Kathleen Louden

October 29, 2014

CHICAGO — Emergency medicine physicians and nurses are preparing to treat patients suspected of having the Ebola virus, and recently helped the Centers for Disease Control and Prevention (CDC) with new guidelines.

The recommendations, developed with the American College of Emergency Physicians (ACEP) and the Emergency Nurses Association, provide "needed direction," coauthor Stephen Cantrill, MD, said in a news release issued here at the ACEP 2014 Scientific Assembly.

The guidelines "reflect lessons learned from the recent experiences of US hospitals caring for Ebola patients," Dr Cantrill explained, referring to the situation in Dallas, where two nurses contracted the virus from a patient they cared for.

"Emergency physicians and nurses are aware there is a risk of being exposed to Ebola because they are on the front lines of caring for patients who may have it," David Pigott, MD, told Medscape Medical News here at the meeting.

Dr Pigott, professor of emergency medicine at the University of Alabama at Birmingham, who served on the guideline development panel, said the new procedures offer a clear step-by-step approach. They cover triaging and assessing patients, safely putting on and removing personal protective equipment, isolating and managing patients who might have Ebola, and informing the proper authorities about suspected cases.

Even before the release of the new CDC algorithm, many emergency departments in the United States, including his own, began drills to practice what to do if they encountered patients with known or suspected Ebola, he said.

Infectious Disease Drills

Despite a recent survey showing that few of the nation's hospitals are well prepared for Ebola, Dr Pigott said he believes "we are ready."

Still, he said he supports the recommendation for a regionalized response to Ebola, in which emergency departments that have identified infected patients transport them to designated facilities with the necessary specialized resources and expertise.

Another emergency medicine physician said he agrees.

"What we've learned is that not every hospital is equipped to deal with these patients," Alexander Isakov, MD, from Emory University in Atlanta, told conference delegates during a well-attended educational session on Ebola.

"We have to close the gap in knowledge of infection control," said Dr Isakov.

Because doffing protective equipment is a risk point for direct contact with this highly infectious virus, the CDC recommends that a trained observer supervise the process.

The protection of healthcare workers also depends on the early identification of a patient's exposure history and Ebola symptoms. Symptoms include fever, headache, musculoskeletal pain, vomiting, diarrhea, and mucosal and gastrointestinal bleeding. However, hemorrhagic complications are not present in all patients, Dr Pigott pointed out.

He stressed that Ebola is not airborne. Transmission requires direct contact with blood or other bodily fluids from an infected person or with infected objects, such as needles.

Asymptomatic patients are not contagious, Dr Isakov emphasized.

Durata Therapeutics supported the Ebola-related lecture. Dr Pigott and Dr Isakov have disclosed no relevant financial relationships.

American College of Emergency Physicians (ACEP) 2014 Scientific Assembly: Presented October 28, 2014.


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