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Preparing for the worst: National Ambulance and the 2014 Ebola virus epidemic

Authors:

Abstract

Background: Ebola virus disease (EVD) is caused by infection with a virus of the family Filoviridae, genus Ebolavirus. It is a type of viral haemorrhagic fever (VHF). The 2014 Ebola outbreak in West Africa is the largest the world has ever seen, and the first Ebola epidemic in history. As of April 15th 2015, there have been a total of 25,826 suspected, probable, and confirmed cases, with 10,704 deaths (41% mortality rate).1 National Ambulance Response: National Ambulance LLC implemented a variety of procedural, educational and engineering controls designed to protect clinical staff from harm and provide safer patient care. This included the provision of a high-risk personal protective equipment (PPE) training programme, a trained observer programme, and increased PPE supply to clinical staff. National Ambulance staff also began screening of passengers on West African flights in Abu Dhabi International Airport in November 2014 to identify potentially infected persons. Key point: Conformance with Centre for Disease Control recommendations regarding personal protective equipment, screening of potentially infected patients and management of suspected cases of EVD was a key component in National Ambulance’s response to the threat posed by the epidemic. Conclusion: The current outbreak of EVD in West Africa has challenged many healthcare systems, including ambulance services, across the globe. No case of Ebola has been detected in the United Arab Emirates to date. Through a process of continuous updating, meeting international best practice recommendations and education delivery, National Ambulance staff are prepared to deal safely and effectively with patients presenting References: 1. Centre for Disease Control (2015) 2014 Ebola Outbreak in West Africa - Case Counts. Available at: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. Accessed 16th April 2015.
Background
Ebola virus disease (EVD) is caused by infection with a virus of the family
Filoviridae, genus Ebolavirus. It is a type of viral haemorrhagic fever (VHF).
Ebola was first discovered in 1976 near the Ebola River in what is now the
Democratic Republic of the Congo.1
There are five identified Ebola virus species, four of which are known to cause
disease in humans: Ebola virus; Sudan virus; Taï Forest virus; and Bundibugyo
virus. The fifth, Reston virus, has caused disease in nonhuman primates, but not
in humans.
The 2014 Ebola outbreak in West Africa is the largest the world has ever seen, and
the first Ebola epidemic in history (Figure 1).
As of April 15th 2015, there have been a total of 25,826 suspected, probable, and
confirmed cases, with 10,704 deaths (41% mortality rate).2
Ebola and the United Arab Emirates
There have been no confirmed cases of Ebola Virus Disease in the UAE.
A number of airline passengers have been quarantined in both Dubai and Abu
Dhabi airports as a result of EVD-like symptoms, however, all have been cleared.
UAE airlines suspended flights to affected countries in West Africa during the
outbreak at various stages.
Summary
The current outbreak of EVD in West Africa has challenged many healthcare
systems, including ambulance services, across the globe.
No case of Ebola has been detected in the United Arab Emirates to date.
Through a process of continuous updating, meeting international best practice
recommendations and education delivery, National Ambulance staff are
prepared to deal safely and effectively with patients presenting with EVD.
Continued adherence with CDC guidance is required to ensure National
Ambulance clinical staff remain equipped to respond safely.
November 2014
Trained observer programme implemented as per Centre for Disease Control
(CDC) recommendations.
National Ambulance staff begin screening of passengers from African flights in
Abu Dhabi International Airport.
January 2015
CDC updated PPE requirements for prehospital and in-hospital providers;
National Ambulance updated PPE requirements as per CDC guidance.
References
1. United States Army Medical Research Institute of Infectious Diseases. (2011) Medical
Management of Biological Casualties Handbook. Maryland: USAMRIID.
2. Centre for Disease Control (2015) 2014 Ebola Outbreak in West Africa - Case Counts.
Available at: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html.
Accessed 16th April 2015.
3. Centre for Disease Control (2015) 2014 Ebola Outbreak in West Africa - Outbreak
Distribution Map. Available at: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-
africa/distribution-map.html. Accessed 16th April 2015.
Acknowledgements & contact details
National Ambulance Clinical Education staff, EMTs & Paramedics
For further information email abatt@nationalambulance.ae
Preparing for the worst: National Ambulance and the
2014 Ebola Virus epidemic
Al Hajeri A1, Batt AM1,2, Haskins BA1,4, Cummins FH1,3,4
1Clinical Education & Research, National Ambulance LLC, Abu Dhabi, UAE.
2 Centre for Prehospital Research, University of Limerick, Ireland
3Graduate Entry Medical School, University of Limerick, Ireland. 4Charles Sturt University, NSW, Australia.
Screening Process
National Ambulance clinical staff continue to screen passengers from West
African and Moroccan flights in Abu Dhabi International Airport
Staff complete the Health Authority of Abu Dhabi Primary Health Screening
Form for positive tests (temperature >37.5°C).
This form investigates symptoms within the previous 21 days such as fever,
headache, diarrhea, bleeding and vomiting.
This screening process also investigates if the person has been in contact
with someone who was infected with Ebola, if they had contact with dead
bodies, or if they were exposed to bats.
Figure 1. Outbreak distribution map as of 8th April 2015.3
Response & Preparation Timeline
May 2014
All staff provided with regular updates on situation in West Africa by Clinical
Education Department.
FFP3 masks introduced into personal protective equipment (PPE) for all staff, fit-
testing conducted.
June 2014
Infection control policies updated, new policy for patients with communicable
diseases developed.
Ebola orientation document published for National Ambulance Staff.
August 2014
Interim Guidance for Monitoring and Movement of Persons with Ebola Virus
Disease Exposure published for National Ambulance Staff.
National Ambulance Ebola Update, infection control and PPE information update
provided to all staff.
September 2014
Infection Control learning package provided to all staff, combining handwashing,
FFP3mask fitting, control measures and Ebola updates.
October 2014
In-house training package developed for high-risk personal protective equipment
donning and doffing.
PPE for all high-risk patients (suspected VHF or communicable disease such as
avian flu et.) to include: FFP3 Face Mask, full-body coverall with hood, full face
shield, eye protector, boot & shoe protectors, inner and outer gloves with taped
cuffs and use of alcohol hand rubs (Figure 2).
Figure 2. National Ambulance practitioner & trained observer with full PPE
Trained Observer Programme
The first step in maintaining personal safety when dealing with high-risk
communicable diseases is to engage a trained observer whenever PPE is
being put on or taken off.
The trained observer programme is a 1-day blended learning educational
intervention that teaches staff the importance of preparation, closed-loop
communication, vigilance, donning and doffing procedures and
documentation requirements.
All National Ambulance staff have access to both High-Risk PPE and Trained
Observer programmes.
ResearchGate has not been able to resolve any citations for this publication.
2014 Ebola Outbreak in West Africa -Case Counts Available at
  • Disease Centre
  • Control
Centre for Disease Control (2015) 2014 Ebola Outbreak in West Africa -Case Counts. Available at: http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html. Accessed 16th April 2015.