Healthcare facilities around the world are woefully unprepared for the next infectious disease outbreak, concluded a recent report published by the British Medical Journal. Here in the U.S., inadequacies in managing outbreaks were plain to see in past responses.
A seat-of-the-pants response
Take the Ebola outbreak in the fall of 2014, for instance. The epidemic was met with widespread, 24/7 media coverage, countless opinions about proper response, and endless committee meetings that failed to produce a final plan by the time the outbreak subsided.
We saw similar responses during the Severe Acute Respiratory Syndrome (SARS) outbreak in 2002, then again during the H1N1 Influenza pandemic in 2009. In both events, a “seat-of-the-pants” response emerged, with initial over-reaction (school closings, ineffective quarantine, misdiagnoses, confusion over proper personal protective equipment) gradually improving out of necessity to be more efficient, given the large numbers of patients needing care.
Ebola: a unique challenge
Unlike the latter examples, the U.S. never saw enough Ebola cases to get to an optimal response, so issues linger.
Since Ebola’s discovery in 1976, we’ve collected information on the transmission, treatment, and personal protective gear needed when someone is diagnosed or suspected of having the disease. And yet, all that know-how seemed to crumble with the first diagnosis in the U.S., occurring in Dallas, Texas, in September of 2014.
The reason was simple: While we had 41 years’ worth of research on Ebola outbreak overseas, we didn’t have enough research on Ebola in the United States. With our modern healthcare facilities, advanced equipment, and infectious disease leadership, you’d think we would’ve had an easier time diagnosing and treating the disease, but we didn’t.
Ensuring a better response
What to do when the next outbreak hits to ensure better outcomes than in the past?
>> Lead with your emergency management (EM) team.
Infectious disease response is a multi-disciplinary effort. Your EM team’s strength is the ability to convene experts, coordinate a response, and develop action plans. These specialized skills are not part of a clinician’s practice, so don’t make the mistake of thinking you’ll figure things out when the time comes.
Your EM team is also skilled at communicating across disciplines and ensuring everyone knows what they need to know. Put them to good use.
>> Trade your committees for a team of experts.
Have you tried to get a committee (or multiple committees) to make a decision lately? It takes a while. Navigating an emergency response through various committees will delay proper response.
Instead, assemble a team of experts, prepare guidance and communication, and use that team as the source of information and direction for your organization. Team members can also act as liaisons to disseminate information and capture feedback from their peers
>> Pick one source.
Everyone will have an opinion, and guidance will differ, depending on the source—World Health Organization, Centers for Disease Control and Prevention, and other organizations and experts.
Pick one and follow through. Copy and paste among agencies and experts will confuse your field teams.
>> Communicate early, often, and honestly.
One of the first messages that should have been communicated to healthcare staff in the last Ebola outbreak is “most of you will not care for a confirmed Ebola patient.” Yet we were training food service staff on wearing personal protective equipment.
Make sure the right people know what they need to know, train designated caregivers, and don’t let cable TV be your information source.
>> Collaborate with local health departments and public safety providers.
Healthcare providers understand infectious disease, standard, droplet, and airborne precautions. Prehospital providers understand level A, B, C, and D protection, primarily for chemical emergencies.
Ebola is not a chemical, and that miscommunication resulted in improper gear used by healthcare and prehospital providers. Be the infectious disease expert, not only for your facility, but your community.
>> Have a distinctive end to the event.
The outbreak will end, eventually. Plan for it, acknowledge it, and notify everyone that the event is over. Having a distinct finish line gives people a reference point for returning their lives to normal.
Finally, use lessons learned in your facility and community to improve and plan for even better outcomes next time around.