I'm a Hazmat-Trained Hospital Worker: Here's what everyone is failing to report.
By Abby Norman
Ebola is brilliant.
It is a superior virus that has evolved and
fine-tuned its mechanism of transmission to be near-perfect. That's why
we're all so terrified. We know we can't destroy it. All we can do is
try to divert it, outrun it.
I've worked in health care for a few
years now. One of the first things I took advantage of was training to
become FEMA-certified for hazmat ops in a hospital setting. My rationale
for this was that, in my home state of Maine, natural disasters are
almost a given. We're also, though you may not know it, a state that has
many major ports that receive hazardous liquids from ships and
transport them inland. In the back of my mind, of course, I was aware
that any hospital in the world could potentially find itself at the
epicenter of a scene from The Hot Zone. That was several years ago.
Today I'm thinking, by God, I might actually have to use this training.
Mostly, though, I'm aware of just that -- that I did receive training.
Lots of it. Because you can't just expect any nurse or any doctor or any
health care worker or layperson to understand the deconning procedures
by way of some kind of pamphlet or 10-minute training video. Not only is
it mentally rigorous, but it's physically exhausting.
PPE, or,
personal protective equipment, is sort of a catch-all phrase for the
suits, booties, gloves, hoods and in many cases respirators worn by
individuals who are entering a hot zone. These suits are incredibly
difficult to move in. You are wearing several layers of gloves, which
limits your dexterity to basically nil, the hoods limit the scope of
your vision -- especially your peripheral vision, which all but
disappears. The suits are hot -- almost unbearably so. The respirator
gives you clean air, but not cool air. These suits are for protection,
not comfort. Before you even suit up, your vitals need to be taken. You
can't perform in the suit for more than about a half hour at a time --
if you make it that long. Heat stroke is almost a given at that point.
You have to be fully hydrated and calm before you even step into the
suit. By the time you come out of it, and your vitals are taken again,
you're likely to be feeling the impact -- you may not have taken more
than a few steps in the suit, but you'll feel like you've run a marathon
on a 90-degree day.
Getting the suit on is easy enough, but it
requires team work. Your gloves, all layers of them, are taped to your
suit. This provides an extra layer of protection and also limits your
movement. There is a very specific way to tape all the way around so
that there are no gaps or "tenting" of the tape. If you don't do this
properly, there ends up being more than enough open pockets for
contamination to seep in.
If you're wearing a
respirator, it needs to be tested prior to donning to make sure it is in
good condition and that the filter has been changed recently, so that
it will do its job. Ebola is not airborne. It is not like influenza,
which spreads on particles that you sneeze or cough. However, Ebola
lives in vomit, diarrhea and saliva -- and these avenues for infection
can travel. Projectile vomiting is called so for a reason. Particles
that are in vomit may aerosolize at the moment the patient vomits. This
is why if the nurses in Dallas were in the room when the first patient,
Thomas Duncan, was actively vomiting, it would be fairly easy for them
to become infected. Especially if they were not utilizing their PPE
correctly.
The other consideration is this: The "doffing"
procedure, that is, the removal of PPE, is the most crucial part. It is
also the point at which the majority of mistakes are made, and my guess
is that this is what happened in Dallas.
The PPE, if worn
correctly, does an excellent job of protecting you while you are wearing
it. But eventually you'll need to take it off. Before you begin, you
need to decon the outside of the PPE. That's the first thing. This is
often done in the field with hoses or mobile showers/tents. Once this
crucial step has occurred, the removal of PPE needs to be done in pairs.
You cannot safely remove it by yourself. One reason you are wearing
several sets of gloves is so that you have sterile gloves beneath your
exterior gloves that will help you to get out of your suit. The
procedure for this is taught in FEMA courses, and you run drills with a
buddy over and over again until you get it right. You remove the tape
and discard it. You throw it away from you. You step out of your boots
-- careful not to let your body touch the sides. Your partner helps
you to slither out of the suit, again, not touching the outside of it.
This is difficult, and it cannot be rushed. The respirators need to be
deconned, batteries changed, filters changed. The hoods, once deconnned,
need to be stored properly. If the suits are disposable, they need to
be disposed of properly. If not, they need to be thoroughly deconned and
stored safely. And they always need to be checked for rips, tears,
holes, punctures or any other even tiny, practically invisible openings
that could make the suit vulnerable.
Can anyone tell me if this happened in Dallas?
We
run at least an annual drill at my hospital each year. We are a small
hospital and thus are a small emergency response team. But because we
make a point to review our protocols, train our staff (actually practice
donning/doffing gear), I realized this week that this puts us ahead at
some much larger and more notable hospitals in the United States. Every
hospital should be running these types of emergency response drills
yearly, at least.
To hear that the nurses in Dallas reported that there
were no protocols at their hospital broke my heart. Their health care
system failed them. In the United States we always talk about how the
health care system is failing patients, but the truth is, it has failed
its employees too. Not just doctors and nurses, but allied health
professionals as well. The presence of Ebola on American soil has drawn
out the true vulnerabilities in the health care system, and they are not
fiscally based. We spend trillions of dollars on health care in this
country -- yet the allocation of those funds are grossly
disproportionate to how other countries spend their health care
expenditures. We aren't focused on population health.
Now, with Ebola
threatening our population, the truth is out.
The truth is, in
terms of virology, Ebola should not be a threat to American citizens. We
have clean water. We have information. We have the means to educate
ourselves, practice proper hand-washing procedures, protect ourselves
with hazmat suits. The CDC Disease Detectives were dispatched to Dallas
almost immediately to work on the front lines to identify those who
might be at risk, who could have been exposed. We have the technology,
and we certainly have the money to keep Ebola at bay. What we don't have
is communication.
What we don't have is a health care system that
values preventative care. What we don't have is an equal playing field
between nurses and physicians and allied health
professionals and patients. What we don't have is a culture of health
where we work symbiotically with one another and with the technology
that was created specifically to bridge communication gaps, but has in
so many ways failed. What we don't have is the social culture of
transparency, what we don't have is a stopgap against mounting hysteria
and hypochondria, what we don't have is nation of health literate
individuals. We don't even have health-literate professionals.
Most
doctors are specialists and are well versed only in their field. Ask
your orthopedist a general question about your health -- see if they can
comfortably answer it.
Health care operates in silos -- we can't
properly isolate our patients, but we sure as hell can isolate ourselves
as health care workers.
As we slide into flu season, a time of
year when we are normally braced for winter diseases, colds, flus, sick
days and canceled plans, the American people have been exposed to
another disease entirely: the excruciating truth about our healthcare
system's dysfunction -- and the prognosis doesn't look good.
Note: In
response to some comments, I would like to clarify that I am
FEMA-trained in level 3 hazmat in a hospital setting. I am a student,
health guide and writer, but I am not a nurse.
