

I have become a part time psych nurse

I wonder why nobody seems to care about mentally ill patients? It is evident in the fact that patients are being housed in emergency rooms because there are no beds available. That's happening in our ER.  It has now become routine to house people for hours, sometimes more than a day.

Funding has decreased for mental health, so patients don't have access to services on an outpatient basis. Just like physical illness, if your condition isn't managed it gets worse and becomes a crisis and sends you to the emergency room.

There are less psychiatrists.  Apparently they aren't paid as well as they used to be, especially in hospitals.  The profession is less attractive because most psychiatrists have essentially become medication managers rather than the therapists they used to be.

Reimbursement for psychiatric patients is less than those who are physically ill making hospital reluctant to increase bed space.

I don't see any of the above changing anytime soon. So the situation will get worse.  We will be part time psych nurses trying to manage patients for hours on end, sometimes overnight and beyond. Patients will lay there with nothing to do, getting more agitated because of it.  They will get bad care because we don't have time to care for them. Our wait time in the ER will increase because there are times when 30% of our beds are occupied by psych patients.  It is more dangerous for the staff because after sitting for hours, sometimes these patients get agitated and start acting out and become violent.

So ERs have become part time psych wards and I have become a part time psych nurse.

nurses have perverse sense of responsibility and loyalty

The administrators at Dallas Presbyterian where the ebola patients have been treated are scrambling. From what I have read only 30% of the hospital is full.  It seems nobody wants to come to a hospital which fumbled so badly.  Can't say I blame them.

Well, everybody knows that a hospital can't survive at 30% so its panic time. It is time to trot out the nurses who are willing to be on TV and say what a wonderful place our hospital is, led of course by the head honcho nurse at the hospital.  They held a press conference praising the hospital essentially saying that those damn radical nurses who said we weren't prepared are wrong, wrong, wrong.  We are a great hospital, so there. This is essentially like saying to someone who is going to intentionally harm you: Its OK, I love you anyway.

Unfortunately, this kind of behavior is typical for a lot of nurses. Oh, the poor hospital, they tried their best, they didn't do it on purpose. Instead of standing up for ourselves and demanding that we be protected, we say to ourselves they are doing the best they can.  Then we go forward and put ourselves in harms way because we are so wacked we are willing to sacrifice ourselves out of some perverse sense of responsibility and loyalty.

Will this hospital recover? They are apologizing profusely left and right. They are shitting their pants about law suits, because they know they will be filed.  They are already mounting their defense. I saw on the internet that the CDC said they were following their protocol, now the CDC realizes that it was inadequate. Our bad, not the fault of the hospital.

Dallas Presbyterian is finished. This will bankrupt them. The public won't forget this for some time.  When they do, it will be too late, the hospital will be closed.

Dear Mr. hospital administrator: you know that ebola patient at the triage window? Good luck with that.

The thing about the ebola crisis is that nurses are at the mercy of hospitals that worry more about the bottom line than they do their own workers. They are playing the odds.  What are the odds that a patient will come into our hospital?  Near zero. Therefore, we won't spend the money on training and isolation suits that are needed.It would be a waste of our money.  We will cover our butts by saying we are "following CDC guidelines".

We will make the training voluntary. We will tell the staff basically: all you have to do is put the patient in isolation and all of our experts we have on call will come to your area and take over. Never fear. We got this.

So here is how I interpret this: When the patient appears at the triage window, I give them a mask to put on. I take them immediately to the designated room.  On the way to the room, I get their name and birthdate. I put them in the room.  I put them in the computer.  Then I call the hospital experts and wait for them to come. I note in the computer that the patient  has no respiratory distress, able to walk independently to room, etc.  In other words, they aren't near eminent death.  I also note that they have been placed in the room and experts called per protocol.

Then we wait, because if you think that I am doing anything beyond that, you are fooling yourself Mr. hospital administrator.  If you aren't going to train me and give me proper equipment, that will be the extent of my involvement.  Good luck with that.

bedside nurses are the experts on how to safely care for a patient with ebola

It turns out Thomas Duncan sat in the emergency department for 30 hours. More than a day. Despite the fact that the second time he came in they immediately knew he had come from Liberia. They isolated him. He sat there for 24 hours before they even did an ebola test.  Then it takes 4-6 hours for that to come back. Did the hospital have the capacity to do the test?

I'm trying to think of why it took so long for the ebola test..  My only conclusion is the doctor didn't think that ebola could have possibly come to the United States, so they weren't thinking in terms of ebola.  They thought of other things, did labs, CT.

So I'm sure that this guy was treated as a typical, perhaps, contact precautions. Since he had no respiratory symptoms, droplet precautions were probably not used.  So that means paper gown and gloves.  Thats it.

As an ER nurse, I'm thinking about what happened in the ER.  Did his nurse have other patients? I have a feeling they did. This guy was sick yes, but not sick enough to be one to one if they weren't treating him as an ebola patient.  No doubt several nurses took care of him over the course of 30 hours. They went in and out of the room many times.  Lab drew his blood, no doubt no special precautions were taken.  He had a CT. He had to go through the halls to CT. He contaminated the CT machine.

No one has talked much about the emergency department part of this. The focus has been on inpatient care because that is where the nurses have become ill.  It is miraculous no ER personnel have not become sick. Little attention has been paid to what should happens when someone shows up at the triage window with symptoms and recent travel.

Most emergency rooms are congested tight spaces.  Mine sure is. My first thought with all of this was: where would we take off the isolation gear?  Not in hall, thats for sure.  Fortunately, my ER has figured out a place with more room to put this patient, with an area outside that could be used for removing gear.

These are the kind of small details that have to be thought of. You can't have an ebola patient in the middle of a busy ER. Would we shut down the ER?  Would we allow other patients to keep coming in? The public would want to know if there was a potential ebola patient in their midst. Do you keep a potential ebola patient in the ER until they turn up positive?  Or do you immediately put them in ICU?  Is ICU ready?  Do they have an area that is empty?  Do they have the equipment ready?

There are a lot of questions. The problem with this is that the people in charge are not the ones who care for patients. They do not think of the details of patient care that we deal with every day.  Bedside nurses should be involved in preparing for something like this.  They aren't.  This is typical of medicine.  All of the daily changes to our practice are decided by people who haven't cared for patients in years. That fact is what makes working as a nurse more and more difficult. This is just one more example.

m....c.....saturday

Dear Mr/Mrs John/Jane Q. Public: don't bite the hand that feeds you

There is starting to be a backlash against the nurse who took a flight to Cleveland and now a lab tech who went on a cruise.  People are starting to turn on them, exclaiming, "how could they travel knowing they took care of the patient!"  They are so SELFISH, so STUPID.  Lacking in COMMON SENSE.

It is obvious that the CDC did not tell these people they couldn't travel.  They were not concerned enough about them to monitor them themselves. They said they could "self monitor".  Even though these people had direct contact with the patient.  So they must have figured, I'm OK I can take my temp anywhere I go. So they went. Now they are being vilified. Just like the first nurse was portrayed as essentially "messing up" the isolation procedures until more information came out.

First of all, NO healthcare worker is SELFISH especially when they are willing to take care of an ebola patient at all.  They are LITERALLY taking their lives in their hands for the sake of caring for someone else. If you aren't a nurse would you volunteer to clean up the poop and vomit of an ebola patient?

Secondly they are not STUPID.  You can't be stupid and be a nurse.  They were following what they were told by "experts".  Their COMMON SENSE told them they should listen to the "experts".

This kind of thing pisses me off royally.  That people have the nerve to say these kind of things about these nurses or other health care workers. Nurses who risked their lives for the patient and are now very ill with ebola. I would suggest that public start thinking about how they are talking about nurses or healthcare workers in this situation. WE are the ones who take care of you when you get ebola.  When we are blamed, we may just say FUCK YOU. You take care of them. You are biting the hand that feeds you.

I haven't gone nuts

You are probably wondering when is she going to lay off the ebola.  I know I have been writing about this continually for a couple of weeks.  You think I'm obsessed, that maybe I have some kind of problem...

I love writing, hence the blog. I am opinionated. I am always analyzing everything.  I am both troubled and fascinated by this response by our country to ebola.  We have never gone through something like this before. It fits right in with what I have written here before about hospitals not being prepared for any kind of disaster. This also has effect on me personally as an ER nurse. This has caused every nurse in this country to pause and wonder about what they would do if this came to their door.

Will all that in mind, I have been writing about ebola.  I would love to have a job writing about health issues.
So anyway, I haven't gone nuts.  I'm not hiding in the basement with my hazmat suit on.

we won't ever be ready for ebola

Lets hope there aren't more than 9 patients with ebola in this country at any one time. That's how many biocontainment unit beds there are available in the country right now.  Four of them are presently filled.

This country has a real dilemna right now.  They are trying to be ready for a disease they aren't ready for. Reality is hitting all of the so called experts in the face.  All their wonderful plans aren't working out the way they thought they would.  The thing is: they still don't get it.

They still think that if they recommend a massive training exercise about isolation gear involving thousands and thousands of healthcare workers across the country it will all be okay.  If they train them using the normal isolation gear, teaching them to take it on and off properly, we will all be okay.  Here is the problem with this:

1) The training so far is not mandatory.  This is hard to believe, but not everyone will go.

2) The gear is inadequate.  There are too many pieces to the ordinary isolation gear which makes it more dangerous to take off.  The ordinary gear is not sufficient.  People need hazmat gear. It is being used by  everyone else taking care of people with ebola, including those in West Africa where it is an epidemic.  It is only in the US that workers are being asked to use something other than hazmat gear.

3) Hospitals are not going to train everyone that care for patients how to use hazmat gear. It is too time intensive. It costs too much money to train and for the suits.

4) We are not prepared to even get rid of the waste from an ebola patient.  Even the people in charge of these biocontainment units can only take care of so many because they can only handle the waste of so many.  If they are saying that, how can an ordinary hospital possibly be ready for the waste?

5) Finally: About the time, the next nurse or other healthcare worker comes up positive for ebola, nurses are going to start refusing to care for these patients.  They will be unwilling to risk it for themselves and their families. Sure, there are going to be some nurses who will being willing to risk it, but I guarantee the vasst majority of nurses will say: uh..no...I don't think so.  I am not going to put my new baby at home in jeopardy because you can't do this right.   Yup, they are going to be willing to risk their jobs over this.

So then what? As a country, we still figure we won't have to deal with more than a few cases. So far there have been seven. Hey, odds are good we won't have an epidemic.  What is very worrisome however is the fact that this is out of control in Africa right now.  I have seen figures of 10,000 a week by December if it doesn't get under control soon.  It isn't going to get under control soon.  1,000,000 cases by January.  The world still thinks it won't affect them. When it gets to that many cases, it will.  Then what?

drug shortage

the brave nurses caring for those with ebola

Here is a really good opinion piece on the brave nurses taking care of the patients with ebola.  They really are heroes.

other nurses support nurse with ebola

So I am watching CNN right now and nurses and other staff are lined up with signs to be there when Nina Pham comes out of the hospital to go to the airport.  They are there to support her.  Its really nice to see nurses support each other at a time when where we are all in a very difficult situation.

my last raise was 65 cents

My last raise was $.65.  I work in an inner city emergency room where I deal with all the people you move to the suburbs to avoid: the junkies, drunks, criminals, hood rats, the mentally ill, the homeless.. Every day I deal with the chronically ill, the neurotic.  I move patients who can be up to 500 lbs.  I am verbally abused, physically abused.  There isn't a day I go home that I am not physically and mentally exhausted.

My job is constantly changing.  New things, machines, procedures, policies, information every day.  I sometimes hold peoples lives in my hands. Literally.  If I make a mistake, you could die. I have to remain calm under tremendous stress.  I have to be ready to deal with someone running in carrying someone who has been shot, someone who is going to have a baby, someone who is dying. I have to juggle lots and lots of things at once.

And now I am faced with ebola.  A disease that could kill you.  It has already killed more than 200 health care workers in Africa.It has infected 2 nurses in Dallas.  I depend on government officials, hospital administrators to have my best interest at heart when it comes to something like this. So far they haven't looked very good.

You are probably scared about ebola.  Will it affect me?  My family?  What's going to happen? Its all so confusing.  Imagine what nurses feel like.  We don't have a choice about caring for anybody who comes through the hospital door.  There they are.  We will have to have to care for them.

These days as  nurse, you can literally be taking my life in my hands taking care of a patient.  I could even die. It could infect my family.

My last raise was $.65.  My next raise will be about $.45.  I wonder if the CEO of the corporation I work for still makes a couple of million dollars.  I wonder if the administrators and managers still make bonuses when they meet corporate goals. They probably do.

They push paper in a safe comfortable office. . I sit at the triage window hoping the next patient doesn't have ebola.

Texas nurses claim outrageous conditions when caring for ebola patient according to National Nurses United

Once again thank you to National Nurses United, the only organization that is standing up for nurses in this ebola crisis. Nurses have been contacting them about the conditions they worked in while caring for Thomas Duncan.

Among the claims made by nurses at Texas Presbyterian:

- when they were concerned about their neck not being covered, they were told to put medical tape around their neck
-hazardous waste piled up in the corner because they had no plan on what to do with it.
- protocols kept changing during the care of the patient

With all this in mind, is it any wonder two healthcare workers have been infected?  No doubt we will hear of more.  I think its time for the CEO and the other administrators to go in and help clean up the patients.  Lets see how they do...

a second healthcare worker in dallas has ebola

Wow.  Another healthcare worker with ebola. It just blows your mind.  How many more people are going to come up posiitve?

I mean seriously, what are nurses and other healthcare workers supposed to think about this?  It gets scarier and scarier.  If I were an inpatient nurse, I would refuse to take care of a patient with ebola at this point. Not until you can guarantee that there is a group of experts in place to assure the proper precautions are being taken, no uh no....

In the ER we are sitting ducks. We won't know the patient has ebola.

What I can't understand is why these patients are not being flown to these hospitals with biocontainment units with personel trained in how to handle things like this.  When asked about why this isn't being done, the CDC director says that this could happen across the country, we all have to be prepared.  True that. Why not, once ebola is diagnosed, fly them to one of these places.  At least then we know the treatment and precautions  will be hat they are supposed to be..  Its just common sense.

At this point, the healthcare workers who cared for Mr. Duncan should be quarantined.  Its obvious there is a huge problem there.  Self reporting is not enough.  Again, common sense.

Nina Pham doing OK, thank goodness

News today that the Texas nurse Nina Pham is doing well.  That  is great to hear. She has been in all nurses thoughts the last couple of days.

It feels like things are starting to move in a good direction with caring for ebola patients.  Meetings with infection control are scheduled in my department.  I wish they were mandatory.

The CDC is starting to recognize that, NO, nurses and other hospital personel are not prepared for this.  Their protocols are very nice but we need practical experience with equipment and practical instructions on how to care for the patients.  I still think that the government should make it mandatory for all hospitals to do this.  You can't trust hospitals to do it.  Maybe its cynical but its realistic.

The CDC will dispatch an emergency response team within hours of a patient being positive for ebola that can help with all the practical aspects of ebola.  Great idea.

It still scares me as a person who works in a department that will have first contact with the patient. There won't be anyone to help us initially.  The thing about all of it is: I welcome training, but we are all human and do the best we can, but sometimes things happen that we don't intend and could contaminate ourselves.  In the ER, we have to rely on each other and watch each other very closely when putting the isolation gear on and off.  Fortunately, apparently the plan, at least in my hospital is to do little with the patient in ER.  Hopefully that will be possible.

national nurses united only organization that is speaking for nurses on ebola

The only organization that is standing up for nursing safety right now is the National Nurses United, the national union of nurses.  They are in the news demanding that hospitals provide the training and equipment needed. They are doing surveys of nurses that tell nurses do not feel they are ready to take care of ebola patients.

According to them, 76% of nurses state that their hospital has not communicated to them how they will care for an ebola patient. Eight five percent say their hospital has not provided education sessions to provide information or ask questions about ebola.  That includes mine.

National Nurses United has threatened to start picketing hospitals.  I hope they do.  Maybe when there are nurses outside the hospitals telling the public that they aren't ready things will change.

Dear Mr. CDC director: you still don't get it about ebola

Dear Mr. CDC director:

You continue to be clueless about ebola and the practicality of caring for patients with ebola.
I am no rocket scientist, I'm not even an almighty doctor, but I am some practical suggestions for you:

1) You and the government need to MANDATE that hospitals have to do practical training of caring for a possible ebola patient.  Do you really think cash strapped hospitals are going to do this voluntarily? Mandate they have the supplies they need.

2) Put any ebola patient in one of the biocontainment units in the hospitals that have them in the four states that have them.  These people have been trained for this event.  They know what they are doing.  We in other places do not and the chances of being contaminated are high. There is equipment available to fly a patient in isolation to another location.  There are companies that specialize in this.

3) Perhaps I don't understand quarantine...but it seems like people who have had direct contact with ebola patients should be quarantined.  I know, I know, they have to show symptoms to be contagious, but why would you have health care workers in their homes, possibly contaminating their families? Someone needs to explain this to me.

I will give you an idea of what it is like right now to be an ER nurse.  We have been referred to the CDC site and our own infection control information on the internet.  We have 2 ebola packets with gown, face shield, booties in the triage area.  We have been instructed to take the patient to an isolation room and expect to do little with them. No blood draws, nothing.  That is assuming they are not unstable.  Hard to believe that would happen.

So lets say the patient is unstable.  I have to go in the room.  I put all the gear on.  I'm ready to come out.  Where do I go to take it off?  I'm assuming that we don't take it off in the room. So there is really no place to go to take it off.  We can't go out in the hall.  We can't walk through the ER to another area.  So I guess we stay in the room forever.  Little joke there, but essentially we have not been told what to do.  Emailed someone about this.  Haven't heard back....

why are people in hazmat gear to clean the apartment of the nurse with ebola and caregivers don't have to wear all of that?

There seems to be some kind of disconnect between what we see when hazmat teams are cleaning the apartment of the nurse with ebola and what we, as healthcare workers, are e being told to wear when caring for a patient.

So I see video on the net of people in full hazmat gear including respirator starting at the sidewalk and spraying the walkway with some kind of cleaning solution.  Stuff is brought out of the apartments and put in large yellow barrels.  WTF?

Then we are being told, oh, you just have to wear a gown, goggles, gloves and foot covers.  Do they not get the contradiction here?  I mean this woman is no longer even there in the apartment and they are taking all of these precautions.  Then we are told we don't need all those precautions.

Do they not think that this contradictory picture scares healthcare workers?  I mean seriously, they need to address this directly.  Tell me why we don't have to wear all what the cleanup crew wears?

maybe nurses should go on strike until they get the proper training and equipment for dealing with ebola

Is anyone else as pissed as hell about how this nurse coming down with ebola is being portrayed by these idiotic fools in charge of the CDC and various health departments? They can kiss my ass. Saying that the nurse "breached" or "violated" protocol.   In other words, it is the nurses fault that she got ebola. If she had done it right, it wouldn't have happened...These idiots in charge of hospitals don't give a shit about whether anybody knows how to deal with this.  They sit in their offices, never having to do actual care of a patient, shifting paper.

Maybe the  nurses in this country need to go on strike to force them to provide adequate isolation gear and training.  That's what it seems like it is going to take.  If you think that a nurse coming down with ebola will make them do anything, you are fooling yourself.

The CDC needs to pull its head out of its ass and admit that they are not ready and they really have no fucking idea it these patients can be safely cared for by anybody.

I heard a doctor "expert" say this morning, that people have been cared for without exposure siting the two doctors who walked out of the hospital after having ebola.   Guess why those healthcare workers never came down with ebola?  They are a part of a team of people who are specially trained at Emory hospital and University of Nebraska to work in biocontainment units where both of those doctors were sent.  They PRACTICE the care, the isolation techniques.  They actually know what they are doing.  What a concept.

I have no doubt that there will be more cases of ebola in Texas. It this nurse was contaminated, others were also and they are now living in the community exposing others. I'm glad our joke of a CDC has that all under control.

health care worker in Dallas has ebola

As health care workers across this country collectively freak out, news that one of their own has ebola.

Think the hospitals will take this seriously now?

This is going to get interesting.   To see the reactions of nurses.  Will we demand training?  Or will we continue to sit back and think it will never come our way? Will we continue to trust our hospitals to take care of us?

Yes, the chance of it happening to us is minimal. Its scary nonetheless.

m. candy saturday

friday night in the ER

Let me set the scene:

Here come Mary and Joe up the walk of shame to the triage desk.  Mary is not happy with Joe and Joe is yelling at Mary, carrying on.  Mary wants to be seen but Joe keeps arguing.  Did I mention Mary and Joe are homeless and they are carrying all their worldly possessions?

So finally I've had enough.  Joe has got to go. I call security.  They start escorting Joe out and Mary follows.  I guess she doesn't want to be seen after all.  Okay, all is quiet in ERland.

What's this?  Here come Mary and Joe back again with Mr. Security officer.  It seems Mary DOES want to be seen.  Joe goes and sits in the lobby.  So I triage Mary and put her in the lobby.  Shortly after, I go to call Mary to go back to a room.  I tell her, after the scene with Joe earlier, he has to stay in the lobby.  Well Mary ain't having' it.  If Joe can't go back, she's not going either.  So she carries on in the lobby.

I once again call security.  Mary and Joe gather up their stuff.  Before they leave, Mary comes up to the desk, and in a gutsy and unbelieveable move asks if they can have bus tokens.

Ah...no Mary...I don't think so...are you shittin' me?

was there racism of the treatment of the ebola patient in Dallas?

Did racism play a role in the treatment of the guy with ebola who died in Dallas?

The family thinks it did. They are siting the fact that there have been four people with ebola in this country,  two survived, one is doing okay and happen to be white.  The black guy died. Is it coincidence?

The guy was let go from the ER the first time he went in with a fever of 103, abdominal pain, DIZZINESS, DECREASED URINATION.  Those last two indicated dehydration, no doubt due to the fever.  They did tests, apparently they were negative, so they sent him home with an antibiotic.  Why the antibiotic?  Was it because of the fever?  The doctor figured it was some kind of intestinal infection?

I'm surprised they let someone with this high of a fever, dehydration and unknown cause of abdominal pain go home.  I'm surprised they didn't at least admit him overnight.

According to records obtained by journalists, the doctor said he had "no fever or chills", which is weird because he had a fever.  Was that just a mistake in charting?  Apparently the nurse charted in triage that the guy had been to Africa.  I would be willing to bet that the doctor never read the triage note, as doctors are want to do. Most of them don't where I work.  Why? I don't know. In this case, because the doctor was not thinking in terms of ebola, reading it may have made the difference.

During his stay, it took a week for the man to get the experimental drug for ebola.  According to what I have read, for a private hospital to obtain something like this requires approvals, thats what delayed it.  Seems like a flimsy excuse.  But whatever.

Here's where I am gong to go all controversial on you.  Was this man treated as seriously as a white person with these symptoms and travel treated?  Get ready.  Probably not.

I hate to break this to you: Minorities are not treated the same as white people in the emergency department. They are not taken as seriously. They are dismissed.  A lot of assumptions are made about them based on stereotypes.  There is not as much sympathy for them. They aren't given those pain scripts like the white people are. In other words, the world of the emergency room is no different than the world outside of it.

Immigrants in the emergency department are a difficult group to deal with.  Many times they don't speak english.  They are from different culture, their way of coping with stress may be way different than we are used to. They may be more expressive.  It takes a lot more time to deal with them and in a busy emergency department that can be a burden.

I am not saying that all staff members in the emergency department are racists. Of course not.  They are probably some of the most tolerant and accepting and kind people you will ever meet.  The thing is most of them are white, they live in this country.  We are subject to the same experience as everyone else. We bring our prejudices and stereotypes with us to work just like everyone else.

A lot of you are probably thinking: how dare you?!! Saying I'm prejudiced. No.  I'm saying that racism is so woven into the very fabric of our society that often times we don't even realize something might be perceived as racist.

So was Mr. Duncan treated the same?  I would say no.   Its just my opinion.  You have a right to disagree with me.

family of nurse in spain with ebola told "not much hope"

The nurse in Spain with ebola is probably going to die. Her family has been told there is "not much hope". She is on a respirator. I watch this with particular sadness because it hits so close to home because she is a healthcare worker just trying to do her job.

This situation is an example of the foolish arrogance of western countries who think they are ready for ebola because they have a more modern health care system than those countries in West Africa.
This is an example of how doctors are missing the boat with ebola.

 This woman went to a doctor twice before finally, on her third visit, somebody connected the dots.  She was sent home from urgent care and a hospital before finally being admitted. Apparently her fever wasn't high enough to warrant concern. She was considered a "low risk".  I'm not sure how that is possible considering she had direct contact with a patient with ebola.

Since this has happened people in Spain are in a panic of course.  Healthcare personnel are outraged that they feels inadequately prepared and say they lack the proper equipment to care for these patients.  One doctor  said the suit he wore to care for the nurse did not fit him properly, the sleeves being too short, exposing his skin.

The nurse apparently lay in the emergency room for 8 hours before she was moved while workers went back and forth and the other patients were exposed.

Of course, health officials in Spain are trying to blame her, rather than take responsibility for poor training and equipment.  According to Reuters, a regional health official made the following statement:

"She has taken days to recognize that she may have made a mistake when taking off the suit. If she had said it earlier, it would have saved a lot of work," he said in a radio interview.

"The top regional health official in Madrid, Javier Rodriguez, has said Romero took too long to admit she had made a mistake by touching her face with the glove of her protective suit while taking it off." 

Well, first off, lets apologize to Mr. Rodriguez for causing him a  "lot of work", in other words having to do his job.  Number two, she didn't "make a mistake",  she probably had no one watching her take off the suit, had no proper training.  That is your fault, Mr. Rodriguez.  It is not the fault of this poor woman.

There are now 80 people in Spain being monitored, 14 of whom are in isolation.

nurses should refuse to care for ebola patients or those who been exposed to the disease

If you think that your doctor, urgent care, hospital, emergency room are prepared to deal with ebola you are fooling yourself.

Hospitals are not prepared for an ebola outbreak and they won't be.  Why not?  Because they won't spend the money to be prepared. To put their employees through training where they could actually handle a biological or chemical event would be costly. In this day and age hospitals are losing money and adjusting to the new reality of decreased reimbursement. They are willing to take the chance that it will never happen at their hospital.

I think they figure they are covered because they have written instructions on what should be done. The thing is those written instructions mean shit.  In a situation where you have this kind of event, you need practical experience or you are literally taking your life in your hands. The most important part of this is the donning and removing of the isolation gear. If you don't do that right, you are screwed. The spanish nurse is proof of that.  One touch of a contaminated hand apparently infected her.

We are told that a fluid resistant gown, regular mask, goggles, gloves (think about double gloving) is sufficient. Wear paper booties.  Apparently you don't have to have a head cover, the back of the gown can be open.  Your head, neck will be exposed.  Now, if you are a nurse, you know that fluids don't always do what you want them to do.  They splash, they fly across the room.

We are told to observe each other as we don and remove the isolation gear, assuming we know how it is supposed to be done.  I don't know how its supposed to be done.  Do I really want to take responsibility for someone else hoping I do it right?

This is really starting to piss me off. I mean seriously, we can't even count on being protected from stuff like this.  I don't want to assume this will never happen.  I want to assume that it will.

What people and administrators and  those who write pretty policies don't get is that if you don't protect the health worker, it doesn't matter what else you do because they are going to get the disease and they are going to spread it to others.  All the fancy equipment, care you provide won't mean anything because you didn't cover the basics.

Maybe nurses should start voicing that they refuse to take care of any potential ebola patients or those who actually have the disease because they feel unprepared and they are not willing to risk their lives or those of their family.  Think that would wake them up?

diary of an ebola healthcare worker

This article is from The Mirror and occurred in July: 

From overflowing morgues to corpses being pushed around in wheelbarrows, a British aid worker today reveals the horror she has seen battling to tackle the Ebola outbreak in West Africa .

Sanitation expert Cokie van der Velde, 54, spent last week helping with charity Medecins Sans Frontieres at a treatment centre in Liberian capital Monrovia and a hospital isolation ward three hours away.

And the grandmother revealed that six of the nurses she worked with have died from the virus.

Yesterday Cokie, of Whixley, North Yorkshire, said: “It is heartbreaking to see such brave people perishing at the hands of this awful disease.”

The recent outbreak, the largest recorded in history, began in Guinea and spread to Liberia and Sierra Leone, killing more than 700 people.

The World Health Organisation said that 60 medics had so far died in West Africa, falling ill as they bravely battled to save other people.

DIARY

Day 1

It’s 5.30am and I’m the first out of bed. It’s a half-hour drive to the Ebola ­treatment centre. I arrive at 7.30am and change into scrubs and rubber boots in the “low-risk zone”.

I need to put on full protective gear. I pull on a pair of examination gloves, and then a yellow suit. It goes up to my neck and down to my ankles. Already I’m starting to sweat.

It’s very humid and hot. Next is the mask, the hood, and then an enormous plastic apron. I fumble with surgical gloves, then thick rubber household gloves. Finally I put on my goggles.

Before I go in the high-risk zone, a staff member checks to make sure not one millimetre of skin is showing.

I start by emptying buckets of faeces and vomit. Some people have terrible diarrhoea or are bleeding, so there’s a lot of cleaning. I make sure they all have water – most are so weak, they can’t even unscrew the lid of a plastic bottle; some can barely speak.

Soiled sheets go in bins, which are taken to the burning pits – once a day we burn the waste. Every day there are dead bodies, every day the number is increasing. When somebody dies, we put their belongings in bags and burn them, with the mattress cover and sheet.

Day 2

I am training some new staff, locals who will work as hygienists and cleaners.

I listen to a radio phone-in. Someone calls in to say there’s no such thing as Ebola. This is the first time the disease has broken out in West Africa, there’s a lot of fear and misinformation. We go through all the rumours and dispel them.

Then I explain what Ebola is and how you can protect yourself.

Day 3

I’m heading out of Monrovia to visit the main hospital in Bong County. It’s a three-hour trip.

When the outbreak started local health workers weren’t taking proper precautions. It spread through the hospital staff. Seven nurses from this hospital have been admitted to the centre in Monrovia; six are dead.

I meet the head of the health team. He’s doing his best in very difficult circumstances, with terrified staff.

They have only one ambulance. The burial team has to use a wheelbarrow, or garbage collecting truck, to move corpses around.

Local religious leaders are preaching against health workers, saying it is them spreading the disease. They’ve set up a small isolation unit, but there’s nobody to staff it. It’s an impossible situation.

Day 4

I feel we’ve reached a tipping point. When I arrived in Liberia four weeks ago, there were four or five patients in the treatment centre. Now the centre is overflowing, we don’t know where to put people, the morgue is full, people are turning up with sick relatives.

Day 5

I wake with a sore throat – it’s almost certainly due to chlorine, but paranoia has set in and I take my temperature for the tenth time this morning.

At night, sleeping can be hard. You lie there thinking, I feel hot, am I getting a fever? If I catch Ebola, who will I get to tell my family?

Imagine what it is like now?

can I refuse to care for an ebola patient?

News that a Spanish nursing assistant has ebola.  She helped care for 2 Spanish missionaries. This is the first time a health care worker outside of Africa has come down with ebola.  That isn't supposed to happen in our modern shiny white health care system where everything is perfect.  We have the protocols, the equipment, right?  Right?

So supposedly this poor woman followed all the protocol and she still has ebola. WTF? From what I have read, the thought is, any health care workers who have died in Africa were probably contaminated taking off the suit. You would think that if any group of people know how to remove the suit, it would be the healthcare workers in Africa.   I'm sure they did exactly as they were told.
but they still got ebola and many died.

So this raises the question: Can a healthcare worker refuse to care for someone with ebola? You probably think: What?! Hey you signed up to care for anyone who came through the door...you knew what you were getting into when you took the job.  True that, but this is way, way different.  We are talking death here folks. We are talking possibly making our family sick.  We are dedicated,
but are we that dedicated?

This reminds me of when HIV came in a big way to the US.  It was terrifying. Little was known about it. Nurses actually quit because they were so scared of it.

So can I as a nurse refuse care? Sure I can. I'll get fired, but I can. I have the same rights to not be forced to do something as anyone else.  Would I?  Thats a tough one. I honestly don't know.  The position I am in, in the emergency department, the option of not having contact with a potential ebola patient is not one that will be given to me. If I'm the triage nurse, its possible.  I don't know what's wrong with you when you walk up to the desk.  Am I going to run away?  No.  I'll do what I need to do, put the mask on you, put you in the isolation room.

As far as whether I would, if I worked inpatient, be willing to care for an ebola patient? I have a husband. I have a son. If I had to care for an ebola patient I wouldn't have contact with them during that time and probably 3 weeks after. I'm not going to take that chance. I'm not in a position where I could quit my job.  Just like you, I have bills to pay. So, bottom line, I guess I would.  Not out of the goodness of my heart, but because I had to.  I am in the same position as health care workers across the world watching this and thinking about it.  It hits home with us a little more than it does the average person

actors fake ebola symptoms and go to hospitals in NYC to test system

As the ebola thing gets weirder and weirder..news comes that in NYC hospitals are sending in actors with fake symptoms to test how well staff will do.  Wow.  I hope I don't work triage tomorrow.  No I don't work in NYC. 

According to USA today: 

"Public hospitals in New York City are concerned enough about Ebola that they've secretly been sending actors with mock symptoms into emergency rooms to test how well the triage staffs identify and isolate possible cases."

In other fun news: 

The director of the European division of the World Health Organization (WHO) states that ebola cases in Europe are inevitable. From the newspaper The Guardian:

 "The WHO’s European director, Zsuzsanna Jakab, said it was “quite unavoidable … that such incidents will happen in the future because of the extensive travel from Europe to the affected countries and the other way around”.

Although the doctor states the risk is still low for the vast majority of people, it is refreshing to hear someone come out and actually tell the truth about the situation, admitting there will be cases and we have to know how to deal with them. 

disaster training is a disaster and ebola is the tip of the iceberg

We still don't get it in this country about ebola .

 We are starting to get some guidelines as to how to handle people coming into the hospital with symptoms of ebola. Gown, gloves, mask, goggles.  Put them in an isolation room. Call infection control.  Nothing goes outside the room. Keep a list of people who have contact with the patient.

This is the kind of stuff that is scary as shit.  On the one hand, we are being told the above.  On the other hand we are seeing how this is handled in other places.  People are in hazmat suits with respirators wearing 3 pairs of gloves. Hazmat teams are cleaning the apartment  where the guy stayed.  The patients coming back with known ebola (the 2 doctors and the cameraman) are being put in specialized biocontainment units.

This country is so woefully unprepared for this kind of event or any kind of terrorist biological or chemical event, it is unbelieveable. Do they really think that this kind of disease can be individually treated across the United States in the event of an epidemic? Do they really think that hospital staffs in small little town hospitals with limited resources are going to be able to handle this kind of patient coming in their door? Do they really think that every hospital in this country has the supplies and training that is going to prevent spread of this to other people?

I think that there should be teams of people across the country who are specially trained to deal with things like ebola, biological, chemical or any other specialized event who are immediately deployed in situations like this.  They KNOW what to do.  They have been trained.  They help the staff deal with the situation.

Every area of the country should have supplies stockpiled for these events.  There should be  supplies to set up a tent city type thing where people can be treated in a special area perhaps away from main population centers.

Guess who has the ability to do all of this? The military.  The military can be deployed and in place it seems like from what I've seen, within 24 hours.  They have this equipment.  They have the training. Every military member has extensive training on how to deal with chemical, biological and nuclear warfare. That is why they are now being deployed to Africa to set up temporary ebola wards.  They have the organization structure in place.

I've seen the military set up a tent city with all the components that go with it from scratch. I would trust them a lot more than our government who despite millions and millions of dollars spent doesn't seem to be able to handle one patient, let alone an epidemic.

spanish nurse infected with ebola

So here comes news that a nurse in Spain, who cared for a priest infected with ebola, has contracted the disease.  Then they wonder why all of us nurses are so concerned about this.

Spain is a modern country with modern infrastructure with all the bells and whistles that go along with taking care of something like this.  They no doubt have an equivalent to the CDC there who are supposed to be experts.  No doubts there are procedures and protocols and directions and supplies that we would have here and yet this happened....

journalist with ebola arrives at nebraska hospital

The reporter who contracted ebola has arrived in Nebraska.The patient in Dallas is in critical condition.  Chances are good that he will die.  Unfortunately..He is on a respirator.  He is on dialysis.

Ebola is a virus.  It is a virus like a cold or the flu is a virus.  Obviously it is a much more dangerous and deadly virus than the cold or flu.   The problem with viruses is that there is no treatment.  Antibiotics don't work.  Basically you have to ride a virus out and hope your immune system can  handle it.

So ebola is transmitted by contact with body fluids.  So lets say Joe was in Liberia on business.  He didn't know that the people he dealt with had family members who died of ebola.  The virus was transmitted to him.

Joe comes home.  He is his normal self.  He doesn't know it but the ebola virus is right now rapidly duplicating in his body.  About 9 days after he comes home, he starts to get sick.  Fever, vomiting, diarrhea, abdominal pain.  He goes down to his local ER.  They ask him if he traveled out of the country.  He says he was in Liberia.  They isolate him and send him to ICU.

Joe develops a very high fever.  His immune system is trying desperately to stop the virus.  It can't keep up.  Ebola has invaded every part of Joe.  It affects your blood vessels, which start to leak. It causes your liver to go haywire and starts destroying it. The liver is what regulates your ability to clot blood so you won't bleed to death.  The damage can cause your blood to clot too much or not enough. The clotting impedes blood flow to your organs, which causes them not to work.   The damage can also cause the blood clotting process to fail and you start bleeding internally.  This is where the blood starts coming out of every orifice you have including your eyes.

The adrenal glands stop working.  They help regulate your blood pressure.  Your blood pressure drops. Your blood pressure hasn't been doing too well anyway with the bleeding from the liver problems and an overwhelmed immune system.  You go into shock. With the shock, oxygen isn't getting where it needs to go, including your lungs.  You have to be intubated and put on a ventilator. Medications are started to bring up your blood pressure which is complicated with your organs failing.   You get blood products, IV fluids.

Each of your organs has a purpose, including your kidneys which have now have failed.  The kidneys help remove waste from your system.  That's no longer possible.  You have no way to get rid of toxic stuff anymore.  You are put on dialysis which is a machine that removes it for you.

When you get to this point, which is the point the guy in Dallas is at, your chances of survival are slim to none. *

Ebola is truly like something out of a horror movie. Imagine your worst medical nightmare and thats about the size of it.

*This is a very simplistic explanation of what happens with ebola.  I am no expert, only a lowly nurse, and therefore, mostly,  really don't know what the hell I am talking about.  But here is my understanding of it, such as it is.

what you don't know about care of those with ebola

It is fascinating to look into how ebola is treated.  To learn the facts about whether we are ready or not.

Fascinating fact #1:  Wonder why the two doctors went to Emory University hospital and the recently infected cameraman is now going to Nebraska Medical Center?  The reason is those hospitals have high-level biocontainment patient care units .  There are four in the country.  Four.   They have a total of 19 beds.  Nineteen beds in the whole U.S. These places are set up to care for people with things like ebola.

Fascinating fact #2:  What do health care workers currently caring for ebola patients wear?  Full body suits and 3 pairs of gloves.  That includes personal respirators, headgear, full-body suits and gloves.  They wear a battery operated respirator that purifies incoming air before the person breathes it.  A fan blowed the air across filters contained in cartridges.  The respiratory covers your whole hed with a clar plastic piece over the face so you can see.  Then they wear a jumpsuit type thing that covers from head to feet.  They wear 3 pairs of gloves, one of which is thick to prevent needle accidents. 

Imagine wear this get up for hours on end.  Thankfully, most nurses have very  strong bladder muscles due to having to hold their urine because they often don't get a break to pee for hours sometimes.   Imagine trying to deal with complicated machines with small keys, syringes and needles with 3 pairs of gloves on.  

Fascinating fact #3: It takes ten minutes to don the suit or take it off.   A second person helps to make sure it is put on right.  They make sure there are no rips or tears.  The suit is then disposed of.  Is the respirator thrown away too?

Fascinating fact #4: The people caring for these ebola patients get 80 hours of training before they even begin caring for the patients.  There are monthly meetings and quarterly drills.  In Nebraska the unit has a 30 person team. 

Fascinating fact #5:  Experts don't think you need all of the above to care for ebola patients.  The CDC thinks that you only need gloves, goggles, face masks and gowns.   Since they don't think its airborne they must not think you don't need negative pressure isolation rooms that filter the air. 

If that is the case, why are these patients being cared for in these biocontainment units?  Just so you know, Dallas Presbyterian doesn't have one of these units.  Also of note, when you see health care workers caring for patients in West Africa, they have the full suit on.   So which is it?  

Here's the thing:  If there was an ebola epidemic in the US, the military would handle it.  They are the only ones ready to deal with something like this.  They have trained for it, have the  equipment and know how to handle it.  The CDC would be out the window.  

nurses feel unprepared to deal with ebola

Hello?  Anybody home?  Mr. CDC director?  All the doctors on TV and the internet who have been giving their opinions on ebola?  The ones who insist we are ready for something like ebola, having been for a long time?  Hello?

Guess what? You know those people who have to actually do the practical day to day care of patients with things like ebola?  You know the nurses?  They don't feel ready to care for them.

Here's the thing, us nurses, we think in terms of reality.  How am I going to get that patient to CT through the halls of the hospital?  What if the patient vomits all over the elevator?  If the patient arrests, will we resusitate?  You might think, of course you will.  I want you to think about what it would be like to resusitate a patient while wearing a hazmat suit.  I want you to think about all the people who run to a cardiac arrest when it happens and the practicality of them having to don the suit before they enter the room.  These are the practical realities that nurses think of.  Other people don't.  They don't have to.  They aren't there 24/7.

Even doctors, who work alongside nurses daily in the hospital really don't have a clue what nurses do 24/7, what they have to deal with.  That is obvious with there insistence that we are ready, ready to care for patients with ebola.  They think we are ready because there are policies on computers.

Here's a practical reality for you:  As of September 1st 240 health care workers have developed ebola in West Africa, 120 have died. How did they get ebola when they followed procedure to don the suit, be very careful about contact with patients?  They figure most of them probably picked it up removing the suit.

Remember two doctors who developed ebola who were brought back to the United States?  A biosafety firm was hired to help the nurses through putting on and taking off the suit. According to Sean Kaufman, president of the biosafety firm that handled this:

According to an article in Newsmax:

 "Our healthcare workforce goes through so many pairs of gloves that they really don't focus on how they remove gloves. The putting on and the taking off doesn't occur with enough attention to protect themselves," he said.  

"A survey by National Nurses United of some 400 nurses in more than 200 hospitals in 25 states found that more than half (60 percent) said their hospital is not prepared to handle patients with Ebola, and more than 80 percent said their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola.Another 30 percent said their hospital has insufficient supplies of eye protection and fluid-resistant gowns."

There are 5700 hospitals in this country.  At 3, 420  (60%) of them, nurses feel they are unprepared to care for ebola patients.  At 4,560 (80%)  hospitals  no policy regarding ebola has been communicated to the nurses.  At 1,900 (30%) nurses don't even feel they have adequate supplies to protect themselves.  I wonder if your local hospital is ready?

the buffoons in charge of response to ebola

In yet another example of the bufoonish way the ebola virus situation is being handled, a story comes about a plane from Brussels to Newark today.  Now keep in mind, the people from the CDC have told us that "we got this", "never fear" etc.

A man gets sick an hour and a half out from landing in the US.  He calls the flight attendant because he is sick.  After she talks with she asks where he originated from guess where? Liberia.

So the plane lands, everyone but the passengers in a couple of rows in front of and in back of his row are allowed to leave.  The CDC people come on and take the guy. Then they tell everybody they can leave. So all of the passengers leave to go through customs, get their bags.  Now mind you this includes the people in the row of the man who was sick and vomiting.

So the passengers are around the airport  completing their business.  Then there is an announcement over the airport PA that the passengers from that flight are not allowed to leave and to gather in a specific area of the airport.  They are held for hours.  Finally they are let go after giving contact information.  Oh by the way, they are given a sheet with symptoms of ebola and essentially wished good luck.

Apparently it is now unclear whether this guy originated in Liberia. A passenger next to him said that he told them he had.  The guy  was apparently going to wait for his young nephew to arrive who was coming from Liberia.

The point of all this? Why the bumbling?  Why the "you can go, no, come on back".  It is obvious that despite all of this going on, the US government does not have any specific plans in place around this disease and those who may have been exposed to it on a place.  That is baffling to me.

good luck with that ebola thing

Here's the thing about the ebola thing or anything similar to it: terrible diseases, chemical or biological warfare....there are many people within the medical community whose job it is to develop protocols about how all of this will be handled.  They come on with detailed plans that are put away in disaster plan sections on computers.  Its all really great...looks really good.

They are the people who buy a few of the latest in disaster materials: hazmat suits, tents to clean people off, etc.  Its all really great.  They even train people in hazmat.  Its stored away somewhere in the hospital or other places.

They plan command centers with detailed algorithms and pictures of who is in control and those below them.

I have been an ER nurse for 25 years. In that time, I have been through maybe 2 or 3 fake disaster drills that nobody takes seriously.  We have a cupboard that houses a orange binder which is about 6 inches think that contains all the plans.  In that same cupboard are disaster triage tags.  I think there are a few orange vests.  As far as I know thats all we have for disaster supplies.  Disaster plans are also on the computer.  Hopefully in a disaster the computer will still function.

Apparently there are disaster carts that we can call for from somewhere.  What is in them?  Who knows.  I don't know.

I have brought this up a couple of times about how we would handle disasters if one happened.  Maybe my interest is because I was in the military in med evac.  We were the people whoo evaced people from war zones.  We trained to deal with chemical, biological warfare.  So I think about this kind of stuff.

I think the people who are in charge like health departments, the CDC make a lot of assumptions that hospitals are ready.  After all, they have developed the protocols, they gave them to the hospitals.  They assume there are plans in place.  They assume wrong.  Sure the stuff is on the computer, but as far as the practical reality of dealing with a real disaster or something like ebola: nada.

So far my hospitals preparation for possible ebola patient is: Ask people if they have been out of the country in the last 3 weeks.  Thats it. Beyond that, who knows?  I imagine this is the case across the United States. I work in a big inner city ER with a diverse population. The hospital administrators believe the CDC and health officials that this couldn't possibly happen at their hospital.  The thing is, Dallas Presbyterian thought it would never happen there either.  But it did.

When the managers and administrators go home they are essentially telling us: Hey good luck with that possible ebola patient or any other disaster thing...

breaking news from experts about Ebola!

From NBC news, BREAKING NEWS from the DUH division:

"American hospitals may need to step up their training for potential Ebola patients, some advocates say, after a Texas incident raised fears about the virus not being properly contained.

The case of the Dallas hospital that initially sent home a man sickened with Ebola highlights an urgent need for better training — not only for the nurses who are the front-line defense against stopping the spread of any disease, but for all health care personnel, some experts say."

Duh.....ya think?!!?

guess what? you have been assigned to care for an ebola patient...

It would be interesting to see how the nurses caring for the ebola patient in Dallas are doing it.  Just practically speaking.

It appears from what I have seen, people in West Africa caring for patients are dressing in what is essentially a hazmat suit. Well lets assume that here the outfit consists of: gown, double gloves, hairnet,  foot covers, googles, mask.  I assume our mask we are fitted for with TB doesn't have to be worn since apparently this is not airborne.

The nurse(s) spends the shift in all of this.  I assume they never leave the room because of the situation and the impracticality of putting this stuff off and on over and over.  To say wearing this gear for hours is uncomfortable is to understate it.

The machinery involved in caring for a critically ill patient like this is complicated.  Just trying to manage the practical care of the patient with the gear on would be very difficult.

So keep in mind everybody who comes into the room: xray, various docs, respiratory therapy has to don the gear. This kind of patient has a lot of tests: xrays, CTs. How is this done?  Is there one xray machine dedicated to them?  Do you take them through the halls to CT?

This patient may be on dialysis.  They may be intubated.  What if they arrest?  Is someone in this situation resusitated?

The practical side of caring for this patient is mind boggling.  Its something the general public has no concept of.  The cost is staggering. Now imagine just ten cases of this across the country.

One last thing: Can a nurse refuse to take care of this patient? Imagine being a new mother with a few months old baby at home.  Would you want to chance bringing something home?  Now I can hear all of you saying: If you use all of the gear, take the necessary precautions, you will be fine.  What about those 2 doctors who used all the precautions in Africa and ending up getting ebola anyway? What about the cameraman who surely had no physical contact with an ebola patient and has now developed the disease?

For healthcare personnel in hospitals, the reality of this hits home.  Chances are almost nonexistent that we as individuals will ever deal with it. It certainly makes you think.

stop lying about ebola

The United States is arrogant.  The officials here saying that ebola would never come to the United States.  We have a better "infrastructure" than those backward West Africans.  We have things set up for these situations.

Yet here we are.  Someone in the United States has ebola, they have exposed up to a hundred people. The system failed when they first came into the hospital.  This despite all the press about ebola,  the CDC directive to ask people if they had been in West Africa.

Now we are hearing, the nurse failed to communicate the fact that this man had come from Liberia to the "rest of the team" That may have been true, but why the hell didn't the doctor ask about travel to West Africa.  It must have been obvious that this guy is African.  Seeing someone with these symptoms, asking them if they travelled seems pretty basic for a doc.

Our officials need to stop telling the public we are ready for this, stop lying.  They need to start moving toward being ready by having specific guidelines for hospitals and all of the equipment and supplies available that are needed to care for these patients.

are we ready for something like ebola? Of course not.

You know what I love?  When officials get on TV and say things like the medical profession and hospitals have been "practicing for years how to deal with something like ebola".  Really?  What does that really mean?  I haven't been doing any practicing and I have been working in the ER for years.  I am on the front lines of medicine where those patients will show up first.

I always feel like we are not prepared for any disaster, let alone some hemmorhagic fever.

If they mean, if you came in with vomitting, fever, muscle pain, etc and said you had travelled to West Africa, would I put a mask on you?  Sure.  I would put you in one of the two isolation rooms we have in the ER.  We would put you on contact precautions.  contact precautions mean we wear gloves and a gown.  Is this enough?

When you see somebody on TV in West Africa treating people for ebola they are dressed from head to toe in an outfit.  They have a hood over there head.  They have things over their shoes. They have people there whose only job is to dress those people to care for them.  The way they are dressed reminds me how we used to dress for chemical warfare training.

Do we have access to these kind of outfits?  Not that I know of.

What would we do with their family members accompanying them? There are many questions that arise.   No one has said ANYTHING to us except saying we should ask people at triage whether they have travelled outside the country.

You probably think I am overreacting.  Come on....its never going to happen at your local ER.  You are probably right.  It is scary nonetheless. It brings this fact front and center: Most ERs are not ready to deal with something like this and they should be.