WESTFIELD – A hearing was held in Boston last Thursday by the joint Committee of Public Health examining how prepared the Commonwealth of Massachusetts is for a potential outbreak of the Ebola virus.
The highly infectious virus that has ravaged several nations in west Africa this year has made its way to the United States, with one man dying of the condition in Dallas and one of the nurses who treated him falling ill, as well.
While hospitals are doing their best to reassure the public despite a recent suspected case in Braintree, groups such as the Massachusetts Nurses Association (MNA), a labor union representing frontline nurses in over 70 percent of the state’s hospitals, haven’t been as optimistic.
“What nurses have to say, universally and across the state, is that we’re not ready,” said MNA Director of Public Communications David Schildmeier last week. “(Nurses) don’t feel safe. They don’t feel there is a plan in place. They don’t feel there has been enough training or that the protective equipment is going to keep them safe.”
“If a nurse at 3 a.m. on an evening shift at a hospital doesn’t feel like she knows what to do or has the equipment to respond, then we’re not ready,” he said. “There may be some nurses who are trained but all hospitals don’t have enough people trained or enough materials and there is no legitimate plan.”
Though the virus was first identified in 1976 and has broken out in sub-Saharan Africa several times since then, arrival in the U.S. is of grave concern to Schildmeier.
“It is deadly. We’ve had SARS and things like that, but it has a 70 percent mortality rate and there is no vaccine,” he said, likening the condition to HIV/AIDS. “That was the last time we were confronted with something that was like a death sentence and this is close to that. You can’t be safe enough.”
Schildmeier said that the state’s hopitals are also starting to see the union’s point of view.
“Because of all the noise we’ve been making and the cases in Dallas, we do see a change, that they are starting to wake up and get serious,” he said. “So let’s do it right while we don’t have a case or a crisis.”
“We’ve called for meetings to sit down, bring our experts in and show the state-of-the-art for care,” Schildmeier said.
Benjamin Craft, director of public affairs and community relations for Baystate Medical Center in Springfield, believes that his hospital – the only Level I Trauma Center in western Massachusetts – is as prepared for a potential case as they can be.
“We are in very regular contact with the state Department of Health, which is one of the coordinators of our state healthcare system response,” said Craft. “So we are well -connected to the preparations for any potential Ebola cases.”
“We have been meeting and making plans for several weeks and the process is to assess the situation, make plans and roll it out in the form of education as is appropriate throughout the organization,” he added. “Everyday we’re making progress in rolling out notifications, training, educational materials. That is something we continue to work on and make as much training as available as possible.”
Craft stated that if a potential Ebola case were to arrive at Baystate, not everyone in the hospital would be caring for that patient.
“In fact, a very small number of folks would be caring for that patient. One of the tricks in the rolling out of education and training is figuring out who are the most important folks to reach in terms of preparedness,” he said.
While a local hospital like Noble Hospital or Holyoke Medical Center could receive a patient with Ebola-like symptoms, Baystate is the only hospital in the region with the capabilities to treat the virus.
“The process of communication and transfer between local hospitals and Baystate is quite well established and the relationships are strong,” said Craft. “We are the only academic medical center out here, so a lot of the folks working in western Mass. hospitals do training here.”
“We’re ready to handle this and we’re continuing to stay as ready as we can everyday,” Craft said.
“Whether it’s an airborne transmission or a direct contact makes a big difference when you identify it,” said Mary Jane Lamb, RN, who oversees infection prevention at Noble Hospital. “Any patient coming into the emergency room goes through a triage process with a nurse and if she feels there’s a chance of an infection, she would have the patient put in an isolation room immediately.”
Lamb said Noble has one airborne isolation room in the emergency room, one in the general medical/surgical ward, one in the intensive care unit and one in the recovery room.
“Many organisms don’t need airborne isolation, they just need to be put in a private room using the correct isolation personal protective equipment,” said Lamb.
Lamb added that Noble’s personnel has always used air-filtered hoods called “pappers” to treat patients in these airborne isolation units.
But for a disease such as Ebola, a virus that spreads through bodily fluid contact, protective body suits are of the utmost importance.
“We have quite a few in stock in our emergency management equipment in our emergency room, as well as in supplies,” said Lamb. “Our emergency manager keeps supplies for something like this or for other types of exposures.”
“We ask patients if they’ve traveled to Africa and if they have we would put them immediately into isolation and then a nurse or doctor in isolation garb – here we use Tyvek suits and the hoods,” she said. “Because Westfield has a very low tuberculosis rate, we don’t use a lot of N95s, a mask that goes around the nose and mouth and needs to be fit-test.”
“We’ll be using Tyvek suits with the pappers to assess patients, and if we determine the patient meets the CDC’s screening criteria for Ebola – they have symptoms and have traveled to one of the countries in west Africa that have Ebola cases – we would then keep them on isolation.”
Lamb added that the hospital is preparing to use portable walls to separate segments of the emergency room to temporarily handle a potential case, but reassured that any Ebola case would be transferred to Baystate.
“We don’t have the capacity to treat a full-fledged Ebola case here. We just don’t have that level of intensive care and infectious disease physicians,” she said. “We have consultants from Baystate who work with us, but you’d need people full-time.”
“We have a good plan in place and we hope we never have to use it,” she said.
