Formulating and improving care while mitigating risk in a military Ebola virus disease treatment unit

Abstract

This paper describes the development of the UK military's Ebola Virus Disease Treatment Unit (EVD TU) that was deployed to Sierra Leone as part of the UK response to the West African Ebola virus disease (EVD) epidemic in 2014 and 2015. It highlights specific challenges faced within this unique Field Hospital environment. The military EVD TU was initially established to provide confidence to international healthcare workers coming to Sierra Leone to assist in the international response to the EVD epidemic and formed a key part of the action plan by the UK's Department for International Development. It was designed and staffed to provide a high level of care to those admitted with suspected or confirmed EVD and was prepared to admit the first patient within 6 weeks of the original activation order by the Ministry of Defence. This article outlines the main hazards perceived at the outset of the operation and the methods used to mitigate the risk to the healthcare workers at the EVD TU. The article examines the mechanisms that enabled the hospital to respond positively to challenges that emerged during the deployment, while simultaneously reducing the risk to the healthcare workers involved in care delivery.

Personal protective equipment solution for UK military medical personnel working in an Ebola virus disease treatment unit in Sierra Leone

“…[6] summarized how the MoD considered Operation GRITROCK to be a success due to ‘excellent clinical care, validated through the WHO [World Health Organization] inspection…and a far lower than expected EVD infection rate among HCWs’. Medical workers were protected by the combination of PPE, donning and doffing procedures, and working practices used within the facility.…”

“…As discussed in the paper by Lamb et al . [6]: ‘a case review of the events leading up to this case could find no obvious problem with their PPE use, but as a precaution the duration any HCW could remain in the red zone was reduced to 90 minutes’.…”

“…PPE was doffed in a designated area, prior to exit into the green zone [6]. A buddy–buddy system where personnel were consistently partnered with the same individual was established.…”

Transferring patients with Ebola by land and air: the British military experience

“…Therefore, the need for monitoring had to be weighed up carefully, as reacting to abnormal readings, whether true or false, was not without consequences. If there was significant deterioration en route, such as reduction in consciousness or massive haemorrhage, then the potential for intervention was limited; basic airway adjuncts, oxygen and intravenous fluids were the ceiling of care 6. For this reason, it was important to ensure that the patient was sufficiently stable prior to embarking on the move.…”

The Impact of Armed Conflict on the Tenth Known Outbreak of Ebola in Democratic Republic of Congo

“…Útoky mají různý charakter -od házení kamenů na zdravotníky, střelbu až po ozbrojené útoky na zdravotnická centra a jejich totální zničení vypálením. S postupujícím časem, přes snahu o osvětu (za pomoci překladatelů, antropologů, zahraničních sociálních pracovníků a psychologů) se situace z hlediska důvěry místního obyvatelstva vůči práci zdravotníků zhoršuje (3,9,14).…”