Considerations for Safe EMS Transport of Patients Infected with Ebola Virus

Abstract

The Nebraska Biocontainment Unit through the Nebraska Medical Center in Omaha, Nebraska, recently received patients with confirmed Ebola virus from West Africa. The Nebraska Biocontainment Unit and Omaha Fire Department's emergency medical services (EMS) coordinated patient transportation from airport to the high-level isolation unit. Transportation of these highly infectious patients capitalized on over 8 years of meticulous planning and rigorous infection control training to ensure the safety of transport personnel as well as the community during transport. Although these transports occurred with advanced notice and after confirmed Ebola virus disease (EVD) diagnosis, approaches and key lessons acquired through this effort will advance the ability of any EMS provider to safely transport a confirmed or suspected patient with EVD. Three critical areas have been identified from our experience: ambulance preparation, appropriate selection and use of personal protective equipment, and environmental decontamination.

Ebola virus disease

“…Ground transport usually involves the use of an ambulance. It is recommended that the ambulance be draped with an impervious barrier or otherwise modified to decrease the possibility of contamination of the vehicle during transport [12,13]. Strict infection control practices should be followed during all phases of transport, including the use of appropriate PPE for both the patient and the healthcare workers, and separation of the driver compartment from the passenger compartment [14].…”

Codification of Islamic Republic of Iran's Emergency Medical Services (EMS) Native Reaction Protocol to Suspected Ebola Patients based on World Protocols

“…If there is a problem like Finding lack of coordination within an organization or between the responsible agencies in transmission the patient, some joint meetings will be held to discuss and resolve potential failures and correct action guidelines and the results of these meetings will be communicated as a decision to all organizations [12,13,15,16].…”

“…Try to bring a clean stretcher with necessary equipment's for transmission the patient, close EMS ambulance and also in transferring the patients from ambulance to hospital we should use special track is covered with waterproof sheet. It is better emergency medical services' personnel don't interfere in the transferring the patient to his hospital room because the possibility of contamination due to the contamination of clothes and hands, but if they do, after getting off the ambulance the stretcher's wheels and the soles of shoes of procedures staff must be disinfected with sodium hypochlorite 10% [4,11,15,16].…”

“…Sterilize the Ambulance inner surface with bleach solution 10% or other approved disinfectants. Sterilize the outer surface of the ambulance with a 10% bleach solution or other approved disinfectants [12][13][14][15][16].…”

Development and Use of Mobile Containment Units for the Evaluation and Treatment of Potential Ebola Virus Disease Patients in a United States Hospital

“…Biocontainment hospitals, such as Emory University Hospital and Nebraska Medical Center, have received confirmed EVD patients with advanced notice. 1 However, the challenge for most health care systems is the identification and management of EVD cases presenting unidentified and unannounced. The larger U.S. health care community quickly found that it was unprepared for the screening, isolation, and treatment of patients with suspected or confirmed EVD.…”