Sunday, October 19, 2014

bedside nurses are the experts on how to safely care for a patient with ebola

It turns out Thomas Duncan sat in the emergency department for 30 hours. More than a day. Despite the fact that the second time he came in they immediately knew he had come from Liberia. They isolated him. He sat there for 24 hours before they even did an ebola test.  Then it takes 4-6 hours for that to come back. Did the hospital have the capacity to do the test?

I'm trying to think of why it took so long for the ebola test..  My only conclusion is the doctor didn't think that ebola could have possibly come to the United States, so they weren't thinking in terms of ebola.  They thought of other things, did labs, CT.

So I'm sure that this guy was treated as a typical, perhaps, contact precautions. Since he had no respiratory symptoms, droplet precautions were probably not used.  So that means paper gown and gloves.  Thats it.

As an ER nurse, I'm thinking about what happened in the ER.  Did his nurse have other patients? I have a feeling they did. This guy was sick yes, but not sick enough to be one to one if they weren't treating him as an ebola patient.  No doubt several nurses took care of him over the course of 30 hours. They went in and out of the room many times.  Lab drew his blood, no doubt no special precautions were taken.  He had a CT. He had to go through the halls to CT. He contaminated the CT machine.

No one has talked much about the emergency department part of this. The focus has been on inpatient care because that is where the nurses have become ill.  It is miraculous no ER personnel have not become sick. Little attention has been paid to what should happens when someone shows up at the triage window with symptoms and recent travel.

Most emergency rooms are congested tight spaces.  Mine sure is. My first thought with all of this was: where would we take off the isolation gear?  Not in hall, thats for sure.  Fortunately, my ER has figured out a place with more room to put this patient, with an area outside that could be used for removing gear.

These are the kind of small details that have to be thought of. You can't have an ebola patient in the middle of a busy ER. Would we shut down the ER?  Would we allow other patients to keep coming in? The public would want to know if there was a potential ebola patient in their midst. Do you keep a potential ebola patient in the ER until they turn up positive?  Or do you immediately put them in ICU?  Is ICU ready?  Do they have an area that is empty?  Do they have the equipment ready?

There are a lot of questions. The problem with this is that the people in charge are not the ones who care for patients. They do not think of the details of patient care that we deal with every day.  Bedside nurses should be involved in preparing for something like this.  They aren't.  This is typical of medicine.  All of the daily changes to our practice are decided by people who haven't cared for patients in years. That fact is what makes working as a nurse more and more difficult. This is just one more example.

Saturday, October 18, 2014


Dear Mr/Mrs John/Jane Q. Public: don't bite the hand that feeds you

There is starting to be a backlash against the nurse who took a flight to Cleveland and now a lab tech who went on a cruise.  People are starting to turn on them, exclaiming, "how could they travel knowing they took care of the patient!"  They are so SELFISH, so STUPID.  Lacking in COMMON SENSE.

It is obvious that the CDC did not tell these people they couldn't travel.  They were not concerned enough about them to monitor them themselves. They said they could "self monitor".  Even though these people had direct contact with the patient.  So they must have figured, I'm OK I can take my temp anywhere I go. So they went. Now they are being vilified. Just like the first nurse was portrayed as essentially "messing up" the isolation procedures until more information came out.

First of all, NO healthcare worker is SELFISH especially when they are willing to take care of an ebola patient at all.  They are LITERALLY taking their lives in their hands for the sake of caring for someone else. If you aren't a nurse would you volunteer to clean up the poop and vomit of an ebola patient?

Secondly they are not STUPID.  You can't be stupid and be a nurse.  They were following what they were told by "experts".  Their COMMON SENSE told them they should listen to the "experts".

This kind of thing pisses me off royally.  That people have the nerve to say these kind of things about these nurses or other health care workers. Nurses who risked their lives for the patient and are now very ill with ebola. I would suggest that public start thinking about how they are talking about nurses or healthcare workers in this situation. WE are the ones who take care of you when you get ebola.  When we are blamed, we may just say FUCK YOU. You take care of them. You are biting the hand that feeds you.

Friday, October 17, 2014

I haven't gone nuts

You are probably wondering when is she going to lay off the ebola.  I know I have been writing about this continually for a couple of weeks.  You think I'm obsessed, that maybe I have some kind of problem...

I love writing, hence the blog. I am opinionated. I am always analyzing everything.  I am both troubled and fascinated by this response by our country to ebola.  We have never gone through something like this before. It fits right in with what I have written here before about hospitals not being prepared for any kind of disaster. This also has effect on me personally as an ER nurse. This has caused every nurse in this country to pause and wonder about what they would do if this came to their door.

Will all that in mind, I have been writing about ebola.  I would love to have a job writing about health issues.
So anyway, I haven't gone nuts.  I'm not hiding in the basement with my hazmat suit on.

we won't ever be ready for ebola

Lets hope there aren't more than 9 patients with ebola in this country at any one time. That's how many biocontainment unit beds there are available in the country right now.  Four of them are presently filled.

This country has a real dilemna right now.  They are trying to be ready for a disease they aren't ready for. Reality is hitting all of the so called experts in the face.  All their wonderful plans aren't working out the way they thought they would.  The thing is: they still don't get it.

They still think that if they recommend a massive training exercise about isolation gear involving thousands and thousands of healthcare workers across the country it will all be okay.  If they train them using the normal isolation gear, teaching them to take it on and off properly, we will all be okay.  Here is the problem with this:

1) The training so far is not mandatory.  This is hard to believe, but not everyone will go.

2) The gear is inadequate.  There are too many pieces to the ordinary isolation gear which makes it more dangerous to take off.  The ordinary gear is not sufficient.  People need hazmat gear. It is being used by  everyone else taking care of people with ebola, including those in West Africa where it is an epidemic.  It is only in the US that workers are being asked to use something other than hazmat gear.

3) Hospitals are not going to train everyone that care for patients how to use hazmat gear. It is too time intensive. It costs too much money to train and for the suits.

4) We are not prepared to even get rid of the waste from an ebola patient.  Even the people in charge of these biocontainment units can only take care of so many because they can only handle the waste of so many.  If they are saying that, how can an ordinary hospital possibly be ready for the waste?

5) Finally: About the time, the next nurse or other healthcare worker comes up positive for ebola, nurses are going to start refusing to care for these patients.  They will be unwilling to risk it for themselves and their families. Sure, there are going to be some nurses who will being willing to risk it, but I guarantee the vasst majority of nurses will say: don't think so.  I am not going to put my new baby at home in jeopardy because you can't do this right.   Yup, they are going to be willing to risk their jobs over this.

So then what? As a country, we still figure we won't have to deal with more than a few cases. So far there have been seven. Hey, odds are good we won't have an epidemic.  What is very worrisome however is the fact that this is out of control in Africa right now.  I have seen figures of 10,000 a week by December if it doesn't get under control soon.  It isn't going to get under control soon.  1,000,000 cases by January.  The world still thinks it won't affect them. When it gets to that many cases, it will.  Then what?