A Close Encounter of the Worst Kind: They began by ‘Googling Ebola’

Robert Mitchell, M.D.
Crisis response trainer Robert Mitchell, M.D.

The fear and overreaction to the Ebola crisis is a direct result of the level of preparedness in the U.S. public health arena and health care communities and the ensuing breakdown of trust. This trust collapse derives from the confused and inadequate federal (CDC) response and messaging all the way to the trust in each other of front-line responders, hospital personnel for one another, in existing hospital systems and in senior-level hospital decision-makers. A similar series of events triggered nurses to refuse to come to work at the Redemption Hospital in Monrovia, Liberia, in June when a fellow employee died from Ebola.

It’s not Ebola. Faced with any widespread health emergency or crisis, the same dysfunctional response would unfold before us. It’s the absence of “readiness” basics or the foundation needed to identify, react and respond to any low frequency, high consequence event.

Appropriately reacting to the events of 9/11, millions of dollars were directed to states to assemble and enable this healthcare and public health readiness infrastructure. Unfortunately, these funds were often diluted or squandered in bureaucracy before actually reaching the hospitals as well as spent in the absence of a comprehensive plan and accountability attached. Not to mention the budget restrictions imposed by a frail economy.

The premise of the “Basic Disaster Life Support” training I encourage all hospitals to complete is this: There are many bad things in this world that can happen. It is unmanageable to predict or plan for every possibility. However, the basics of preparedness and response are always the same; they provide structure and empower the rapid detection, reaction, information gathering, communication, leadership and management templates needed to put a plan in place and execute it effectively — by any organization — at any time. These basic disaster response elements were displayed to the max this past March in Liberia on a Firestone Tire Company rubber farm.

In a nutshell, the Firestone organization recognized the growing Ebola threat could potentially overtake its 8,500 employees and 71,000 family dependents, a veritable city, shutting down the harvest and production. Following the “awareness” or detection of this impending crisis, they assembled a “command” group, beginning with gathering information. As portrayed in the Wall Street Journal article cited above, they began by “Googling Ebola.” What resulted was a multifaceted plan involving widespread communication and risk messaging within their “rubber” community, educating and outlining hygiene and funeral guidelines. They restricted entrance to the farming community. Set up makeshift clinics using shipping containers. Converted pick-up trucks to ambulances. A dedicated broadcast radio station came on line featuring stories and firsthand accounts of local residents who had survived the disease or with family members afflicted and recovering. Around-the-clock call-in phone lines were put in place to answer all questions. They multitasked their chemical-spill response gear to “biologic” protective wear.

Results?

Ebola infections were halted while outside the rubber farm community the disease remains rampant, a result of government confusion, inaction or dysfunction. Heard of Nicole Lurie, M.D., M.S.P.H.? In August the World Health Organization proclaimed a “Public Health Emergency of International Concern,” a rare and very significant pronouncement. Few in the U.S. acted on this declaration. Dr. Lurie is the Assistant Secretary for Preparedness and Response (ASPR). “The mission of (her federal) office is to lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters….The ASPR also coordinates interagency activities between HHS, other Federal departments, agencies, and offices, and State and local officials responsible for emergency preparedness and the protection of the civilian population from acts of bioterrorism and other public health emergencies.”

I’m not excusing the CDC or the mistakes made by the 900-bed, Harborview-like medical center, Texas Health Presbyterian Hospital. But where is the ASPR office and leadership?

Why, you may ask, are health care workers catching Ebola — 233 health care professionals in West Africa and 2 nurses here? Aren’t they trained for this? Aren’t they wearing the maximum protective gear? Aren’t all hospitals trained in isolation techniques and infectious disease containment as well as all potential disasters?

These are all good and reasonable questions. The answer quite simply is no, they are not. As stated earlier, it is impossible to be prepared for all types of disaster or emergency. It’s like saying all hospitals are able to treat severe trauma or heart patients or children or cancer or kidney dialysis patients. We all know there are “specialty” institutions for these because very specific training and equipment is required. We don’t think that unusual, right?

So why is this Ebola thing different? It’s not. It’s the same premise: Very special training and equipment is required and not every hospital is equipped or has staff trained for this. That said; Every hospital is required to be able to detect, react and respond to all such instances, including stabilization or containment and transport to an appropriate facility if necessary.

What can you do? Hope and pray Ebola does not become widespread. Be aware of what is happening here in Seattle/Edmonds and in the world. Support, engage and encourage our own front-line responders at Swedish Edmonds, Fire District 1 paramedics and the volunteers of the unfunded Disaster Medicine Project as they prepare for a possible “close encounter” of the worst kind.

– By Robert Mitchell, M.D.

Robert Mitchell, M.D., is an Edmonds resident for 30 years, board certified in OB/GYN, practicing at Stevens/Swedish-Edmonds for 18 years, retired from active OB/GYN practice in 2002. He is a crisis response trainer devoted to hospital emergency preparedness.

  1. Re: the Firestone rubber farm story… which is very interesting and instructive… say what you will about corporations, they are often more effective responders in emergency situations than unwieldly public bureaucracies. Corporations tend to have more competent managers (fewer appointees or exemplars of the Peter Principle); there is a clearer command hierarchy, immune to public debate. Things move faster.

    Remember that in the post-Katrina crisis period, the Anheuser-Busch company switched nearby breweries/bottlers over to bottling and shipping water, and they were trucking fresh water into the stricken zone on their own initiative while FEMA was still Googling “hurricane.”

    It makes me think that the screwups in Ebola containment to date are an unfortunately natural aspect of public-agency disaster planning — with the wrong people in critical positions, too many constituents to satisfy, too much preening for camera — and if we really wanted to get a handle on this threat we’d tap private sector expertise. Sure, corporations generally act in their own self-interest (Anheuser-Busch bottled that water for the PR, and deserved it). But they’re effective.

  2. Tom,
    Thanks for reading the article. Your comment, of course, regarding the private sector is very true. Wal-Mart and FedEx were both extremely effective in assisting in New Orleans in the aftermath of Katrina as well. Corporate preservation of the revenue stream always runs parallel to and depends on protection of the human “bloodstream”.
    Doc Mitchell

  3. Bob – excellent article! I agree completely with Tom – and your point, “Corporate preservation of the revenue stream always runs parallel to and depends on protection of the human “bloodstream” rings true.

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