Ebola: What does EMS need to know?
Although the risk to the U.S. is small, EMS providers should be educated on how to identify symptoms and treat Ebola patients
By Dr. Alexander Garza
The largest outbreak of Ebola in history is occurring in Western Africa, with more than 1,700 infected and 1,000 deaths from the virus so far. The World Health Organization declared it a public health emergency, and Doctors Without Borders is calling it a disaster.
So how exactly did this outbreak happen? Should we in the U.S. be concerned? And what information does EMS need to know?
Although Ebola is a very concerning virus, the risk to the U.S. is still quite small. However, EMS providers should be educated about what to look for in an Ebola patient and have access to and training in use of isolation equipment.
Remember these eight points.
- Early detection can be difficult due to the non-specific symptoms.
- Patients with an unexplained fever and recent travel to a country known to have had Ebola — specifically Guinea, Liberia, Sierra Leone and Nigeria — or had direct contact with someone known to have Ebola, should be treated as infected until proven otherwise.
- Exercise immediate contact isolation in patients with suspected Ebola to include gloves, goggles or face shield, full-body gown and respiratory mask.
- Immediately notify the receiving hospital that EMS is transporting a suspected Ebola patient, since this patient will need to be isolated upon arrival.
- Thoroughly decontaminate all equipment and surfaces potentially contaminated from treating a suspected Ebola patient.
- Be extremely careful with blood exposure and limit the number of interventions such as starting IVs and using nebulizers unless clinically indicated.
- Have a plan for contacting the local or state health department if a case is confirmed to be an Ebola patient.
- Have a plan for workforce issues such as quarantine of EMS providers.
What is Ebola?
Ebola is the virus that causes Ebola Hemorrhagic Fever. The virus was discovered in 1976 when there were two simultaneous outbreaks in the Sudan and the Democratic Republic of Congo (called Zaire at the time). Some of the patients came from a village situated near the Ebola River, hence the name Ebola.
Outbreaks usually occur when a human comes into contact with body fluids from an infected animal such as a chimpanzee or gorilla, particularly when the animals are used as a source of meat. The African fruit bat is also thought to be a reservoir that can pass the virus through contact with its droppings.
Signs and symptoms
Once a human has contracted the Ebola virus there is an incubation period where the patient is not yet symptomatic. This period can last from two to 21 days.
It makes this infection particularly troubling, since someone could leave one of the countries with Ebola and not become ill until they have reached their destination weeks later. This is why people exposed to Ebola are quarantined for 21 days with daily fever checks to make sure they do not have an active infection.
Once a patient becomes symptomatic, he will display signs typical for any viral infection such as fever, nausea, joint pain and headaches. Other symptoms include conjunctival hemorrhages (burst blood vessels in the eyes), rash and sore throat, although these are less typical.
Once the patient develops a fever, he is considered infectious and has the potential to spread the virus to others through bodily fluids. Health care workers are particularly susceptible to the virus if strict contact isolation precautions are not taken.
Once symptomatic, patients can become deathly ill within days, with nausea and vomiting, bloody diarrhea as well as bleeding from other sites. Left untreated, this eventually leads to shock and death.
There is no vaccine for Ebola and with the exception of some experimental drugs, there is no approved therapy other than aggressive supportive care. Ebola is extremely lethal with a fatality rate of up to 90 percent. The current outbreak has a fatality rate of around 60 percent.
Why is this outbreak so bad?
There are a number of issues that have made this outbreak the perfect storm for an Ebola outbreak. Location and culture are two of the prominent issues.
This is the first time that Ebola has appeared in Western African countries. All of the previous outbreaks of Ebola have been in either Eastern or Central Africa.
Because of this, it is likely that the illnesses were not recognized quickly and strict isolation and quarantine practices were not instituted until the virus had already begun to spread. This is coupled with the fact that the countries of Western Africa are some of the poorest in the world with limited medical and public health infrastructure.
There are cultural issues as well that are challenging. It is African tradition to directly handle the dead bodies of family members. At the time of death, the body is at its most infectious period and it is therefore easy to spread the virus to unsuspecting family members.
Likewise, since this virus has not been seen in this region of Africa, the population has been slow to accept that a virus is causing such illness in the communities, with some people blaming western non-governmental organizations such as Doctors Without Borders for bringing an illness into their communities.
In addition there is still a reliance on traditional faith healing by a village medicine man. This practice causes the virus to spread to those in the community.
What protections are in place in the U.S.?
Customs and Border Protection agents are trained to passively screen all patients coming into the U.S. from foreign countries for signs of illness. In addition, 20 airports around the country are equipped with quarantine officers from the Centers for Disease Control and Prevention.
Should the officers encounter someone with symptoms or appearing ill, they will be referred to the quarantine officer for evaluation.
In addition, CDC has recently sent some 50 experts to Western Africa to combat the virus. CDC performs testing on suspected cases and offers expert advice to clinicians around the globe.
They work in direct contact with local and state health departments and issue case definitions and guidance on handling cases of Ebola.