On Sept. 28, the EMS world as we knew it changed—not only in Dallas, Texas, but nationally. The interesting thing is none of us realized the change until 48 hours later when we learned the first patient to be diagnosed with Ebola in the U.S. had been transported by a Dallas Fire-Rescue (DFR) ambulance.
Over the course of the next three weeks, every member of DFR was impacted, and EMS agencies across the nation felt the ripples that began in Dallas and moved
coast-to-coast with startling speed, driven in no small part by the nation’s media outlets.
While there were many impacts felt by DFR through the duration of this incident, we’ll focus on three key areas: decontamination of the ambulance after the incident, the effect of being placed in an in-home monitoring status for the three DFR members who transported the patient, and changes to DFR PPE policy.
As DFR personnel were evaluating the index patient they knew something unusual was occurring. They later recounted that they found the index patient to be febrile and had been told the patient had recently been in West Africa. However, they also said they never truly believed the patient had Ebola.
Due to the patient’s history, paramedics utilized the PPE they felt was consistent with DFR policy.
After transporting the patient, they disinfected the ambulance in accordance with department procedures. Neither the paramedics nor the ambulance were contaminated with any bodily fluids from the patient during the transport.
Following hand-off of the patient at the hospital, the paramedics wiped down surfaces of their stretcher utilizing a germicidal cleaner and then used a tuberculocidal aerosol disinfectant to disinfect the entire patient compartment.
When it was later determined that the patient was being tested for Ebola, the administrative decision was made to take the ambulance out of service until additional information could be obtained.
The unit was again disinfected at that time—out of an abundance of caution.
On the morning of Sept. 30, two days after transporting the patient, DFR learned the patient was being tested for Ebola. The day was very busy for those of us in EMS administration as we worked with various city, county and community partners to determine the best course of action if the Ebola test came back positive.
The health and safety of the paramedics who transported the patient was our primary concern. We were later relieved when it was determined their level of risk for exposure was very low, based upon information obtained from epidemiologists at the Dallas County Health Department and other sources.
As our plan of action was developed, it was decided we would follow CDC recommendations and place the three personnel into an in-home monitoring program for 21days from the date of exposure, following a baseline medical examination.
Once the positive test result was confirmed later that afternoon, our plan was presented to city leadership, approved and put into effect.
After their baseline evaluation was completed, they were driven home by DFR staff and were asked to not leave their home for the remainder of the 21 day monitoring period. Their families were allowed to stay in the home and live their lives as normally as possible.
All three members were asked to monitor their temperature twice daily and report those readings to the medical director who was in regular contact with Dallas County Health and State Health Department authorities.
Throughout the entire ordeal, all three medics remained calm and determined, and maintained a positive mental outlook.
As was anticipated, all three members completed the monitoring period without exhibiting any symptoms of Ebola and returned to work without incident.
DFR benefited from processes and procedures already in place. For many years, DFR has had a strong communicable disease program. A full-time nurse manager coordinates the program, which focuses on immunizations, exposure management, and education.
However, as a result of this incident, DFR completely reevaluated and revised all related procedures, equipment and training. This process identified and immediately addressed a number of areas in need of improvement.
Additional PPE items were ordered and distributed, including one-piece coveralls, shoe covers with leggings, and bonnets. Pre-existing procedures were updated to reflect national best practices and current CDC recommendations.
Updated training in PPE use began and all new policies, procedures and training bulletins were distributed to all DFR members as well as local, state and national EMS agencies.
Of course, we would have preferred that this incident hadn’t occurred. But Dallas was first, and we believe our department stepped up and has emerged stronger than it was before this situation began.
We believe the lessons learned, and the policies and procedures we developed in Dallas, will benefit EMS systems throughout the U.S.
This incident served as a wake-up call not only for our department but also for the national EMS community. Our paramedics are certainly more conscious about how to utilize PPE appropriately, and our procedures and equipment have been updated.
We are proud of how our personnel responded, reacted professionally and remained calm, and maintained a positive mental outlook throughout their encounter with this deadly disease. We hope our experience and policy modifications assist other fire and EMS response agencies.