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Ebola, Leadership, and Responsibility

Ebola, Leadership, and Responsibility

I am a surgeon. I am not an Epidemiologist nor an Infectious Disease specialist. Anything I say on this subject should be regarded as the musings of an educated layman. That said, I have been profoundly disappointed in the response of my profession to the current Ebola scare in this country. I don’t use the word crisis because it is not a crisis in the United States. The crisis is in West Africa. Nevertheless, the media have done little to calm fears of rampant spread of the disease to America. The response of our professional organizations and public health institutions has been scientifically correct and yet has been an abject failure in the eyes of the public. The guidelines coming out of the CDC and the Public Health Service seem fragmented, incoherent, and sometimes contradictory. Measures, which in the public mind seem reasonable such as flight bans and quarantines, are dismissed with an attitude of superiority that borders on arrogance. I know the reasons that such measures were not recommended, but those reasons were not communicated in such a way that the lay person could understand and support. Instead, the response of the experts sounds dismissive and political rather than reasonable and scientific. Leadership involves more than issuing the correct orders and directives. It also means effective communication of the mission and goals of the organization. In this case, there has been a failure of leadership from the top. “The experts have done little to alter the perception that they are either political hacks or arrogant academics…”   Some of the irrationality about this disease can be blamed on...
New Ebola Guidelines for Emergency Departments

New Ebola Guidelines for Emergency Departments

The American College of Emergency Physicians (ACEP) has been working with the CDC and the Emergency Nurses Association to establish procedures to help emergency personnel evaluate and manage emergency patients suspected of possible Ebola infection.  The CDC published the new guidelines for emergency departments during ACEP’s annual meeting where experts from across the country are meeting to discuss key issues, including Ebola. The new guidelines, an Ebola management algorithm, can be found and printed here. The guidelines were evaluated and approved by a panel of experts—consisting of emergency physicians and emergency nurses with expertise in infectious disease and disaster preparedness—appointed by ACEP’s president. “It’s critical to protect the emergency medical staff who are on the front lines of caring for patients who may have Ebola,”  said Alex Rosenau, MD, FACEP, immediate past president of ACEP.  “They are the ones most at risk for contamination, because they come in direct contact with the patient, as demonstrated by the infections of the nurses in Dallas and the recent case of the emergency physician in New York.   On behalf of our 34,000 members, we are so grateful for the recovery of the nurses and we are optimistic that Dr. Spencer will recover as well. ” The CDC guidelines include advice for: ♦ Assessing patients, including those for whom travel histories are unavailable (for example, when patient s are unconscious). ♦ Putting on (donning) and removing (doffing) of personal protective equipment (PPE). ♦ Managing and isolating patients who may have Ebola. ♦ Informing hospital personnel and other authorities about possible infection. ♦ Providing direct observation of health care workers during the donning and...
Ebola: Are We Prepared?

Ebola: Are We Prepared?

While the government came out last week proclaiming that healthcare workers are prepared for an Enola outbreak, the majority of us do not feel this is the case. Virtually no one in the US has seen, or treated, a case of Ebola virus in the past. Now, not only are we expected to recognize patients that may be infected with this deadly virus, we need to be prepared to prevent the spread of this highly contagious pathogen if we were to encounter it. The CDC has done an excellent job passing its guidelines to ER’s and local health departments across the nation. But, these simply have not trickled down to those of us on the front lines: doctors and healthcare workers in outpatient settings, nurses, EMT’s paramedics, and all those who may be the first to encounter an Ebola patient. This represents a very significant gap in the system. There is no one to blame for this gap. Everyone is working hard to get a handle on it, but it simply is an enemy we have never seen before and are forced to develop guidelines for it as we are under attack. The CDC advises that if you have a suspect patient in your practice, place him/her in an exam room, close the door, and contact the local health department. I work evening hours. The health department closes at 5PM. I cannot keep my patient locked in the exam room until they open up again in the morning. Of course, a breach of the suggested protocols will have to be made to get this patient to the emergency room where...

Emory University, Ebola, and the Duty to Care

When news broke that two American medical missionaries stricken with the virulent Ebola virus were being transported to the United States, opinions around the world, in America, and on the streets of Atlanta, GA, were mixed…as they yet remain. Some passersby lauded Atlanta’s Emory University Hospital (EUH) for welcoming the sick to the institution. Others grew nervous that nearby citizens and anyone visiting or currently an inpatient at the facility may become infected. Many wondered how Dr. Kent Brantly, and missionary Nancy Writebol became infected in the first place; and others asked, “Why can’t we just send workers to Liberia, and treat the patients there? Why bring them here at all?” A Dr. Ford Vox expressed the concerns and fears of many in a Bloomberg View blog, “Who Invited Ebola to Atlanta?” While the Washington Post published, “Why you’re not going to get Ebola in the United States.” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention (as well as other experts in infectious diseases) made rounds on Sunday news programs, assuring the American—and Atlanta—public that there is little risk to the general population. For some, Dr. Frieden’s words lacked comfort, considering two recent publicized failures in CDC protocol involving highly infectious agents—highly contagious flu viruses and potentially aerosolized anthrax spores. When called before Congress, Dr. Frieden admitted that these were not isolated instances, but part of a broader problem with the agency. So can Dr. Frieden speak with such confidence in this Ebola matter, with these two patients housed within walking distance of the CDC campus? Similar to the Bo Bergdahl dilemma—do we return any...
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