Units are available for first point of contact of suspected EVD patients without exposing hospitals to contamination.
NJ:
Hackensack University Medical Center plans to use mobile unite as Ebola ‘hot zone’
OCTOBER 24, 2014, 11:25 PM LAST UPDATED: FRIDAY, OCTOBER 24, 2014, 11:31 PM
BY MARY JO LAYTON
STAFF WRITER | THE RECORD
http://www.northjersey.com/news/hackensack-university-medical-center-plans-to-use-mobile-unite-as-ebola-hot-zone-1.1117839?page=all
Though most hospitals designated to treat Ebola patients have created specialized isolation units within their facilities, Hackensack University Medical Center is planning a different approach: pressing into service its mobile satellite emergency department, parked several blocks away. It’s behind a McDonald’s, in fact.
The plan needs approval from the federal Centers for Disease Control and Prevention, and a team is scheduled to tour the hospital and mobile unit today to test Hackensack’s readiness. The hospital is one of three in New Jersey, along with Robert Wood Johnson University Hospital in New Brunswick and University Hospital in Newark, designated by Governor Christie this week as primary treatment centers for any Ebola cases that might arise.
The unit, located on property the hospital owns off Newman Street in Hackensack, consists of two 43-foot trailers and a 48-foot trailer with expandable sides. Known as the MSED, it is licensed by the state as an operating room and critical-care center with seven beds, a portable field lab, oxygen generators, and digital X-ray and sterilizing equipment.
It has been placed nearly half a mile from the hospital’s main campus, far from expectant mothers, surgery patients and emergency room crowds who might be anxious at the idea of Ebola patients being treated in the same facility.
The unit, acquired with more than $10 million in government funding, is ready for deployment in bioterror attacks or manmade and natural disasters, HUMC officials said.
So far, though, the hospital has only dispatched the unit for far more pedestrian tasks: It was rolled out to aid victims of Superstorm Sandy and was on site at the 2014 Super Bowl at Metlife Stadium, where it was used to tend to injured fans.
Dr. Joseph Feldman, chairman of the emergency trauma department, couldn’t recall any surgeries taking place in the unit, just minor intervention such as stitches.
Treating Ebola patients could be its greatest challenge, he said. “This will show the maximum capabilities but flexibility of the system,” Feldman said, during a tour Friday afternoon.
“Anything you can do in an ICU [intensive care unit] you can do here,” he said. “This is more advanced than some of the community hospitals.”
The CDC did not respond to calls seeking comment about treating Ebola patients in a mobile unit.
Today, the agency is sending members of its new public health SWAT team, created last week by the Obama administration, to the hospital. Known as a FAST team — Facility Assessment and Support Teams — the officials will tour the hospital and unit to ensure that isolation and treatment areas are adequate and prepped and that physicians and nurses are properly suited up and effectively trained. Hackensack staff have trained in Level 3 protective gear – impermeable body suits, thick outer gloves, sealed hoods, taped seams and a breathing pack that filters air, hospital officials said.
Hackensack and the other two New Jersey designated centers are Tier 2 hospitals. Only four other hospitals in the nation – none in New Jersey — are Tier 1, the highest level of biocontainment capabilities.
On Friday, the governor suggested that the three New Jersey hospitals might also be asked to house people the state decided to put under mandatory quarantine because they had been in contact with Ebola patients in West Africa. The quarantine possibility was triggered after a New York doctor who treated patients in Guinea was diagnosed with Ebola this week, after he had ridden on subways and in cabs following his return from West Africa.
A health care worker who was the first person quarantined Thursday after arriving at Newark Airport and later developed a fever, was in isolation and under evaluation at University Hospital in Newark, according to the state Health Department.
A tour of Hackensack’s unit on Friday revealed seven beds in a 700-square-foot “hot zone,” although there would be far fewer beds in the event confirmed cases needed treatment, Feldman said. Another area in the trailer, also considered a “hot zone” would be used to evaluate patients who report symptoms consistent with Ebola and who have a travel history that warrants concern, Feldman said. Outside, in a heated tent area, critical-care nurses and emergency and infectious disease physicians who treat patients would remove protective gear with a buddy system to ensure safe “doffing.”
There’s a “lab within a lab” so that no Ebola-contaminated specimens could spill and cause a contamination problem. The unit is equipped with negative room pressure and medical staff are trained to enter through one door and leave through another to avoid risking contamination of other areas.
Patients could still show up in the hospital’s Emergency Department, Feldman said, so all staff, including valets, nurses, lab technicians and others are trained to handle any potential case. But the MSED down the street from the hospital campus will be the primary treatment area for Ebola patients.
“We are taking great lengths with the CDC so if we do eventually have an Ebola patient, we will isolate them and make sure we’re treating them in the best possible way and in a way that will not be at all impacting the rest of our operation,” Robert C. Garrett, Hackensack’s president and chief operating officer, said Friday.
Most hospitals that have treated Ebola patients in the U.S. have biocontainment units within their facility: The physician who tested positive for Ebola in New York City is in treatment in a specialized unit in Bellevue Hospital. The Nebraska Medical Center in Omaha successfully treated two people who contracted Ebola at its Biocontainment Patient Care unit on the seventh floor of its building, a 10-unit area isolated from the rest of the hospital. Since July, four Ebola patients have undergone treatment at Emory University Hospital’s isolation unit on the ground floor of the Atlanta hospital but separated from other patient areas. Three of those patients have recovered and have been discharged.
Likewise the “Special Clinical Studies Unit” located in a building at the National Institutes of Health Clinical Center in Bethesda, Md., was where Nina Pham, the Dallas nurse who contracted the disease after caring for Ebola victim Thomas Eric Duncan, was treated. She has recovered and, on Friday, went to the White House, where President Obama greeted her with a hug.
At Robert Wood Johnson University Hospital in New Brunswick, executives created a completely self-contained unit within the main hospital, said spokesman Peter Haigney.
University Hospital in Newark, which was evaluating its third possible case of Ebola — two other cases were false alarms — has designated an area in what appeared to be an ambulatory care center on the property. “It’s an extended treatment area that is considered part of the hospital,” spokeswoman Stacie Newton said.
However, there is some evidence that Hackensack is not alone in its thinking about treating Ebola patients off-site. A large hospital in Wichita, Kan., recently purchased a converted shipping container to use as a mobile isolation unit to treat Ebola if need be.
The 760-bed Wesley Medical Center bought the facility from a non-profit called “Clinic In A Can,” which customizes containers mostly for remote areas in foreign countries with poor infrastructure. It’s the first one that they have sold for use in the U.S., but the group reported receiving several calls from other interested hospitals due to the Ebola crisis.
“It can act as an isolation unit because it’s designed to function as an ER [Emergency Room] or an OR [Operating Room] if need be,” said Kyle Stevens, project manager of Clinic In A Can. “Some hospitals may find it useful to have something like this.”
http://www.kansas.com/news/local/article3193714.html
Clinic in a Can – a Wichita-based nonprofit that converts shipping containers into medical clinics – is trying to raise $300,000 for Ebola crisis response in Africa.
The effort includes sending eight of its solar-powered clinics, collecting food locally and collecting money for food to be purchased by aid organizations in Africa, said Mike Wawrzewski, a physician assistant and founder of Clinic in a Can. “We’re trying to create a Wichita response, and we hope as many people become involved as possible and that it becomes a focus instead of people on the sidelines wondering what can they do,” Wawrzewski said.
“Now they have something they can do, because it’s better to fight it and treat it over there. The longer it goes on, the potential of us having to treat it at our back door goes up.”
The disaster response plan has three components:
20 percent of the money will be sent to Graber Ministries in El Dorado to buy rice and beans in Africa to feed Liberians.
70 percent will be used to offset the cost to build and ship eight solar-powered clinics to Liberia. ▪ 10 percent will go to Heaven Sent Ministries for a community food-packing event that will fill a 20-foot container to be sent to Liberia.
The Ebola outbreak is different from anything Clinic in a Can has responded to before.
The organization, which built its first clinic in 2005, has sent clinics to South Sudan, to Haiti after the 2010 earthquake, to the Philippines after Typhoon Haiyan last year and to tornado-ravaged Moore, Okla., in 2013. All surfaces in the clinics can be decontaminated, Wawrzewski said. It’s a step up from many of the Ebola treatment centers in Liberia, some of which are made of 6-foot posts wrapped with plastic.
“Their medical system is overwhelmed, and it’s the consequences of poor infrastructure and poor sanitation,” Wawrzewski said.
The clinics are operational for up to 20 years, and this is the first time the organization has made them completely solar-powered. “That’s very important in Liberia, because their power system is horrible,” he said.
The eight clinics being constructed now will be ready to ship in about three weeks if funding is in place. Wawrzewski said he hopes to partner with the U.S. Agency for International Development to fly the containers overseas and for U.S. military personnel to put them in place. If they cannot be flown, they will go by ship, which can take up to 30 days. The containers will also be packed with equipment, including personal protective equipment for medical personnel who are treating Ebola patients. Clinic in a Can recently sent one of its containers to the international airport in Lagos, Nigeria. There it will be used to screen Ebola patients.
Clinic in a Can is also partnering with Carespan for telemedicine services from the U.S. to medical staff members in Liberia, Wawrzewski said.
(Lancet Oct 25 2014) Ebola control: effect of asymptomatic infection and acquired immunityEvidence suggests that many Ebola infections are asymptomatic, a factor overlooked by recent outbreak summaries and projections. Particularly, results from one post-Ebola outbreak serosurvey1 showed that 71% of seropositive individuals did not have the disease; another study2 reported that 46% of asymptomatic close contacts of patients with Ebola were seropositive. Although asymptomatic infections are unlikely to be infectious, they might confer protective immunity and thus have important epidemiological consequences.
Big snip
Unlikely to be infectious? I don't know about that.
At any rate, it's yet another display of how little we actually know about Ebola Zaire.