Patterico's Pontifications

10/14/2014

Nurses Do Not Believe They Have Been Sufficiently Trained And Prepared To Treat Ebola Patients

Filed under: General — Dana @ 8:40 pm



[guest post by Dana]

From a group statement released by the National Nurses United union after Thomas Eric Duncan’s attending nurse Nina Pham tested positive for Ebola:

There was no advance preparedness on what to do with the patient, there was no protocol, there was no system.

The union claims that because there were no protocols in place at the time of Thomas Duncan’s admittance to the hospital, nurses were put at great risk.

More troubling:

The guidelines were constantly changing and “there were no protocols” at Texas Health Presbyterian Hospital Dallas as the hospital treated a patient with Ebola, the co-president of National Nurses United says. Protective gear nurses initially wore left their necks exposed; they felt unsupported and unprepared, and they received no hands-on training, co-president Deborah Burger says, citing information she said came from nurses at the hospital.

The hospital released a statement defending itself:

Patient and employee safety is our greatest priority and we take compliance very seriously. We have numerous measures in place to provide a safe working environment, including mandatory annual training and a 24-7 hotline and other mechanisms that allow for anonymous reporting.

And, in a survey conducted by the National Nurses United union, three out of four nurses do not believe they have been adequately educated on Ebola at their hospitals:

Out of more than 1,900 nurses in 46 states and Washington D.C. who responded, 76 percent said their hospital still hadn’t communicated to them an official policy on admitting potential patients with Ebola. And a whopping 85 percent said their hospital hadn’t provided educational training sessions on Ebola in which nurses could interact and ask questions.

The survey also found that 37 percent of nurses felt their hospital had insufficient supplies for containing the deadly virus, including face shields and goggles or fluid-resistant gowns.

–Dana

17 Responses to “Nurses Do Not Believe They Have Been Sufficiently Trained And Prepared To Treat Ebola Patients”

  1. Hello.

    Dana (4dbf62)

  2. What a surprise! As a layman I don’t believe nurses have been sufficiently trained and prepared to treat Ebola patients. I also don’t believe they’ve been trained to deal with the virus itself or any potential outbreak. Then, why should they? That’s like teaching them how to deal with a polio or smallpox epidemic. We simply don’t have those things here unless the government allows them to get here.

    Hoagie (4dfb34)

  3. As a layman, I would say it’s about time that a union helped workers rather than being a pimp for the Democratic Party.

    Death does provide clarity.

    Ag80 (eb6ffa)

  4. I also feel awful for all the soldiers who will be in harm’s way for the vanity of TFG who doesn’t even like them.

    Gazzer (4d1091)

  5. When are not nurses complaining about something or other?

    nk (dbc370)

  6. An LA based nurse has been raving about this on his blog for a while.

    http://raconteurreport.blogspot.com

    There are some very good and talented people who work on this stuff, mostly in the DOD biodefense programs: USAMRIID, NMRC, DTRA. The DOE labs have a lot to contribute (especially bioinformatics, which benefits from the sort of research ORNL and LANL have always done. Some very good stuff in the academy, too — Lipkin Labs at Columbia, Texas A&M, Johns Hopkins, many others. And some commercial firms have done amazing stuff. This is all stuff government should do or fund, even in a narrow reading of the constitution.

    DHS’s Bio-D efforts are duplicative, and CDC seemed to decide that communicable diseases are too pedestrian for them to play with when they can instead be trying to do human experiments in the epidemiology of sugary soft drinks.

    Kevin R.C. O'Brien (e2d5eb)

  7. I think they have a legitimate complaints especially when assholes try to blame them. Plus Medicins sans Frontieres, the experts on protocols now have 16 infected HCWs and 9 have died. This is an impending disaster. Hospitals can’t afford to treat Ebola.

    According to her, after the CDC outlined its preparation strategy, one hospital administrator responded, “What you’re telling us would bankrupt my hospital!” She said that that administrator represents a Southern California hospital.

    McCaughey noted that there was no word on the call of who would pay for hospitals to get themselves ready for Ebola patients.

    And then she added: “Treating one Ebola patient requires, full time, 20 medical staff. Mostly ICU (intensive care unit) people. So that would wipe out an ICU in an average-sized hospital.”

    In the case of Texas Presbyterian, McCaughey says that the hospital cordoned off its ICU to care for Thomas Eric Duncan and sent the rest of its ICU patients to other area hospitals. She added that many communities will not have multiple hospitals to choose from, so one Ebola case could cripple ICUs in small towns.

    Small towns are unlikely places for Ebola but few hospitals could do this for one patient, let alone five.

    Mike K (90dfdc)

  8. Mike K,

    There also appears to be a disagreement with where it’s best to treat the patients: local hospitals or hospitals with special units. IOW, can all hospitals treat patients safely? There is risk associated with transporting patients to special units instead of keeping them local:

    Don’t assume that moving patients to a specialized unit is best, said Dr. Eileen Farnon, a Temple University doctor who formerly worked at the CDC and led teams investigating past Ebola outbreaks in Africa.

    “It is also a high-risk activity to transfer patients,” potentially exposing more people to the virus, she said.

    Still, there’s a big difference between a 40-bed community hospital and a 900-bed hospital like Texas Presbyterian or a big medical center affiliated with a university, said Dr. Dennis Maki, a University of Wisconsin-Madison infectious disease specialist and former head of hospital infection control.

    “I don’t think we should expect that small hospitals take care of Ebola patients. The challenge is formidable,” and only large ones truly have enough equipment and manpower to do it right, Maki said.

    “If we allow it to be taken care of in hospitals that have less than optimal resources, we will promote the spread,” he warned.

    What would the cost of transporting be compared to keeping in a local hospital and creating a special unit or providing the necessary personnel whose numbers might sink a small hospital?

    Dana (4dbf62)

  9. i posted the survey link a few days ago in another Obola thread…

    here in the Valley, Valley Presbyterian apparently has an unused floor, and there is talk about converting it for use.

    also have been reliably informed that, when the CDC showed up at Marina hospital to get their samples from a patient that was transported from a plane that landed at LAX (they’re the closest HCF) that the feds showed up in full RACAL suits, which is obviously several orders of protection stronger than the BS paper gowns they’ve been telling everyone else to use.

    as Resident Evil put it tonight: “if a patient like that comes in the ED, look for the staff to exit the building on the other side and drive off as soon as they hear about it…” the management team at her HCF is having kittens over this stuff, and no, they are NOT really ready to deal with this 5hit as it needs to be dealt with.

    redc1c4 (269d8e)

  10. if you follow the link embedded in the name of the poster who wrote #6, you’ll find a really interesting blog, if you’re into history, firearms, etc…

    i’d suggest you take a look, even if it isn’t your regular cuppa, as it were.

    redc1c4 (cf3b04)

  11. considering i’ve seen nurses routinely break protocol dealing with MRSA, seen or staff outside in the scrubs, only to go right back to the OR with the same outfit, booties, head covering, etc, i never had a warm fuzzy that the system was ready for this.

    nor is there likely to be enough disposables in the supply system to furnish the volume that will be needed if this takes off.

    also, i submit that the DWB casualty rate suggests that the virus has mutated again, and the current protocols, no matter which one you pick, are inadequate.

    too bad we didn’t stick with the tried and true idea of a quarantine. that’s what we get for letting an idiot with a room temperature IQ make the decisions about how to deal with this #JVvirus

    if they don’t get a handle on this real fast, it could get beyond ugly.

    redc1c4 (cf3b04)

  12. that should be “OR staff”…

    redc1c4 (cf3b04)

  13. Dr. Dennis Maki, a University of Wisconsin-Madison infectious disease specialist

    A brilliant and extremely diligent man, a “doctor’s doctor”.
    It is “common sense” that “practice makes perfect”, and for any kind of specialized care, from heart surgery to whatever, that you want to go to a place that has enough experience to be good at it.
    That said, it is certainly true that transporting a patient from one hospital to another is not trivial.

    MD in Philly (f9371b)

  14. Protective gear nurses initially wore left their necks exposed . . .

    I thought this was supposed to be the Zombie Apocalypse, not a vampire tale.

    Mark L (da8bb9)

  15. The reality of Africa is that they do not have all of the resources of the US, including store rooms full of disposable gowns and stuff.
    I’m guessing that US officials, perhaps without any direct knowledge of the procedures in Africa or direct contact with people who do, figured the following;
    “In Africa they essentially use contact and droplet precautions. Since they do not have the luxury of disposable stuff, they use rubberized gear that they decontaminate between uses. So we will use ‘our version’ of those same precautions”.

    Which is essentially to shield the body from direct contact with infectious fluids on the patient, on surfaces around the patient, and direct flying debris (not things floating in the air). As such, while caring for the patient, the exposed neck would be behind the face shield and wouldn’t need any other covering.

    Those assumptions do not consider the reality that perhaps the necessary amount of the virus needed to cause infection is very small, and the possibility for contamination when taking off the gear is high; that the efficacy of the usual “African protocol” is due in part to the decontamination procedures.
    The additional feature, as pointed out by SarahW and another person, is that in the setting of mechanical ventilation and other more invasive procedures, the possibility of airborne spread through aerosolized particles is an issue not encountered in Africa.

    Mike K commented that there are methods that check for how successful one’s use of contact precautions is, like chewing on one of those dye pills after you brush your teeth to see how well you did.

    It appears from pictures of the Boston hospital with a potential Ebola patient that they are using decontamination procedures.

    MD in Philly (f9371b)

  16. Nurses Deployed Soldiers Do Not Believe They Have Had Been Sufficiently Trained And Prepared To Treat For Ebola Duty Patients

    Headlines of future past.

    I can’t wait for the LHMFM and the CDC to voxsplain to me just what a complete surprise it all is.

    Steve57 (4d34f4)

  17. #16, Steve: Drudge has a link to a NYT story about the Pentagon hiding chemical warfare injuries to our soldiers in the 2004-2010 period. One soldier was awarded a Purple Heart for mustard gas exposure only to have it retracted three weeks later. A total of 17 U.S. servicemen were injured, and their injuries kept secret until now. The weapons, several thousand rockets, had been buried in 1991 or thereabouts, and so the geniuses at the Pentagon decided that they weren’t related to what was going on in Iraq after our invasion. The area where these weapons were buried is now falling into the hands of ISIS. And the expectation is that more buried rockets will be found.

    This must have been quite a pleasant discovery to EarLeader. He learned that he can deploy our troops to West Africa and then wrap any casualties in secrecy. So the military is good for something after all. And a good deal of the Pentagon must be rank and file Dems in order to have kept this secret during the “Bush Lied People Died” campaign of public vilification in the immediate aftermath of the war.

    NB: The assistant secretary of defense who is onsite in West Africa is Michael Lumpkin. He seemed a bit overwhelmed by the complexity of setting up Ebola hospitals in a third world country. Wiki has a short bio on the fellow. He was a SEAL and retired with the rank of Commander. He ran for Congress against Duncan in 2008 and lost 40% to Duncan’s 56%. But he landed on his feet as a good Democrat always does. I think we’d be better off with a Seabee for the task at hand, but the man must have some good qualities.

    bobathome (5ccbd8)


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