Protocols for firefighters responding to Ebola-related 911 calls were already being put into place last week before officials learned that a “small number” of residents are self-monitoring for signs of the deadly virus.
“This is something we’re probably going to have to deal with,” said David Stapp, Arlington’s medical operations battalion chief. “We have to make preparations.”
Stapp said Arlington received a list Thursday of residents who are taking their own temperatures twice a day because of their loose connections with Texas Health Presbyterian Hospital Dallas or the three Ebola patients who have been treated there. One resident, for example, works at the hospital but was not in contact with any of the infected patients or involved in their care, Stapp said.
“These are all people who are self-monitoring and they are all extremely low-risk,” said Stapp, declining to say how many names were on the list. “We don’t currently have anyone near a high-risk level by the CDC [criteria] that is being monitored in Arlington.”
Gathering key information is the first step in the screening of potential patients.
For all medical calls now coming in to Arlington’s 911 center, call takers are asking about the patient’s temperature and symptoms, such as abdominal pain, diarrhea and vomiting, as well as recent travel to areas hit by Ebola or contact with someone diagnosed or monitored for the virus. If there is a reason for concern and the patient is not suffering an immediate life-threatening condition, such as a heart attack, only one firefighter dressed in protective clothing would make contact with the patient to conduct an in-person assessment, Stapp said.
“No one else is going to go in unless absolutely needed,” he said. “If they have a positive screen with 911 or their symptoms were such that we had a concern, it’s not going to be like we do with other EMS calls. We are not going to rush into their house. It will be much slower and methodical now if they have Ebola-like symptoms until we can do our own screen.”
But to speed the process up once a concern has been identified, Arlington already has a specially prepared ambulance, which can be easily decontaminated, on standby. The city’s medical director or another appointed official in the case management team will work with Tarrant County Public Health, the state health department and the Centers for Disease Control and Prevention to determine which area hospital the patient is taken to, Fire Chief Don Crowson said.
“We’ll ensure the proper next steps are determined. We have a system in place. We’re ready to activate that system if needed,” Crowson said.
‘Doing all we can’
As of Friday, 143 people were being monitored for contact or possible contact with Ebola, related to the Dallas outbreak, according to the Centers for Disease Control and Prevention. Of those, 11 are known contacts and 132 are possible contacts.
More than 70 of those being monitored are healthcare workers at Presbyterian Dallas who had contact with Thomas Eric Duncan, who died Oct. 8 after being the first person diagnosed with Ebola in the United States.
Two of the hospital’s nurses are known to have contracted the virus. One nurse, Nina Pham, is in fair condition and is being treated at a special biocontainment unit at the National Institutes of Health in Bethesda, Md. Another nurse, Amber Joy Vinson, is being treated at Atlanta’s Emory University Hospital, which successfully treated Ebola patients.
One screening tool firefighters now have is infrared thermometers, which can measure body heat a few inches away from the patient, eliminating exposure to bodily fluids like with a traditional thermometer. The Fire Department bought 40 of them for $2,000, using money provided by the city’s ambulance contractor for medical system improvements.
“It’s not a device that tells us you have Ebola. It’s another tool to assess patients,” Crowson said. “We’re trying to address the Ebola issues as comprehensively as possible. While the spread of the disease is very low, we are doing all we can to protect our responders and do a better job for the people we serve.”
The Fort Worth Fire Department said it will also purchase the thermometers.
Arlington has purchased sets of additional personal protective gear, such as shoe covers, face masks, gloves and gowns, but they are the same types firefighters already use to avoid contact with patients’ bodily fluids.
Training set this week
This week, the department has scheduled three days of training to show firefighters how to properly put on their personal protective gear. The specially trained hazardous materials team is responsible for removing the protective gear from any firefighters who come in contact with a patient suspected of having Ebola.
“It’s so detailed. Trying to turn everybody into an expert, we are setting ourselves up for failure,” Stapp said.
Firefighters took similar precautions to protect themselves when dealing with the discovery of suspicious envelopes containing white powder during the anthrax scare in 2001 and later years.
“We’re definitely going to deal with it. Do I think a lot of people are going to have Ebola in Arlington? No, I don’t,” Stapp said. “I do think we will run on lots of scares just like the white powder calls.”
Patient privacy and keeping the public calm are other concerns for the city. To avoid alerting local media or others who listen to public safety scanners, Arlington 911 dispatchers have been instructed not to mention Ebola when communicating over the radio with first responders.
“As long as people are doing what they are told, you will never hear the word Ebola over the radio. We don’t want to cause fear,” Stapp said.
Ebola is spread through contact with blood and other bodily fluids of an infected person. The World Health Organization said people are not contagious until they are displaying symptoms, such as fever, sore threat, headaches, joint and muscle pain and muscle weakness.
“Until you are symptomatic, you can’t give it someone else,” said Stapp, urging the public to keep the risk of contracting Ebola in perspective with other more common contagious illnesses. “This is new and it’s scary and it’s uncharted but you have a better chance of getting killed by the flu.”