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June 22, 2019

Last week, two hospitals in Vermont participated in a training exercise to evaluate our region’s ability to react to the potential threat of Ebola or other such pathogens. An actor involved with the exercise appeared at Central Vermont Medical Center’s (CVMC’s) emergency department early Tuesday morning with “symptoms” consistent with Ebola. Beginning with that moment, CVMC staff and their colleagues at three other hospitals practiced exactly the steps they would take if the situation—and the consequences—were real.

CVMC called University of Vermont Medical Center (UVMMC) to alert them of the patient’s needs. UVMMC, as Vermont’s Level-1 Trauma Center, is the state’s designated assessment hospital and is responsible for evaluating and caring for a suspected Ebola patient for up to 96 hours. They initiate and coordinate testing for Ebola and either rule it out or transfer the patient to an Ebola treatment center.

When UVMMC got the call from CVMC, it deployed a critical transport ambulance from its Colchester barracks along with staff who would accompany the patient. Back at CVMC, staff took steps to isolate the patient from other patients and staff. They designated “clean” areas and “dirty” areas and kept the patient comfortable until special transport could arrive.

After the ambulance pulled into the bay at CVMC’s Berlin location, the first two staff members who would care for the patient donned personal protective equipment. During an exhaustive procedure, which involved the reading of guidelines for “donning” and two safety officers assisting, the two-member team climbed into three layers of clothing, tucking pants into long socks, sealing overlapping layers with thick tape and checking their bodies repeatedly for any lesions that might allow the virus easier access. The extensive process ended with headgear complete with respirators.

When with caregivers had donned their PPE, they quickly bundled the patient into the critical transport truck and making their way to Burlington.

Meanwhile workers at UVMMC began the donning process to equip staff there with PPE so they could treat the patient. The PPE gear, which includes a cooling vest, is so heavy that it’s not safe for a caregiver to wear it for more than two hours. Throughout the training exercise, care teams needed to be on deck to relieve their colleagues and continue the patient’s care. They also had to follow procedures for “doffing” any gear that could be dirty after they transported or treat the patient.

At UVMMC, staff from the Medical Intensive Care Unit (MICU) were waiting for the ambulance at the bay, ready to whisk the patient to a prepared sealed environment. They completed their assessment and determined that the patient’s “symptoms” were consistent with Ebola. The next day, the exercise continued as the team transported the patient to the nearest Ebola treatment center at Massachusetts General Hospital.

This exercise is one of the many things hospitals must do to prepare for all manner of emergencies: a public health crisis, an active shooter, a weather event, biohazards--the list goes on.  And hospitals must be ready for all of the above while also attending to patient care, community need, regulations and federal guidelines, leading reform, etc. Indeed, CVMC and UVMMC were careful to demonstrate during the training that is was only a drill, but around the exercises’ participants moved the rest of the staff-- attending to real emergencies, performing surgeries, delivering babies—the same activities that would take place if real Ebola risk were to threaten our state.

Seeing our members’ staff in PPE is daunting. Certainly, it’s difficult to think about a disease so deadly that, as UVM Medical Center flight nurse Michelle Greeson stated, “even one exposure could be detrimental.” But I feel comfort in knowing that our hospitals take every measure possible to make sure all the fine people in our health care system know their respective roles in protecting patients, the community and their co-workers should an emergency occur. Last week’s exercise was just one of these measures.

Jeff Tieman
President and CEO, VAHHS