Ebola presents a new paradigm from the ER

Ebola is frightening but not for the reason you may imagine.

A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths.  As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department.  I left that day inspired that I had the education and training to provide great care to those in need and was proud to be part of a larger medical community that performs at the highest level.  But what became most reassuring was that the health care system largely worked.  Despite the initial chaos of the event, patients were distributed to the major hospitals in the Bay Area and treated effectively.

While the high mortality rate and process of dying from Ebola are scary enough, what frightens me is our nation’s current plan of attack: the emergency department.  Of course the Center’s for Disease Control (CDC) has an array of protective steps to screen high-risk individuals entering the U.S. (recent travel to Liberia, known exposure, etc.) and CDC teams available to map out potential contacts of a contagious patient.  But if a high-risk person enters the U.S. without symptoms or a known exposure what is the CDC doing to protect the individual and society when they become ill?  For these people, the CDC recommends going to the nearest health care facility.  For most Americans this means going to the emergency department.

Although emergency departments are prepped with informed medical professionals, medical equipment, testing capabilities, and potentially life saving treatments – consider the not so hypothetical case of the first person to be diagnosed with Ebola in the United States.  The patient began having symptoms on September 24th, initially went to the hospital on September 26th but was sent home because his symptoms were too vague to be diagnosed.  The flu, for example, and many other common non-lethal viruses also have vague symptom.  Two days later, he returned to the hospital and was finally put into isolation.  The impact: Several paramedics and emergency room workers are under quarantine.

One could argue that the medical professionals at the initial hospital visit just forgot to incorporate a travel history into their medical decision-making.  Prominent medical officials from the CDC and the National Institutes of Health (NIH) initially attributed this event as a failure to do just that.  Now additional screening steps are being implemented at American airports.  But in this age of technological advances can we do better?

We need to develop a technological platform the CDC can utilize to communicate with individuals entering the U.S. from these high-risk countries.  I’m no tech guru but isn’t there an app for that?  This approach could facilitate earlier detection by medical authorities, facilitate safe transport to medical facilities, and reduce or eliminate hazardous contact with a potentially infected patient.  Communicating with high-risk individuals entering the country for the extent of Ebola’s incubation period (21 days) could serve as an important prevention technique.

While the emergency department today represents a miracle of American health care where car crash victims, heart attacks, strokes, and broken bones can all be safely and effectively taken care of — Ebola presents a new paradigm.  Depending on a travel history and airport screening is not enough.  Our first patient should help us consider not only what failed to occur but more importantly what additional safeguards our health care system can and should provide.

Joshua Elder is an emergency medicine resident.

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