The string of errors in Dallas shows that neither the Centers for Disease Control and Prevention nor the local hospital was ready for the first US case of Ebola. New York and other cities can learn from what went wrong.
On Sept. 25, Thomas Eric Duncan, a Liberian with an undiagnosed case of Ebola, went to the emergency room at Texas Health Presbyterian Hospital in Dallas. The medical team overlooked his recent arrival from Ebola-infested West Africa and discharged him with antibiotics.
That was the first of several mistakes that have put at least 48 Dallas-area residents at enough risk of contracting Ebola that they’re being monitored twice daily, and in some cases quarantined.
Hospital officials at first blamed the electronic-medical-records system, rather than admit staff had made an error. Such dodges allow deadly mistakes to be repeated.
After his discharge, Duncan’s condition worsened. Two days later, as he huddled in a blanket, with vomiting, diarrhea and reddened eyes, his girlfriend’s daughter called 911.
But Dallas wasn’t screening 911 calls for Ebola, something that New York City is already doing.
So the paramedics got their first warning only after the ambulance arrived: The daughter told them Duncan had arrived from West Africa and could have a virus. They grabbed masks and gloves before helping Duncan, who was vomiting profusely, into the ambulance.
Those paramedics are now being monitored for symptoms.
But after it brought Duncan back to the hospital, ambulance No. 37 remained in use for another 48 hours. Paramedics who staffed it during that time and the patients they picked up are also being monitored. Dallas health authorities spent much of Sunday looking for a homeless man who rode in the ambulance.
Dallas isn’t entirely to blame for missteps. The CDC had failed to alert officials that ambulances should be equipped for answering possible Ebola calls, and that any ambulance used for that purpose should be taken out of use.
Yet this issue came up in CDC’s Aug. 5 conference call with hospital administrators and doctors.
A questioner asked if feverish patients who’d traveled from West Africa should stay put or be brought into the hospital. CDC epidemiologist Barbara Knust said they should be brought in for evaluation. But neither she nor any other CDC expert on the call warned against ambulance reuse.
A month later, the ambulance the CDC used to bring two Ebola-infected health-care workers to Emory University hospital was lined with bio-containment sheets, and paramedics wore Tyvek “space suits.” Then the ambulance went through a 2½-hour decontamination process.
Not so in Dallas. Not until Oct. 1, after the Dallas fiasco, did the CDC issue guidelines for ambulances.
Officials were also caught unprepared to dispose of Duncan’s contaminated bedding and clothes, and waste from the hospital: Two federal departments, Transportation and Health and Human Services, are still wrangling over rules for transporting virus-laden items on highways.
Dallas’ plight is a warning to get ready. That means equipping first responders and drilling ER and 911 personnel to pay attention to travel histories. New York City is sending actors into public hospitals to test ER staff for readiness.
Most important, hospitals need to double down on the infection-control procedures that doctors and nurses should be following every day.
Medical mistakes — missed diagnoses, medication errors, infections caused by lax hospital procedures — lead to an astounding 400,000 preventable deaths in the United States each year.
Lack of rigor is to blame. Hurried cleaning staff overlook half the items in a hospital room when preparing it for the next patient. The germs are left to linger, causing an infection.
Stressed medical staff frequently fail to clean their hands in between patients, carrying germs from one bed to the next.
Preparing hospitals to cope with Ebola will encourage discipline and attention to correct procedures. That will save lives, even if we’re lucky enough to be spared more cases of this deadly virus.
Betsy McCaughey is chairman of the Committee to Reduce Infection Deaths and a senior fellow at the London Center for Policy Research.