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Pre-hospital transportation in Western countries for Ebola patients, comparison of guidelines.

Coignard-Biehler H, Isakov A, Stephenson J - Intensive Care Med (2015)

View Article: PubMed Central - PubMed

Affiliation: SPILF COREB Emergences (Coordination Opérationnelle du Risque Epidemique et Biologique), COREB AP-HP, LabEx IBEID Institut Pasteur, Service des Maladies Infectieuses et Tropicales, SAMU 75, Hôpital Necker-Enfants Malades, Paris, France, helene.coignard@nck.aphp.fr.

AUTOMATICALLY GENERATED EXCERPT
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The emergence of the Ebola virus disease (EVD) outbreak in West Africa threatens regional and global public health security... Although the epidemic is largely confined to West Africa, most Western countries where there is a possible risk of imported EVD have developed guidelines and procedures for the transport of confirmed or suspected cases of EVD... In the USA, the Interagency Board for Equipment Standardization and Interoperability describes a spectrum of risks based on patient symptomology and application of personnel protective equipment (PPE) to accommodate the level of risk... Symptoms of the patients to transport vary, and precautions must take into account the patient’s condition and the risk they pose to transporting clinicians... To simplify the risk assessment and organization of transportation that follows (presented in Table 1), two sorts of patients have been identified: a possible Ebola patient with few symptoms apart from fever can be considered to have a low risk of transmission (case 1 in Table 1), and a patient with symptoms of profound diarrhea and vomiting, bruising, and bleeding or one with confirmed EVD several days into the course of their illness poses a substantial risk of transmission to transporting clinicians (case 2 in Table 1)... Adequate training of HCWs is essential, with the following recommended requirements: prior to transport of a possible or infected Ebola patient, all healthcare workers must receive repeated training and have demonstrated competency in performing all required infection-control practices and procedures; repeated practice in donning/doffing of proper PPE is indispensable for the development and demonstration of competence; the overall safe management of Ebola patients is best executed with observation/supervision of the critical actions required of the transport team... The minimum PPE, which can be designated as “low grade,” includes at a minimum gloves to protect the hands, a gown or coverall to protect the clothing, and a mask/face shield to protect the mucous membranes. “High-grade” PPE involves a robust visor in addition to a fluid repellent suit, boots, double gloves, face mask, and head protection... There are also positive-pressure suits (PPS), which have the advantage of excellent protection, superior comfort and vision... These very expansive PPSs are available in Germany, for example, but reserved to specific circumstances in specialized treatment centers... Whatever the PPE chosen, the staff needs to be confident and competent in wearing it and its safe removal... In West Africa, Ebola patient transportation has been a source of secondary cases because of the absence of a robust “prehospital” health system, leading to transportation of patients mostly by their families, without implementation of infection control measures... However, safe transportation of Ebola patients by non-governmental organizations as “Doctors without borders” are organized... Guidelines of Western countries do not seem to be relevant in Africa, because of the healthcare worker/patient ratio, expensive costs of safety measures (number of vehicles and protective equipment for personnel), and the absence of prehospital organization.

No MeSH data available.


Transportation of Ebola patients
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Fig1: Transportation of Ebola patients

Mentions: Comparison of our three countries' guidelines highlights the importance of key principles that are necessary for a trained team [13] to improve their performance in stress conditions and avoid possible fatal mistakes, including the necessity of detailed procedures concerning doffing and disinfection, as well as risk assessment for each situation, with procedures adapted to local circumstances and the patient’s clinical presentation (Fig. 1). This guidance is continuing to evolve to accommodate new data and experience.Fig. 1


Pre-hospital transportation in Western countries for Ebola patients, comparison of guidelines.

Coignard-Biehler H, Isakov A, Stephenson J - Intensive Care Med (2015)

Transportation of Ebola patients
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4502292&req=5

Fig1: Transportation of Ebola patients
Mentions: Comparison of our three countries' guidelines highlights the importance of key principles that are necessary for a trained team [13] to improve their performance in stress conditions and avoid possible fatal mistakes, including the necessity of detailed procedures concerning doffing and disinfection, as well as risk assessment for each situation, with procedures adapted to local circumstances and the patient’s clinical presentation (Fig. 1). This guidance is continuing to evolve to accommodate new data and experience.Fig. 1

View Article: PubMed Central - PubMed

Affiliation: SPILF COREB Emergences (Coordination Opérationnelle du Risque Epidemique et Biologique), COREB AP-HP, LabEx IBEID Institut Pasteur, Service des Maladies Infectieuses et Tropicales, SAMU 75, Hôpital Necker-Enfants Malades, Paris, France, helene.coignard@nck.aphp.fr.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The emergence of the Ebola virus disease (EVD) outbreak in West Africa threatens regional and global public health security... Although the epidemic is largely confined to West Africa, most Western countries where there is a possible risk of imported EVD have developed guidelines and procedures for the transport of confirmed or suspected cases of EVD... In the USA, the Interagency Board for Equipment Standardization and Interoperability describes a spectrum of risks based on patient symptomology and application of personnel protective equipment (PPE) to accommodate the level of risk... Symptoms of the patients to transport vary, and precautions must take into account the patient’s condition and the risk they pose to transporting clinicians... To simplify the risk assessment and organization of transportation that follows (presented in Table 1), two sorts of patients have been identified: a possible Ebola patient with few symptoms apart from fever can be considered to have a low risk of transmission (case 1 in Table 1), and a patient with symptoms of profound diarrhea and vomiting, bruising, and bleeding or one with confirmed EVD several days into the course of their illness poses a substantial risk of transmission to transporting clinicians (case 2 in Table 1)... Adequate training of HCWs is essential, with the following recommended requirements: prior to transport of a possible or infected Ebola patient, all healthcare workers must receive repeated training and have demonstrated competency in performing all required infection-control practices and procedures; repeated practice in donning/doffing of proper PPE is indispensable for the development and demonstration of competence; the overall safe management of Ebola patients is best executed with observation/supervision of the critical actions required of the transport team... The minimum PPE, which can be designated as “low grade,” includes at a minimum gloves to protect the hands, a gown or coverall to protect the clothing, and a mask/face shield to protect the mucous membranes. “High-grade” PPE involves a robust visor in addition to a fluid repellent suit, boots, double gloves, face mask, and head protection... There are also positive-pressure suits (PPS), which have the advantage of excellent protection, superior comfort and vision... These very expansive PPSs are available in Germany, for example, but reserved to specific circumstances in specialized treatment centers... Whatever the PPE chosen, the staff needs to be confident and competent in wearing it and its safe removal... In West Africa, Ebola patient transportation has been a source of secondary cases because of the absence of a robust “prehospital” health system, leading to transportation of patients mostly by their families, without implementation of infection control measures... However, safe transportation of Ebola patients by non-governmental organizations as “Doctors without borders” are organized... Guidelines of Western countries do not seem to be relevant in Africa, because of the healthcare worker/patient ratio, expensive costs of safety measures (number of vehicles and protective equipment for personnel), and the absence of prehospital organization.

No MeSH data available.