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

Abstract

Ebola virus disease (EVD) has been the subject of recent attention due to the current outbreak in West Africa, as well as the appearance of a number of cases within the United States. The presence of EVD patients in the United States required health care systems to prepare for the identification and management of both patients under investigation and patients with confirmed EVD infection. This article discusses the development and use of a mobile containment unit in an extended treatment area as a novel approach to isolation and screening of potential EVD patients.ACADEMIC EMERGENCY MEDICINE 2015;22:616-622

Patients Under Investigation for Ebola Virus Disease in the United States: Hospital Preparedness Planning and Alternate Care Facilities

“…The evolution of ACFs to current formats, including the shelters described by Sugalski et al, 11 has been reviewed, and characteristics, site requirements, and concepts of operation of the various options have been described. 15 The solution developed by Sugalski et al is a hybrid of the portable hospital unit and the building of opportunity that offered discrete isolation spaces, as well as all of the utilities and other service requirements identified in both historical and current documents.…”

“…15 The solution developed by Sugalski et al is a hybrid of the portable hospital unit and the building of opportunity that offered discrete isolation spaces, as well as all of the utilities and other service requirements identified in both historical and current documents. 11 In most recent planning documents and deployments, the mission of ACFs was to decompress hospitals by treating large numbers of lower-acuity and/or palliative care patients in the surge facilities, allowing hospitals to manage those requiring procedures or medical support that can only be provided there. Most scenarios that involve use of ACFs are mass casualty incidents such as detonation of an improvised nuclear device or highintensity earthquakes; however, ACFs were employed during the 1918 influenza pandemic and are included in current pandemic flu plans.…”

“…19 Since these are not the conditions that are driving the use of the portable isolation facilities described by Sugalski et al, 11 normal standards of care must be provided there. Some PUIs may be or may become more seriously ill with either EVD or another febrile illness acquired during travel before definitive diagnosis.…”

“…Most of the issues were at least partially solved simply by use of a separate facility that was visibly remote from the main patient care areas. Selection, acquisition, and training staff in the use of appropriate PPE are essential, but the addition of personnel trained and experienced in PPE donning and doffing to supervise these procedures, 9,11 and adjusting both shift length and work/rest cycles, 21 appear to allay apprehension of providers working with EVD patients. Finally, while there are allowances for sharing personally identifiable, protected health information during public health emergencies, 22 this should not extend to uncontrollable media identification of PUIs and medical personnel caring for them.…”

“…9,10 In this issue of Academic Emergency Medicine, Sugalski et al 11 describe the challenges encountered by a designated Ebola assessment hospital located in a city with a large West African expatriate population and near one of the five airports whose quarantine stations were equipped for EVD screening. Their initial experience with a series of PUIs will be familiar to many in emergency medicine:…”