Preparing for Ebola: Is New York City Ready?
NEW YORK CITY -- The hall was packed, the speakers were primed, and the message to thousands of healthcare workers gathered here today was simple: Ebola will not sneak up on the Big Apple.
But for many of the rank and file -- thousands of healthcare workers gathered at the Jacob K. Javits Convention Center to hear that message -- the bold words were cold comfort.
"We've known about Ebola since July or August. Why have we only just now started preparing for an Ebola patient?" That was the sentiment shared withMedPage Today by an ER nurse, who works for one of the eight Ebola designated treatment hospitals in NYC. He, like most of the healthcare workers who spoke with MedPage Today, requested to remain anonymous.
A charge nurse from the same hospital system -- who also requested that her name be withheld -- said that her facility has BSL level 3 protection, but not level 4 to protect staff from contracting Ebola.
The ER nurse said that the mask didn't cover the jaw and neck completely. "What if I cut myself shaving?" he said.
The nurses said they had talked to their union representatives about not having the right equipment or training to treat a patient with Ebola. "We only have practice equipment," they said. The nurses also said they both still questioned exactly how Ebola is transmitted.
Last week, the NYC department of health told city hospitals that they had until October 26 "to get their policies in place and to get their training in process," Debbie Friedland, RN, of St. John's Episcopal Hospital in Far Rockaway, Queens, told MedPage Today in an interview. "The hospitals are being held accountable for that. I know the department of health started doing spot checks at the hospitals yesterday."
"Prior to what we saw in Texas, we'd been doing training in a very slow and steady way," Brian S. Koll, MD, an infectious disease specialist at Mount Sinai Hospital in New York City, told MedPage Today in an interview. "Because of what happened in Texas, we're now beginning to ramp up our efforts, and speed up our efforts."
"We have ongoing training, and this does not mean that if somebody with Ebola shows up at my hospital today that I would be putting them in a unit that's not yet ready, or where staff have not been trained," Koll said.
But the charge nurse quoted above was not convinced. She noted that hospitals had given staff a pamphlet for reference but, "would you have a fireman learn from a Power Point?"
In one of the eight designated Ebola hospitals, both the pediatric ER and adult ER are sharing one small room that has been set aside for Ebola patients.
On the Front Lines
"Doctors aren't the ones at risk, because they're not the ones going inside the rooms of the patient," a nurse said.
One EMT, who also insisted on anonymity, said first responders like himself, firefighters, and police, know their jobs put them in the door first. Unless the 911 call identifies the person as potentially Ebola infected, they could encounter infected patients at any time.
The EMT said that he and his colleagues were equipped with protective gear, but don't quite know when to use it.
A home healthcare nurse said no one is talking to them about Ebola preparedness and training. "We go into people's houses," she said. "How do you know who's at that house? Who's been in that house?"
If the EMT were to be exposed to Ebola, he said he'd have to be quarantined, which he seemed to be OK with. The charge nurse, however, said she would not be OK.
Her biggest fears, she said are "what happens after? Who's going to take care of my kids? Who's going to pay my salary?"
Questions About Staffing
"I have 684 hours sick time, but I don't call out sick," said a nurse who spent 17 years working in the emergency department of a city hospital.
Hospitals don't have enough staff to post a screening person at the front door of the ER, another nurse said. "There's no way to take a nurse off the floor to stand at the door and screen patients."
And the nurses said that at their hospital one staff person raised another important question: who will clean up after an Ebola patient?
Typically, the nurses said, there is a cleaning staff, but they wondered if healthcare workers like LPNs and RNs would be forced clean up after an Ebola patient.
Koll emphasized that hospital staff should not panic. He told his ICU staff that he wouldn't allow Ebola-infected patients to be treated on site without properly equipping and training the hospital staff.
"For us as caregivers, we want to make sure that somebody holds the administration's feet to the fire," Friedland said.