Md. Hospital, First Responders Participate in Ebola Drill

The Frederick News-Post, Md.

Nov. 15—An Ebola readiness drill on Tuesday was so realistic that a battalion chief arriving on scene tried to chase away members of the Frederick Memorial Hospital communications staff who were gathered to watch and take photos of a "patient" receiving treatment in the parking lot of FMH Crestwood.

"He had seen the trucks and came over to assist," said Melissa Lambdin, a spokeswoman for the hospital. "He didn't know it wasn't real. So, he saw the camera and was like, 'Why are you taking pictures of the patient?' And I was like, 'I work at the hospital. This is a drill!'"

Now in its third year, the Ebola exercise helps county first responders and hospital staff prepare for any patient who may need care for a highly infectious disease. Protocol for those "patients under investigation" is stringent and specific, with little room for error in a real-life scenario.

As a result, the half day of training is also an intensive process, with careful monitoring of the patient from the first call for assistance to treatment at the hospital.

The training is especially prescient in Frederick County, where Ebola exposure is a more realistic risk, said Dr. Rachel Mandel, the hospital's assistant vice president of medical affairs. Scientists at some Fort Detrick agencies regularly work with the virus in high-level biocontainment labs. In 2014, two Ebola patients—an American doctor exposed to it and a nurse infected in the line of work—were also flown to Frederick Municipal Airport before being taken by ambulance to the National Institutes of Health in Bethesda for treatment.

"That's another reason why training is so important," Mandel said. "They were taken to NIH, but what if something had happened? What if there was a car accident and they had to be diverted here? We need to be ready for that."

On Tuesday, rescue workers trained under slightly different circumstances from previous years, responding to a "patient"—played by Kristie Culler, a hospital employee—who drove to FMH Crestwood and called 911 from the parking lot. In that situation, a patient would need to be transported from their first location to the main FMH campus on West Seventh Street.

Last year, the scenario involved a pregnant patient who also required transport from a previous location, while the year before covered an infectious visitor who arrived at the hospital by private car.

Because the alert on Tuesday went out over the scanner as a "trouble breathing" call, responders were also responsible for evaluating the patient and determining the severity of her symptoms, said Lt. Matthew Wilby, a supervisor with the Frederick County Division of Fire and Rescue Services.

Within 20 minutes of the initial call, three paramedics had recognized the patient as potentially infectious and began donning protective gear, including plastic aprons and latex gloves. About 50 minutes after the call, the workers were changing into full biohazard clothing—thick protective jumpsuits, green rubber boots, and respirator masks that obscured their faces from view.

Transporting a potentially infectious patient also takes patience on the part of responders, Wilby said. Rescue workers can't transport an Ebola patient in a regular ambulance without fully disinfecting the entire vehicle after use—a nearly impossible task. Instead, they would request a mobile isolation unit, or a reserve ambulance usually kept at the county's hazmat station in Spring Ridge.

Depending on the location, it can take more than 30 minutes for that mobile unit to arrive, Wilby added. That delay, in such a charged situation, can be exhausting for both the patient and paramedics. 

"If you're that patient, you're going to be like, 'Why am I not at the hospital by now?'" he said. "So then you have to keep them calm. It's tough. This is not going to be a fun call for anyone."

Hospital workers are also charged with keeping the patient isolated from other visitors. FMH nurses met rescue workers at the loading dock at the back of the building—far from the main emergency department entrance—and transported the patient in an isopod, a sort of mobile hospital bed encased in a sturdy plastic bubble.

Once the transport was complete, Culler was replaced in the exercise with a brand-new simulation mannequin, purchased by the hospital this year with grant money from the state. The graphically realistic dummy can cry, convulse and bleed, just like a real patient, and was programmed to display some of the more distressing symptoms of Ebola at the training on Tuesday.

"We have it prepared to do some rectal bleeding," said Jamie White, the director of nursing quality and professional development at the hospital. "We're preparing to have it vomit. Real-life practice is great and important, of course, but when you're trying to practice invasive procedures like you might need to do on an Ebola patient, it's easier to use the mannequin."

FMH is one of only five "assessment hospitals" in Maryland, a criterion that describes centers equipped to monitor and hold Ebola patients for up to 96 hours before they're moved to a higher-level treatment hospital such as Johns Hopkins, Mandel said.

That makes a fully realized training even more important for staff members. The exercise on Tuesday ended only after the mannequin "died," which gave nurses and other FMH employees the chance to practice wrapping the body for removal by the state Anatomy Board.

"That number in Baltimore is included on our checklist," said Margaret McNeill, a clinical nurse specialist at FMH. "Those hand-off protocols are also important to reduce the risk of exposure."