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Old 10-15-2014, 09:43 AM   #181
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If true (and I suspect it is true) this is a scathing indictment of emergency preparedness. Sloppiness like this kills people. I expect many other facilities would be no better prepared. The bar needs to be raised, now. No wonder the CDC will be sending a Swat team with equipment to every new case.
The hospital in Dallas is totally unsuitable for this type of care. They would be totally incapable of handling more that a couple of cases. This type of care is not something they are equiped to deal with let alone on a large scale.

The obvious incompetents at the CDC needs to do more than send people to whichever facility "won" the Ebola lottery. A whole facility needs to be established geared towards handling multiple cases. This can start as a small area but it need to be able to grow as needed if this thing gets out of hand.

I would avoid this Dallas hospital and I suspect most people will. A dedicated facility is needed.
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Old 10-15-2014, 09:49 AM   #182
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If true (and I suspect it is true) this is a scathing indictment of emergency preparedness. Sloppiness like this kills people. I expect many other facilities would be no better prepared. The bar needs to be raised, now. No wonder the CDC will be sending a Swat team with equipment to every new case.

http://t.thestar.com/#/article/news/...es_charge.html
What is more concerning is that Ebola shouldn't be a tough virus to handle. Imagine if this was a more contagious virus? The results wouldn't be pretty.

I think sloppiness to some extent is unavoidable. That's why you have to have a process that mitigates sloppiness. What's interesting is that we still don't know why the RN became infected with Ebola. It's assumed that she must have slipped up, but as far as we know she followed the appropriate process and still became infected. I'm skeptical we'll ever really know how she became infected, but there really are only two options: there was a break in protocol or the protocol isn't 100%.

It seems to me that it would be appropriate to require staff to work in teams. This way they can at least identify what went wrong when it happens and overall, having additional oversight makes people more honest. No short cuts and an extra set of eyes to notice any inadvertent slip-ups. Or maybe video monitoring of patient care so it can be reviewed after the fact? This would be cheaper and would at least allow post-analysis in case something does go wrong.
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Old 10-15-2014, 09:52 AM   #183
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If I were living in Texas, I would question whether the Department of Health there is up to the task. After all, Ebola patients were admitted to three other hospitals in three other states and survived and the virus didn't spread to the staff. Why was Texas the only one, so far, that lost control of the situation?
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Old 10-15-2014, 10:06 AM   #184
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This is really hitting too close to home. The apartment complex where this second health care worker lives is the same one my DD lives in. And my DD is a nurse in Dallas although thankfully at a different hospital.

I've already told DD to avoid the gym in the complex just in case any sweat was left on machines from the infected resident. I'm sure such a scenario is deeply unlikely but hey, it's my DD. Trying not freak out but this is getting our attention for certain. It's the scenarios we can't think of that really have me worried.

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Old 10-15-2014, 10:13 AM   #185
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If I were living in Texas, I would question whether the Department of Health there is up to the task. After all, Ebola patients were admitted to three other hospitals in three other states and survived and the virus didn't spread to the staff. Why was Texas the only one, so far, that lost control of the situation?
I would say poor information/training protocols and onsite follow-up from the CDC and fact that Duncan was the first patient to be diagnosed in the US. The real issue to me is that they missed this the first time Duncan visited the hospital, but again I suspect that was due to mindset it could never happen here and was the first such occurance.
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Old 10-15-2014, 10:17 AM   #186
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If I were living in Texas, I would question whether the Department of Health there is up to the task. After all, Ebola patients were admitted to three other hospitals in three other states and survived and the virus didn't spread to the staff. Why was Texas the only one, so far, that lost control of the situation?
Texas was the only state that had a bozo walk in off the street with Ebola. All the other facilities were special facilities selected for their expertise in these types of cases.
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Old 10-15-2014, 10:19 AM   #187
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But how long does it take to confirm a case of Ebola? Honestly I don't know, but I wonder if those tests would take a day or two, perhaps? Then, I am envisioning another day or two for the newly created response team to travel to the hospital in question and report in at that location. I am wondering if by the time they get there, the hospital may have been making unintentional mistakes for days.

I do hope that the CDC is at least e-mailing informational packets immediately to hospitals with even unconfirmed cases of ebola, and perhaps consulting with the proper folks at these hospitals via Skype or telephone.

We live in the 21st century, not the 19th, and sending out a response team sounds like sending mail via the pony express, to me. Sure, having experts actually physically there would be wonderful. But also, information can be sent by much faster methods.
That's a good question. I know they do a rapid-blood test to see if you have Ebola, but I can't find how long this takes. My guess is that's in the order of hours, not days.

Also, if you are suspected of Ebola, then you are immediately quarantined until the results come back. They assume that you are infected until proven otherwise, which is the right approach. I'm guessing that the earlier stages of Ebola aren't as contagious, which can provide some time before CDC/trained staff arrives.

I still believe that you need to have staff that has been trained to deal with this type of outbreak on-site. It's not enough to send information. There's a big difference in learning something and having actual experiencing in dealing with something. The latter is needed in this case and it looks like that is what's happening, which is good.
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Old 10-15-2014, 10:28 AM   #188
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The real issue to me is that they missed this the first time Duncan visited the hospital, but again I suspect that was due to mindset it could never happen here and was the first such occurance.
DW gives me grief over this but I have told her that the biggest reason he wasn't admitted the first time is that it is almost certain that he had no insurance and the doctor involved had no clue what he had. I suspect that the hospital discourages random admittance of uninsured patients unless it's obviously critical.

From the reports I've read the guy clearly had a fever (103 F - I recall correctly) but that in itself isn't life threatening. He was sent home with antibiotics which wouldn't help a viral infection. Was that a misdiagnosis or just giving the guy something to get him out the door? There was also clearly a miscommunication that this guy was not flagged as being from an ebola area. The whole thing was done properly if he had a serious bacterial infection and was from Kenya (not intending to be political but I couldn't resist ). It's easy to be critical with 20/20 hindsight.
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Old 10-15-2014, 10:41 AM   #189
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Aparently, in Africa, experts watch each person put on their gear and take off their gear making sure they do it correctly. In the USA, we assume our hospital workers are so competent that they don't need the expert. Not so good.
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Old 10-15-2014, 11:01 AM   #190
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Aparently, in Africa, experts watch each person put on their gear and take off their gear making sure they do it correctly. In the USA, we assume our hospital workers are so competent that they don't need the expert. Not so good.
It's hard to believe this is not being done for something this serious. Where I worked we had to be qualified to use protective clothing. We were requaled/trained annually. We worked in teams. They were monitors ( people ) to do nothing but oversight ( not involved in the actual activity) to ensure things were done per procedure. We also had emergency procedures and were trained and drilled on them. The work activities were done with detailed procedures. Video surveillance was used to remotely monitor all activities. The job would be shutdown for "protocol" failures. The video was used to determine what went wrong and prevented finger pointing .

Based on what is coming out, the CDC and medical industry is flying by the seat of their pants and making things up as they go.
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Old 10-15-2014, 11:02 AM   #191
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I still believe that you need to have staff that has been trained to deal with this type of outbreak on-site. It's not enough to send information. There's a big difference in learning something and having actual experiencing in dealing with something. The latter is needed in this case and it looks like that is what's happening, which is good.
Exactly. Written instructions and brochures are not up to this task. In-person training, practicing under supervision with real PPE, and STRICT adherence with policing are required to get the techniques consistently right. It is very challenging to work while wearing Level 4 PPE.
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Old 10-15-2014, 11:13 AM   #192
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It's hard to believe this is not being done for something this serious.

Based on what is coming out, the CDC and medical industry is flying by the seat of their pants and making things up as they go.
The hospital in Dallas was not designed for or intended to ever handle anything like ebola. The crime here was their attempt to handle it.

I believe there are four hospitals in the US designed for this type of contageous disease. I wonder where our two new cases are being treated. I fear that the same hospital is trying to deal with it. I am sure that even with all the "learning" they've experienced this is not the right place for these new patients.

I'm pretty sure it's not cost effective to attempt to get every hospital in the US up to the standards necessary to handle ebola. I think it sure makes sense for contingency plans to be developed to establish regional treatment centers that specialize in ebola.
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Old 10-15-2014, 11:28 AM   #193
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The preparation of a 'pad' for a module for infectious disease patients can be done in advance. Water, electricity connections is easy to do. I would design a separate sewerage containment facility, perhaps an incinerator. The module can be moved to the site as needed. IMHO it needs to be designed to accommodate several ganged together. If not Ebola then another deadly disease.
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Old 10-15-2014, 11:35 AM   #194
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The second infected nurse flew from Cleveland to Dallas the day before reporting her symptoms.



CDC says second nurse diagnosed with Ebola flew from Cleveland to Dallas the day before she reported symptoms | Dallas Morning News


The CDC says she flew Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth International on October 13, landing at 8:16 Dallas time. The CDC is asking all 132 passengers who flew on that trip to call 1-800-232-4636.
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Old 10-15-2014, 11:40 AM   #195
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The CDC says she flew Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth International on October 13, landing at 8:16 Dallas time. The CDC is asking all 132 passengers who flew on that trip to call 1-800-232-4636.
Don't they have a flight manifest?

It seems like it should be the CDC calling, not the other way around.
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Old 10-15-2014, 11:45 AM   #196
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The second infected nurse flew from Cleveland to Dallas the day before reporting her symptoms.



CDC says second nurse diagnosed with Ebola flew from Cleveland to Dallas the day before she reported symptoms | Dallas Morning News


The CDC says she flew Frontier Airlines Flight 1143 from Cleveland to Dallas/Fort Worth International on October 13, landing at 8:16 Dallas time. The CDC is asking all 132 passengers who flew on that trip to call 1-800-232-4636.
WTF is wrong with the system? Why were all of the workers that had anything to do with this patient quarantined?
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Old 10-15-2014, 11:46 AM   #197
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WTF is wrong with the system? Why were all of the workers that had anything to do with this patient quarantined?
I am wondering about that too. I thought all the contacts were being monitored. I was assuming their travel would be restricted. I certainly didn't think they would be going to Cleveland.
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Old 10-15-2014, 11:51 AM   #198
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What is interesting is that so far non of the people who actually lived in the same apartment as the fellow who died of Ebola have contracted the disease. Or am I wrong?
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Old 10-15-2014, 11:55 AM   #199
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I think along with fast tracking ZMapp, them folks really need to think about trying to build a better Hazmat suit (one that's easier to take off without getting infected) or a better decontamination area.
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Old 10-15-2014, 11:58 AM   #200
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This is really hitting too close to home. The apartment complex where this second health care worker lives is the same one my DD lives in. And my DD is a nurse in Dallas although thankfully at a different hospital.

I've already told DD to avoid the gym in the complex just in case any sweat was left on machines from the infected resident. I'm sure such a scenario is deeply unlikely but hey, it's my DD. Trying not freak out but this is getting our attention for certain. It's the scenarios we can't think of that really have me worried.

Muir

Yikes! That would be way too close for comfort for me.
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