Inside Sedgwick County's ambulance for highly contagious patients
The fear of a highly contagious disease outbreak in the U.S. used to feel like something out of Hollywood.
That fear materialized when two nurses in Dallas contracted Ebola while treating the first U.S. Ebola patient in 2014. The country learned just how ill-prepared its system was to care for patients with contagious diseases.
In reaction to the Ebola outbreak — and sped up by the Dallas nurse case — Via Christi Hospital St. Francis developed an isolation unit to test and temporarily treat highly contagious patients.
“We know it’s not if, but when, it will happen so that really keeps us focused on staying prepared, staying in that state of continual readiness,” said Carolyn Koehn, director of safety and emergency management for Via Christi.
“Something will happen at some point, and we have to be ready,” she said.
Something will happen at some point, and we have to be ready.
Carolyn Koehn, director of safety and emergency management for Via Christi
Sedgwick County EMS has dedicated an ambulance for highly contagious patients. An old ambulance was retrofitted with a separate ventilation system from the driver area and stays draped in plastic, ready to transport a patient suspected to be highly contagious.
It’s all part of a national plan to better treat and contain patients with contagious diseases in the U.S. The plan was formed by the U.S. Centers for Disease Control and Prevention and carried out by the Kansas Department of Health and Environment.
Via Christi has not used its remodeled isolation unit for any real patients, but has repeatedly practiced with staff and keeps the area patient-ready at all times.
It’s Ebola today, but it’s going to be something else tomorrow.
Karen Bally, director of infection control for Via Christi
“It’s Ebola today, but it’s going to be something else tomorrow,” said Karen Bally, director of infection control for Via Christi.
About the unit
The isolation area is locked from the rest of the hospital with limited staff access, its own outdoor entrance and a separate ventilation system.
The unit consists of five areas, with varying levels of protective gear required in each. It’s designed as a one-way street – clinicians enter on one side and work through the unit only in one direction.
Clinicians with special access to the unit enter a hallway enclosed by two sets of doors with a preparation room where they spend about 20 to 30 minutes putting on protective clothing with another person’s help.
Once covered head-to-toe, the clinician goes though the second set of doors into a hallway attached to the patient room. The hallway begins what’s called the “hot zone” — the disease-contaminated area.
That’s where clinicians care for the patient and clean bodily fluids in the room. Whenever a clinician is in the patient room, another helper will stand in the hallway to handle the waste and help with whatever the clinician needs. The person taking care of the patient is not supposed to go in and out of the room, so they take and give items to the hallway worker.
When finished, the medical providers take off booties before leaving the patient room and get help from another person to undress from the protective gear. This is also a 20- to 30-minute process. The two carefully, and systematically, roll all the clothing out and away from the clinician to make sure none of the outer layers touch the clinician’s skin.
Clinicians systematically dress and undress from the protective clothing with another person’s help. Each process takes 20 to 30 minutes.
Ebola infections spread through bodily fluids.
Then the medical provider goes to an attached shower before leaving the room clean and with new scrubs.
All of the patient’s bodily fluids, trash from inside the room and protective clothing worn by workers are drenched in bleach, bagged five times in impermeable plastic and disinfected before being taken from the unit.
Waste from the unit and from the ambulance is classified at the highest risk possible – higher than any other hospital or medical waste.
The response plan
The response teams at Via Christi and Sedgwick County EMS volunteered to partake in the response plan. The team practices periodically with fake patients to be ready for a real case.
Charles Hunt, state epidemiologist for the Kansas Department of Health and Environment, said the state approached Via Christi, Sedgwick County EMS and the University of Kansas Hospital in Kansas City about a year ago to gauge interest.
All three agreed to participate and started planning for the hospital units and ambulance.
Sedgwick County is the only EMS team in Kansas selected by the state to transport a patient suspected of having a highly contagious disease.
The Sedgwick County paramedics would pick up the patient anywhere in the state and drive them either to Wichita or to Kansas City.
The units at St. Francis and at KU Hospital are designed to care for an isolation patient for up to 96 hours.
Via Christi Hospital St. Francis and KU Hospital are designed to assess and care for an isolated patient for up to 96 hours. The patient would then transfer to an out-of-state treatment center.
After that, the patient would be transferred to a treatment center, such as the University of Nebraska Medical Center in Lincoln, Neb., or at Emory University Hospital in Atlanta, Ga.
Hunt said the Kansas Department of Health and Environment would coordinate communication — between the CDC, county health department, diagnosis hospital and treatment hospital.
He said the state would also conduct a public health investigation, which involves tracking all people the patient came in contact with before and after the diagnosis.
Hunt said all hospitals should have basic protective gear — like nose and mouth coverings — to protect medical staff if a patient can’t be transferred right away due to natural disaster or weather.
“All hospitals have a role to play,” he said.
The unit sits in a vacant area adjacent to St. Francis’ emergency department. Via Christi spent $298,000 on the structural renovations, but budgeted for $309,000.
To put on the protective gear, the clinicians start in scrubs and crocs. Then they put on a full-body suit with connected gray footies, a hood and a zipper up the front torso. The suit is fluid resistant, and feels like a mattress tag.
For some cases, workers can put on a heavier, impermeable suit.
After the suit is on, they put on another pair of foot coverings that rise to just below the knee. Then they put on three pairs of gloves — each different colors to keep track — along with a hair net and plastic apron to cover the front zipper.
The hood on the suit goes up and a battery pack with an attached tube for air straps goes around the waist. The tube hooks into a head mask that covers the entire head, neck and shoulders of each clinician to blow fresh air into the head covering.
When a patient is first suspected of having a highly contagious disease in Kansas, the clinic or hospital where they first went for treatment will hold them in a closed room until the Sedgwick County ambulance arrives to take the patient to St. Francis.
Kyle Burtch, a paramedic on the EMS bio-safety response team, said he and his team would take the plastic-covered ambulance anywhere in the state to pick up the patient.
He said it would take about an hour and a half for the team to get out on the road after the initial call.
He said it would probably take double that amount of time for a team to drape the plastic back over the ambulance after the call.
“It’s kind of a luxury here that we have a dedicated ambulance,” he said.
“A lot of other services use just an ambulance off the street.”
It’s kind of a luxury here that we have a dedicated ambulance. … A lot of other services use just an ambulance off the street.
Kyle Burtch, a paramedic on the EMS bio-safety response team
He said Sedgwick County had an ambulance that was going to auction when the state asked the county to take part, so it converted the vehicle for isolation patients.
Unlike other paramedic responses, speed is not the most important factor in responses to Ebola-style diseases. Instead, precision and precaution are most important.
“This is a very regimented thing,” he said.
Burtch said paramedics treating the patient would dress in the same head-to-toe protective gear used in the isolation unit at Via Christi. One paramedic would drive the ambulance and paramedics would follow the ambulance in a Suburban with extra equipment, in case something happened during the ride.
Everyone on the team is trained to work any position, he said.
The ambulance also has a containment dome for patients with diseases contagious by air. It resembles a plastic version of an iron lung — the chamber previously used for polio patients.
It’s a clear, dome-like device with plastic gloves lining the sides, so paramedics can reach the patient without opening the container. Air filters thoroughly clean the air before it’s let out from the patient area into the rest of the ambulance. Paramedics would still wear the full-coverage suits while treating the patient.
“We’ve trained, we’ve prepared, we drill at least six times a year for this,” Burtch said. “We’re prepared, we’re ready. So if it comes, it comes.”