Nearly one year ago, two American medical missionaries infected with Ebola virus disease in Liberia were evacuated by air ambulance to Emory University Hospital in Atlanta. Emory's decision to treat these first patients in the United States with Ebola virus disease (EVD) as well as two additional patients, and the preparedness and protocols that led to their safe and successful treatment, are described in PLOS Medicine.
Lead author is David S. Stephens, MD, vice president for research in Emory's Woodruff Health Sciences Center and professor and chair in the Department of Medicine.
"Countries throughout the world will continue to be affected by future communicable disease threats and outbreaks," says Stephens. "The many challenges and the strategic and tactical lessons learned by Emory physicians, nurses, faculty, staff, and administrators in treating patients with Ebola virus disease provide us an opportunity to share information that may help others to prepare, prevent, and treat difficult emerging diseases. Our experience with Ebola virus disease as an academic health center demonstrates the importance of preparation, communications and detailed implementation."
Emory's decision to accept the patients was made in coordination with the U.S. State Department and the Centers for Disease Control and Prevention (CDC), and was based on medical need, confidence in Emory's preparedness, including 12 years of training to address highly communicable diseases, and Emory's ability to use the experience to advance knowledge.
The patients were treated within the Serious Communicable Diseases Unit (SCDU) in Emory University Hospital, a special isolation unit established in 2002 in close collaboration with, and funding from the nearby Centers for Disease Control and Prevention (CDC). The SCDU was originally designed to care for CDC scientists and staff who contracted highly communicable diseases in laboratory settings or while traveling abroad.
As an academic medical center, Emory was able to benefit from established strong programs in health care delivery, quality, infectious diseases, infection control and biosafety, immunology, vaccines, biodefense, travel medicine, emergency medicine and public health.
Strategy and tactics included detailed planning and teamwork across multiple units; use of both standard and experimental treatment options; an emphasis on biosafety; robust internal and external communications including consistent messaging, patient privacy and public education; protocol development with enhanced infectious disease screening and precautions; research; addressing unanticipated challenges such as waste management; and the logistics of working closely with government agencies, international research leaders, university partners and biotech/industry contacts.
Within Emory University Hospital, a support team met twice each day including top administrators, nursing and physician leaders, and key communicators. In addition to infectious disease specialists, all aspects of hospital services were involved, including critical care medicine, renal medicine and other subspecialties, pharmacy, environmental services, engineering/facilities support, and pastoral care/counseling.
The Emory Environmental Health and Safety Office was a key member of the support team and provided continuous training and evaluation on safety and preparedness as well as consultation with other national biosafety leaders.
Emory's Department of Emergency Medicine and the Emory Office of Critical Event Preparedness and Response were instrumental in developing safe patient transport and emergency care, working closely with Phoenix Air Group and the Grady Hospital Ambulance service.
Following the successful discharge of the four patients, Emory has continued to disseminate best practice information and new knowledge about treatment, complications, and the clinical course of Ebola; serve as a national leader in education and training; create new university forums; develop education materials for residents, fellows and the general public; present clinical and research findings at scientific meetings and in journal articles; and engage in the broader policy issues of preventing and treating highly contagious diseases.
Other authors include Bruce Ribner, MD, director, Emory Serious Communicable Diseases Unit; Bryce D. Gartland, Emory University Hospital COO; Nancye Feistritzer, chief nursing officer, Emory University Hospital; Monica Farley, director, Emory Division of Infectious Diseases; Chris Larsen, MD, DPhil, dean, Emory University School of Medicine; and John Fox, former president and CEO, Emory Healthcare.