Philadelphia Officials Clash over Ebola Readiness

Official assurances that the city is fully prepared to deal with Ebola collided Thursday with impassioned pleas from front-line health-care workers who said they need more and better equipment and far more training to safely care for patients infected with the deadly virus.

During a City Council hearing that lasted nearly four hours, top leaders from the city’s public health agencies, fire department, airport, and major hospitals said that while Ebola presents some unique challenges, they have been effectively controlling other serious threats such as anthrax, bird flu, and HIV for decades.

“Every hospital has the equipment they need,” said Mark Ross, regional manager of the Hospital and Health System Association of Pennsylvania. “Ebola is just one of a host of serious infectious diseases hospitals must be prepared to identify and safely treat each and every day.”

But union officials representing nurses, other hospital personnel, and paramedics cautioned that this kind of overconfidence has already threatened lives.

The two nurses at Dallas Presbyterian Hospital who became infected with Ebola after treating Thomas Eric Duncan wore “flimsy protective gear” and received “no proper training,” said Joseph Schulle, president of the Firefighters and Paramedics Union Local 22. “This is more likely than not the same protective gear the department expects will protect our first responders.”

Patricia Eakin, president of the Pennsylvania Association of Staff Nurses and Allied Professionals, dismissed repeated assertions by hospital administrators that they are observing all the latest guidelines set by the Centers for Disease Control and Prevention, and said that those guidelines have already proven to be inadequate.

The doctors, nurses, and others who successfully cared for two medical missionaries at Emory University Hospital this summer wore significantly more gear – known as personal protective equipment or PPEs – than the CDC had recommended, she said.

None of them became infected, Eakin said, and Philadelphia’s health-care workers deserve the same safeguards.

The lengthy and complicated process of learning to correctly “don and doff” protective gear “can’t be short-circuited,” she said.

While the Emory staff, already experienced in the procedure, were retrained and had to practice over and over before they were permitted to treat a patient, Eakin said that few, if any, of Philadelphia’s hospital workers have received that kind of careful instruction.

Seated at the panelist’s table, which was equipped with a large jar of hand sanitizer, Fire Commissioner Derrick Sawyer said that by Friday, all of the city’s paramedics will have been trained to safely respond to a suspected case of Ebola.

The department has been screening patients for Ebola since early August, Sawyer said, and formed its own task force to establish safety practices.

The CDC “gave us the baseline, but we’ve gone above and beyond,” he said, holding up a PPE rolled up tightly in plastic wrapping. The suit, he said, was one of 700 already on hand, with 1,000 more on order, in addition to more durable foot coverings and stronger face masks.

Although that gear goes beyond the minimum, Schulle said, it is still insufficient. He also said that most training entails only a verbal explanation of proper don and doff procedures and some handouts.

Officials described daily conference calls, extensive communication networks, strategy sessions, and monitoring of CDC guidelines.

While lauding his hospital’s efforts, Edward Jasper, the director of the department of emergency medicine at Jefferson University Hospital, said a disease as lethal as Ebola is bound to present some unexpected challenges.

Quoting Helmuth von Moltke, a 19th-century Prussian field marshal, Jasper said, “No battle plan survives contact with the enemy.”

Nevertheless, he said he could not imagine that any city is doing more, has better collaboration with government agencies or better hospitals than Philadelphia.

“All of our hospitals have a very high level of expertise,” said Patrick J. Brennan, an infectious-disease specialist and chief medical officer for the University of Pennsylvania Health System.

Asked to grade Philadelphia’s preparedness, Brennan said, “The only acceptable score is a perfect grade. We are striving for that.”

As the largest of Penn Medicine’s hospitals, Brennan said, HUP has been asked by the American Hospital Association to serve as the regional center to care for American health workers returning from countries where they helped treat patients with Ebola.

On Thursday, the Children’s Hospital of Philadelphia reported that it was one of several U.S. pediatric hospitals chosen to provide medical care for children with Ebola.

When a councilman asked if all Ebola patients should be referred to a select number of experienced and well-equipped hospitals, Herbert Cushing, chief medical officer of Temple University Hospital, responded, “That would be an unequivocal yes.”

Cushing was the only hospital official at the hearing who said he shared employees’ concerns about insufficient equipment and training.

“What the nurses are saying is so,” said Cushing. “Their worries are appropriate and accurate. We’re just getting started.”

It would not have made sense, practically or financially, to go to great lengths to prepare workers until recently, he said, because the information – and techniques – need to be fresh in people’s minds.

Now, however, is the time, he said.

There is no reason to panic, Cushing said. And people should not expect the CDC to have all the answers.

“The public is dreaming that the CDC is like something they see in movies,” he said. “It’s not like they have an army to train SWAT teams. They mostly collect data, analyze outbreaks, and compile reports.”

Rather than relying on the agency’s recommendations, he said, Temple is going to follow the battle-tested advice of Eileen Farnon, an infectious-disease specialist at the hospital who recently returned from Liberia.

And in the meantime, he said, he hopes that any patients who need to be treated for Ebola are referred to centers like Emory, which have the experience, extensive resources, and thoroughly trained staff that even the best regional hospitals cannot match.


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