Jasmin Islam: Ebola readiness—lessons from a district general hospital

Since the Ebola outbreak was confirmed back in March 2014, I, like many doctors, have been following its progress with a great deal of interest and sadness over the increasing number of deaths, which have included several healthcare workers. In relation to the current outbreak, there have been no confirmed cases of Ebola in the UK and, given increased surveillance and awareness, the risk of importing a case remain low. However, all hospitals should be prepared.

In May, the microbiologists in our hospital began circulating Public Health England (PHE’s) updates regarding Ebola to increase awareness among admitting clinical staff. This included distribution of the PHE viral haemorrhagic fever (VHF) algorithm, which is recommended for the assessment of all suspected Ebola cases. With hindsight, this provided false reassurance about how well we were prepared to manage any potential clinical scenario. And, although our hospital (East Surrey Hospital) is the closest to Gatwick airport, there was an assumption that in reality all possible cases would probably head straight to a large shiny teaching hospital, bursting with full body suits and isolation units, rather than presenting to our district general hospital (DGH).

At the end of July, while listening to coverage of the Ebola outbreak on the BBC, our first patient duly presented to our emergency department, having just arrived back from a three week teaching trip in Sierra Leone. Thankfully, the patient was subsequently deemed to be low risk.

However, the early stages of the patient’s admission were characterised by anxiety around where and how the patient should be assessed—heightened by the extensive media coverage, and the announcement the UK government were having a Cobra (Cabinet Office Briefing Room) meeting on Ebola the same day. Should we keep the patient in the ambulance or bring them in? Should we wear full protection or just gloves and an apron? How should the patient be transported to radiology? What bloods should be taken, and could they be processed routinely in our lab?

Reflecting on the case, my overriding feeling was relief that the patient did not have VHF, but I also had a sense that we now had an opportunity to get things right before the next possible case.

An emergency planning meeting was called the next day, where we addressed several key points: what triage services were available at our local airport, the need for improved travel screening questionnaires for triage, establishing a designated isolation room in the emergency department, and a reiteration of the nature of the protective personal equipment for both hospital and ambulance staff.

Since the first case, we have had a further five suspected cases of VHF, although—thankfully—none has been confirmed as positive. I am now confident that if we got an actual case we are much better placed to manage the situation, thanks to the tireless work of our emergency staff, matrons, and infection control teams to ensure we are fully prepared.

This whole experience has raised a few points for reflection. Firstly, assume nothing. Just because you work in a DGH does not mean that you won’t be drawn into a disaster or complex situation. Secondly, although protocols are incredibly helpful, be prepared for the fact that people will not have read them, won’t know where to access them, and often fail to wear the correct protective equipment (quite possibly because they have not read the protocol).

Finally, be readily available for frequent meetings; after all, the NHS continues to survive and thrive because we work so well as a team. So, in conclusion, I would reiterate the advice given by Fletcher et al in an Editorial in The BMJ. Having access to the VHF protocol is not enough. Time spent training and educating staff, and knowing who to call, could save a lot of distress and panic when you get your first possible case. I wonder if we should be encouraging more routine simulated training for a range of major disasters because, in the end, practice really does make perfect.

Jasmin Islam works as an ST3 in infectious diseases and medical microbiology at East Surrey Hospital.

Competing interests: I declare that I have read and understood the BMJ policy on declaration of interests and I have no relevant interests to declare.