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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EClosing the gaps in education and training can ease anxiety about Ebola virus disease (EVD) and help health care workers be more comfortable and better prepared when faced with a patient suspected to have the disease. This article discusses prehospital evaluation and management of patients with serious communicable disease, as well as information on the pathogenesis of EVD.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEnvironmental \u0026amp; Wilderness Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EViral Infections Critical Care\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EEnvironmental \u0026amp; Wilderness Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EViral Infections\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEmergency Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECritical Care\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EClosing the gaps in education and training can ease anxiety about Ebola virus disease (EVD) and help health care workers be more comfortable and better prepared when faced with a patient suspected to have the disease.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn a session devoted to EVD, Alexander Isakov, MD, MPH, Emory University School of Medicine, Atlanta, Georgia, USA, focused on prehospital evaluation and management of patients with serious communicable disease. David C. Pigott, MD, University of Alabama at Birmingham, Birmingham, Alabama, USA, provided up-to-date information on the pathogenesis of EVD.\u003C\/p\u003E\u003Cp\u003EDr Isakov focused on the need for health care workers to understand and implement strict infectious control measures to screen, identify, and manage patients with EVD, emphasizing the following key points when dealing with individuals who have returned from one of the affected West African countries:\n\u003C\/p\u003E\u003Cul class=\u0022list-unord \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n               \u003Cp id=\u0022p-5\u0022\u003EAsymptomatic patients are not contagious\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n               \u003Cp id=\u0022p-6\u0022\u003ERisk of transmission increases with the severity of illness\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n               \u003Cp id=\u0022p-7\u0022\u003EInfection control revolves around preventing exposure to blood and infectious bodily fluid\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n               \u003Cp id=\u0022p-8\u0022\u003EPersonal protective equipment (PPE) should reflect the condition of the patient and operating environment\u003C\/p\u003E\n            \u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n               \u003Cp id=\u0022p-9\u0022\u003ESpecial supervision is advised when during decontamination and disinfection procedures and when health care workers doff PPE.\u003C\/p\u003E\n            \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n      \u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EDr Pigott explained that the Ebola virus typically enters the host through a break in the skin or via mucous membranes. The virus spreads through the lymphatic system to regional lymph nodes, liver, and spleen, infecting and replicating in a variety of cells and causing cytotoxic tissue damage, endothelial injury, increased vascular permeability, and loss of vascular tone [Toner E et al. \u003Cem\u003EDisaster Med Public Health Prep\u003C\/em\u003E. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EAlthough EVD is very infectious and requires only a few particles (estimates as low as 1\u201310 virions) to cause infection, Dr Pigott emphasized that transmission requires direct contact with infected body fluids. Vomit, feces, and blood are most infectious, whereas other fluids, such as sweat and saliva, carry lower risk of transmission. Patients with more advanced disease are more highly viremic, and their body fluids contain higher levels of virus. There is risk of transmission via contact with contaminated surfaces. In Dr Pigott\u0027s opinion, speculation that EVD could mutate to an airborne form is unsubstantiated. \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E lists the risk level by type of exposure to infected patient.\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15538\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15538\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15538\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003ERisk Level by Type of Exposure to Infected Patient\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-14\u0022\u003ETo educate and train health care workers on EVD, Dr Isakov drew on the experiences and evolving policies developed more than 10 years ago at Emory University Hospital\u0027s Serious Communicable Disease Unit. A joint venture between Emory University Hospital and the Centers for Disease Control and Prevention (CDC), this unit is one of the 4 health care facilities identified in the United States that had special provisions in place to care for patients with serious communicable diseases, like Ebola.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EDr Isakov reviewed the algorithm provided by the CDC to screen suspected EVD patients with at the point of entry [\u003Cem\u003EIdentify, Isolate, Inform: Emergency Department Evaluation and Management of Patients With Possible Ebola Virus Disease\u003C\/em\u003E. CDC. 2014].\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EEstablishing exposure history is the critical first step that informs the rest of the screening. If a patient has traveled in the previous 3 weeks to one of the 3 West African countries with epidemic EVD (Guinea, Liberia, and Sierra Leone) and has signs or symptoms of illness (fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal pain, unexplained hemorrhage), he or she is put in a private room.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EDr Isakov also emphasized the importance of the CDC\u0027s recommendation to stratify patients based on their degree of signs and symptoms. For example, when caring for patients with copious diarrhea and vomiting, health care workers need more protection than for patients presenting simply with fever.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPROTECTING HEALTH CARE WORKERS FROM EXPOSURE\u003C\/h2\u003E\n         \u003Cp id=\u0022p-18\u0022\u003EHealth care workers should avoid contact with any of the patient\u0027s vomit or diarrhea or other bodily fluids, which requires adequate PPE. It is critical for health care workers caring for patients to receive training on the proper way to don and doff PPE, whether managing a patient in-hospital or transporting them via ambulance or other forms of transport.\u003C\/p\u003E\n         \u003Cp id=\u0022p-19\u0022\u003EFor patients who arrive in ambulances or other forms of transport, decontamination and disinfection of the ambulance or transport are also necessary. Procedures also implemented to facilitate vehicle disinfection include isolating the driver compartment from the patient compartment, and protecting the patient compartment environmental surfaces with impervious barrier drapes.\u003C\/p\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EFor all of these measures, Dr Isakov emphasized the need for supervision of the process to ensure no lapse in procedure that could inadvertently expose a health care worker to infectious fluids [Isakov et al. \u003Cem\u003EAnn Intern Med.\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003Cp id=\u0022p-21\u0022\u003ECurrently, the only established treatment for EVD is supportive care: symptom control, hydration, electrolyte repletion. However, Dr Pigott provided a brief overview of investigational treatment options for EVD and the evidence to date (\u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15539\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15539\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15539\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-22\u0022 class=\u0022first-child\u0022\u003EExperimental Interventions for EVD\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-24\u0022\u003EDr Pigott concluded by highlighting the CDC\u0027s 3 major strategies to address the current EVD outbreak: prevention (reducing disease outbreaks), detection (identifying cases and contacts), and response (establishing training and treatment centers) [\u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2014].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/46\/4.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzogm1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzogm1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}