Ebola Update: Get Your Travel Histories

The U.S. remained relatively unscathed as West Africa’s Ebola crisis stretched into November, but EMS systems shouldn’t get complacent—the outbreak exposed serious vulnerabilities many need to repair. 

It’s raised several issues, says infection-control expert Katherine West, RN, of Infection Control/Emerging Concepts in Manassas, VA. 

“First, we have not given enough training and attention to the proper use of PPE and transmission-based precautions,” West says. “Second, we tend to fall off of asking travel histories on patients. Getting travel histories began with SARS, then bird flu, then H1N1 and MERS, and still it is not consistently being done. This needs to be on all patient assessment sheets!”

The CDC recommends PPE with full body coverage for those who care for Ebola patients, with training and procedures to support its proper use and removal. Per the CDC, travel histories should focus on countries with widespread transmission.

In one of those, Liberia, the rate of new infections seemed to be in decline. But Sierra Leone was seeing sharp increases, and WHO officials emphasize that cases can appear to fall or level off, only to surge again later. 

The number of U.S. cases remained at four: original patient Thomas Eric Duncan, who died in October; his nurses Nina Pham and Amber Vinson, now cleared of the disease; and New York physician Craig Spencer, who appeared to be recovering.

A third issue for American EMS systems is that OSHA requires compliance monitoring in its bloodborne-pathogens and tuberculosis plans, and many departments don’t do it. “Compliance monitoring,” says West, “is how we identify noncompliance and the need for retraining.”

EMS systems should continue to follow guidance from the CDC, WHO and other reputable bodies, and should, as in all areas, be guided by science over fear and emotion. 

Additional resources: 

• Latest CDC Ebola guidance—www.cdc.gov/vhf/ebola/hcp/index.html; 

• World Health Organization Ebola page—www.who.int/csr/disease/ebola/en/; 

• PPE guidance—https://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html; 

• EMS preparedness checklist—www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf; 

• EMS EVD screening tool—www.cdc.gov/vhf/ebola/pdf/evd-screening-criteria.pdf; 

• EMS World November article—www.emsworld.com/article/12010347.