88th Medical Group using multi-disciplinary approach to Ebola planning Published Oct. 24, 2014 By By Col. David Duque 88th Aerospace Medicine Squadron commander WRIGHT-PATTERSON AIR FORCE BASE, Ohio -- There is a lot of news coverage concerning the Ebola Virus Disease (EVD) outbreak of West Africa. It is a serious disease, highly infectious, and the current outbreak is the largest in history, according to the World Health Organization. The U.S. military is now supporting the fight in West Africa to contain the outbreak. In addition, there are now two reported cases in the United States. On Oct. 10, it was reported that a medical worker contracted Ebola from a hospitalized patient in Dallas, even though she was using the recommended personal protective equipment (PPE). The Centers for Disease Control and Prevention (CDC) is investigating what breach in PPE protocols happened that led to this exposure. This certainly emphasizes the complex management issues facing hospitals that will treat EVD patients. The 88th Medical Group has been preparing since early September for the task of managing an EVD patient and ensuring we have an effective response plan. We are using a multidisciplinary approach to Ebola planning since care for an EVD patient will require support from several hospital departments. The chief of Infectious Diseases, chief of Aerospace Medicine, chief of Medical Services, Public Health Flight and other clinical staff have reviewed patient detection, treatment and infection control protocols provided by the CDC, Air Force Materiel Command and the Air Force Medical Operations Agency to ensure we are ready. On Oct. 8, the 88 MDG conducted a walk-through of what we would do if we received a suspected case of Ebola. We identified the locations a patient is likely to enter the 88 MDG, through the emergency department or primary care, for example. Next we looked at all the hospital sections and services we might need to access. These might include the intensive care unit, isolation rooms, lab or radiology services, hospital housekeeping/ disinfection, and waste disposal. A consistent message from world medical experts is to ensure proper screening of patients and collect a thorough travel history since most cases of Ebola have been exposed in West Africa. The CDC considers a patient highly suspicious for Ebola virus disease if they have a fever (greater than or equal to 101.5°F or 38.6°C) or compatible symptoms in an ill patient who has traveled to an Ebola-affected area (currently West Africa) in the 21 days before illness onset. This information has been shared with the 88 MDG professional staff, and the Public Health Flight is collecting this information on returning deployers. Public Health has also prepared preventive health information for deployers who may deploy in support of the Africa mission. The 88 MDG has also underscored information sharing and education for its staff. Our disease experts continue to review the almost daily civilian and military guidance and consolidate the information for our staff. As the CDC has emphasized, preventing cross infection within our hospital staff will require meticulous attention to detail especially in the use of PPE. Our infectious disease specialist and infection control officer are working with hospital staff to ensure they understand the PPE requirements and are prepared to treat a suspected EVD patient and prevent cross-contamination/ exposure to our staff. This includes following strict infection control standards. As mentioned earlier, paramount to this will be quickly identifying a suspected EVD patient through matching of symptoms with accurate travel history. This multi-disciplinary approach to a complex and serious patient issue will help the 88 MDG be ready if we need to treat an EVD patient. Until the outbreak is contained, the 88 MDG will continue to monitor the situation, provide staff guidance and training, and modify our medical response protocols as needed.