Despite the hard lessons of 9/11 and Katrina, and millions in grant and tax money “fed” for disaster preparedness to the states and hospital systems for equipment and training, a state-of-the-art, 900-bed acute care hospital in Dallas, TX failed to identify an Ebola patient, flu-like symptoms and all, fresh from Liberia.

Is this Dallas hospital an outlier or exception to the norm? Not likely.

Delivering babies for over 20 years as a practicing obstetrician, I spent long hours studying fetal heart monitoring and contraction patterns, intensely scouring for any evidence of impending harm to mama or baby. Over time I acquired the “art” of obstetrics, a subconscious “gut” feeling; in other words, after many years and many babies, to not rely solely on all the technical-warning apparatus available today. Delivering babies is not a video game, and no one wants a bad outcome, especially one that could have been avoided.

Not since retiring from OB in 2002 had I experienced that same uneasy “gut” feeling that something is not “right”. Affected deeply as far back as the 1986 Space Shuttle Challenger disaster and again with 9/11, I am interested in crisis-brewing events. Now fully immersed in planning for possible catastrophic societal disruptions primarily for healthcare, I monitor the “airwaves” and Internet.

This past summer my “medically-attuned antennae” awakened from seeming hibernation and sensed abnormal patterns once again while following the outbreak of Ebola in West Africa. They were confirmed on September 30th when Director Thomas Frieden, M.D. of the Center for Disease Control held a press conference regarding a confirmed Ebola patient.

If you have not heard, a previously undiagnosed case of the deadly and highly contagious Ebola virus was diagnosed in Dallas, TX, the first ever to be on U.S. soil; 2 possible additional cases in D.C. and Atlanta as of now. Two previous cases of already-diagnosed patients were flown back and treated successfully from West Africa where the death toll is now over 3,000 since March.

Experts in public health and in the U.S. biologic weapons defense “community” have speculated and warned for some time that global exposure to a contagion was bound to happen with the explosive growth, speed and availability of worldwide air travel. Early signs were there with SARS and more recently MERS (Middle Eastern Respiratory Syndrome), neither of which had the infectious and fatality potential of Ebola.

What is worrisome to me is our woefully unprepared healthcare system. The Dallas patient presented to the emergency department of a state-of-the-art, 900-bed acute care hospital facility (over twice the size of Harborview Medical Center) with flu-like symptoms and a recent travel history from Liberia, West Africa.

If you have ever needed to go to an ED, you know the drill. You sit in the waiting room, possibly hours, surrounded on all sides by coughing, sneezing and nose-blowing. With those symptoms and travel history, this patient was all but wearing a sandwich board sign saying “I have Ebola”. After being evaluated, he was sent home on antibiotics. Not the proper treatment for any viral infection, let alone Ebola. Alarmingly, this could happen anywhere, at any hospital. Likely it has already. This is just the first to be identified. As of this writing, we are awaiting the lab test results of those 2 other prospects.

You may ask; how can this happen? Despite all the protocols, all the checkboxes and criteria of regulations and compliance, this patient was sent home on antibiotics. Add to that, 2 days later this same symptomatic Dallas Ebola patient was transported back to the very same ED by an unknowingly-exposed Dallas Fire medic unit, which stayed in service for 48 more hours; neither Dallas Fire nor the Fire paramedics were notified of their Ebola exposure.

These are serious breakdowns in the healthcare system, but not unexpected by those who know and understand what’s in play. Emergency departments operate at or over capacity all the time. A “just-in-time” hospital business model to stay in the “black” dictates staffing and inventory resources of medications and supplies. There is a constant battle for budgetary “crumbs” resulting in little attention spared for emergency management and preparedness nationally in hospitals as this contributes nothing to the “bottom line”.

What can we do? First, stay alert and informed to what is happening in the world and the U.S. Even quiet little Edmonds is just a plane, train or bus ride away from such a contagion. Second, be outspoken in support of organizations like our Swedish Edmonds, Fire District 1 and Operation Military Family in their efforts to be more proactive in disaster preparedness with unfunded, volunteer programs such as the Disaster Medicine Project.

Disasters are lurking, whether stemming from increasing train traffic of coal or Bakken oil or an outbreak of some little-known, bizarre yet highly lethal viral infection. Both demand the same vigilant, prepared healthcare system and workforce. Unfortunately, we are not there.

One last thing – wash your hands often.

– 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.