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.