Entering the Red Zone: Establishing an Interdisciplinary Specialized Medical Team for Ebola Preparedness

Once believed to be contained to a tropical area in Africa, medical care for a patient with the Ebola disease virus (EDV) remained isolated to the areas affected by this horrific disease.  The recent spread of the virus to the western hemisphere has created an urgent need for training and preparation of healthcare workers.  The Center for Disease Control (CDC) has recommended that all healthcare facilities establish procedures for the screening, isolation, and transfer of care for any patient suspected of having a highly contagious disease, in order to prevent a global health crisis.  The EDV has proven to be a complex pathogen with a high infectious load; even a microscopic level of exposure can cause infection.  Increased viral shedding and rapid spreading of the disease require specialized isolation and containment procedures.  The Medical University of South Carolina (MUSC), a large academic medical facility with over 700 adult and pediatric beds and two emergency departments, recognized the need for global staff education in order to comply with CDC recommendations.  MUSC also identified itself as a potential EDV treatment site and the need to establish an innovative training program with protocols and procedures for escalating care.  All medical facility personnel were required to complete a basic educational PowerPoint with post-test to demonstrate knowledge of screening and isolation procedures for all patients.   A specialized medical team (SMT) with advanced training in the procedure and care of the Ebola patient was then formed.  This specialized team underwent a rigorous three day training course which was separated into two parts.  A didactic approach was used to review Ebola disease virus pathophysiology, symptoms, and typical disease progression.  Case studies and procedures for lab draws, telemedicine conferencing, and additional supportive equipment and tests were all also reviewed.  The second portion of the training was interactive including the donning and doffing of personal protective equipment (PPE), practice in basic patient care while in PPE, and inter-disciplinary high-fidelity simulations including containment procedures, post mortem body shrouding, and the coordinated transition of care from a transport team to the designated unit.   SMT members included pre-hospital staff, registered nurses, respiratory therapists, and physicians who volunteered for the training.   The implementation of the SMT demonstrated a reduction in anxiety of staff by safely and proactively training personnel in a coordinated training environment.   A specific tool “glow germ” was used in all simulation activities to mock Ebola disease transmission.  Participants were screened for “glow germ” following any activity in order to detect any break in procedure and possible exposure.    Further recommendations include a process for revalidation of skills including unannounced mock patient drills with team members donned in PPE.   “Glow germ” measurement should also be used in all revalidation sessions.   The recent spread of the Ebola disease virus to the United States has clearly demonstrated the need for preparation and training for healthcare personnel.  All healthcare institutions should establish an education plan for staff in order to screen and isolate suspected patients.  In addition, facilities preparing to care for an Ebola patient should form a specialized medical team (SMT) in order to provide advance training and practice.  Meticulous adherence to policy and the ability to provide care in personal protective equipment is essential to the safety of all team members.  The formation of a specialized medical team utilizing interdisciplinary training establishes standardized protocols for care, prepares personnel in specialized protective equipment and disease containment, and proactively prepares healthcare workers for any global health crisis.