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Facing isolated Ebola cases, how should U.S. boost training for health care providers?

How prepared are hospitals, doctors and nurses to handle Ebola cases in the United States, and what measures should be taken to increase safety? Judy Woodruff gets an assessment from Dr. Howard Markel of the University of Michigan and Katy Roemer of National Nurses United.

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    It’s a question that drove this day:  Just how well-prepared are hospitals, doctors, nurses and others to handle Ebola cases?

    We ask that of two people watching this closely.

    Katy Roemer is a registered nurse who works at Kaiser Permanente Medical Center in Oakland California. She’s with National Nurses United. It’s the largest union of registered nurses in the U.S. And Dr. Howard Markel, he’s author of several book on epidemics and quarantines, including “When Germs Travel.”  He’s a professor on the history of medicine at the University of Michigan. He’s also a regular contributor to our Web site.

    We welcome both of you to the program.

    Katy Roemer, to you first.

    How prepared from your perspective are hospitals and health workers to deal with the Ebola crisis?

  • KATY ROEMER, National Nurses United:

    We’re not prepared enough. We have done a survey that has surveyed nurses throughout the United States. More than — more than 2,000 nurses have responded to that survey in 46 states and the District of Columbia.

    And what the nurses are saying is that we are not prepared; 85 percent of those nurses say that they have not had face-to-face training where they could have their questions answered; 76 percent of our nurses are saying that they have not been able to see any sort of a protocol for dealing with Ebola.

    Nurses are putting our lives on the line in order to be able to care for these patients, and we expect the very highest levels of equipment and training to be able to do so. And that includes the optimum equipment and hazmat suits.


    Professor Markel, are the nurses’ concerns warranted?

  • DR. HOWARD MARKEL, University of Michigan:

    Well, I think, certainly, based on what happened in Dallas, that there is concern.

    You know, wearing protective gear and protecting yourself against Ebola is no easy matter. It’s one thing saying you can do it, but actually doing it is quite difficult. Let’s put it this way. If you were in a regular garden-variety operating room, there’s a charge nurse watching each and every individual there to make sure they don’t break sterile technique.

    Now, that’s a technique that’s been used over 100 years. But they watch to make sure somebody doesn’t scratch their face or push up their glasses, because that would break that. Now, multiply that times 1,000, and put many more layers of productive gear, it is not so easy to manage a patient this way.


    So, Katy Roemer, to you, it’s clear that Ebola is not something that’s rampant in the United States, as it is in West Africa right now. Given that, what do nurses need at this moment, given the fact that it’s still a very isolated thing in the United States, in one hospital in Texas?


    So what we’re asking for is optimal personal protection equipment, which includes hazmat suits, and we are asking for the training, so that we can put them on and take them off in a manner that’s safe, because those are the two really high-risk points in terms of providing — using the equipment, when you put them on and when you take them off.

    We want a buddy system to be put in place, so that we have the observer watching what we’re doing and that we are putting them on and taking them off correctly. And we want the face-to-face training so that we can, you know, have all of our questions answered. This is a real patient safety issue for us. We want the ability to keep our patients safe and we want the ability to keep ourselves and our community safe.


    Dr. Markel, how easy is it to do what Katy Roemer is saying nurses want done?


    Well, in the heat of the moment, it’s very difficult, because we’re not only fighting this epidemic. We have to bring everybody in the health care system up to speed.

    And it brings to mind that the United States does have four specialized containment centers in the NIH, at Emory, in Nebraska and in Montana. And one might question, shouldn’t those patients with Ebola be sent to very highly specialized places, where the nurses, doctors, and other health care workers are specifically trained?

    You know, you have to be trained not just once or a couple of times a year. These are things you have to do on a regular basis to sort of get a muscle memory of how to do all these things so that you don’t contaminate others or yourself.


    But is that practical, Professor Markel, to transfer patients after they have been identified to another hospital that has a higher level of protective experience and training?


    Well, it’s a good question.

    I think we need to make it practical if the hospital in question doesn’t feel prepared to take care of that patient. And we do that kind of thing all the time. What we have to make very safe is the means of transfer.

    But, that aside, there’s lot of things that we often do that the CDC is involved in doing and local and state health departments are doing in terms of helping nurses and doctors on the front lines, in emergency rooms and hospitals across the country, to make sure they feel comfortable thinking Ebola when they have a patient who says they have been in Africa in the last 21 days, and has a fever or vomiting and other symptoms like that, and also that they can quickly put on that protective gear to protect themselves as well.


    Katy Roemer, in the near term…


    Yes, sure, go ahead. I — go ahead.


    Yes, I just want to respond to that, because the reality is that patients can walk into a hospital or a clinic at any moment.

    And so to say that we would just have training at the regional centers doesn’t provide for safe, adequate care for the patients that might walk in and access care at any one of our hospitals or clinics throughout the United States. So we are asking for training for nurses who are providing care in all those areas, so that we know how to identify, so that we have a communication plan, so that we have the ability to isolate patients when we need to and that we can, you know, provide immediate care, which is what we’re going to be required to do.


    Right. It’s clear that this is an ongoing issue, and we will continue to look at it.

    We thank you both, Katy Roemer, Professor Howard Markel.


    Thank you.


    Thank you.

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