Nurses, the frontline care providers in U.S. hospitals, say they are untrained and unprepared to handle patients arriving in their hospital emergency departments infected with Ebola.
Many say they have gone to hospital managers, seeking training on how to best care for patients and protect themselves and their families from contracting the deadly disease, which has so far killed at least 3,338 people in the deadliest outbreak on record.
The U.S. Centers for Disease Control and Prevention has repeatedly said that U.S. hospitals are prepared to handle such patients. Many infectious disease experts agree with that assessment.
Dr. Edward Goodman, an infectious disease doctor at Texas Health Presbyterian Hospital in Dallas that is now caring for the first Ebola patient to be diagnosed in this country, believed his hospital was ready.
The hospital had completed Ebola training just before Thomas Eric Duncan arrived in their emergency department on Sept. 26. But despite being told that Duncan had recently traveled from Liberia, hospital staff failed to recognize the Ebola risk and sent him home, where he spent another two days becoming sicker and more infectious.
"The Texas case is a perfect example," said Micker Samios, a triage nurse in the emergency department at Medstar Washington Hospital Center, the largest hospital in the nation's capital.
"In addition to not being prepared, there was a flaw in diagnostics as well as communication," Samios said.
Nurses argue that inadequate preparation could increase the chances of spreading Ebola if hospital staff fail to recognize a patient coming through their doors, or if personnel are not informed about how to properly protect themselves.
At Medstar, the issue of Ebola training came up at the bargaining table during contract negotiations.
"A lot of staff feel they aren't adequately trained," said Samios, whose job is to greet patients in the emergency department and do an initial assessment of their condition.
So Young Pak, a spokeswoman for the hospital, said it has been rolling out training since July "in the Emergency Department and elsewhere, and communicating regularly with physicians, nurses and others throughout the hospital."
Samios said she and other members of the emergency department staff were trained just last week on procedures to care for and recognize an Ebola patient, but not everyone was present for the training, and none of the other nursing or support staff were trained.
"When an Ebola patient is admitted or goes to the intensive care unit, those nurses, those tech service associates are not trained," she said. "The X-ray tech who comes into the room to do the portable chest X-ray is not trained. The transporter who pushes the stretcher is not trained."
If an Ebola patient becomes sick while being transported, "How do you clean the elevator?"
Nurses at hospitals across the country are asking similar questions.
A survey by National Nurses United of some 400 nurses in more than 200 hospitals in 25 states found that more than half (60 percent) said their hospital is not prepared to handle patients with Ebola, and more than 80 percent said their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola.
Another 30 percent said their hospital has insufficient supplies of eye protection and fluid-resistant gowns.
"If there are protocols in place, the nurses are not hearing them and the nurses are the ones who are exposed," said RoseAnn DeMoro, executive director of National Nurses United, which serves as both a union and a professional association for U.S. nurses.
Unlike influenza or the common cold, which can be spread by coughing and sneezing, Ebola is only spread by contact with bodily fluids from someone who is actively sick. That means the risk to the average person is low, but for healthcare workers, the risk is much higher.
As of Aug. 25, more than 240 healthcare workers have developed the disease in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died, according to the World Health Organization.
Many of these infections occurred when healthcare workers were removing the personal protective gear – masks, gowns, gloves or full hazmat suits used to care for the patients, said biosafety experts.
Sean Kaufman, president of Behavioral-Based Improvement Solutions, an Atlanta-based biosafety firm, helped coach nurses at Emory University through the process of putting on and taking off personal protective equipment (PPE) while they were caring for two U.S. aid workers flown to Atlanta after becoming infected with Ebola in West Africa.
Kaufman became known as "Papa Smurf" to the Emory nurses because of the blue hazmat suits he and others wore that resembled the cartoon character.
"Our healthcare workforce goes through so many pairs of gloves that they really don't focus on how they remove gloves. The putting on and the taking off doesn't occur with enough attention to protect themselves," he said.
Nurses say hospitals have not thought through the logistics of caring for Ebola patients.
"People say they are ready, but then when you ask them what do you actually have in place, nobody is really answering that," said Karen Higgins, a registered nurse at Boston Medical Center.
Higgins, an intensive care unit (ICU) nurse, said hospital officials have been teaching nurses on one of the regular floors how to care for an Ebola patient.
"I said, well, that's great, but if the patient requires an ICU, what is your plan," she said. "They looked at me blankly."
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