Ebola Virus Disease Treatment Unit Research Articles

Personal protective equipment solution for UK military medical personnel working in an Ebola virus disease treatment unit in Sierra Leone

SummaryThe combination of personal protective equipment (PPE) together with donning and doffing protocols was designed to protect British and Canadian military medical personnel in the Kerry Town Ebola Treatment Unit (ETU) in Sierra Leone. The PPE solution was selected to protect medical staff from infectious risks, notably Ebola virus, and chemical (hypochlorite) exposure. PPE maximized dexterity, enabled personnel to work in hot temperatures for periods of up to 2 h, protected mucosal membranes when doffing outer layers, and minimized potential contamination of the doffing area with infectious material by reducing the requirement to spray PPE with hypochlorite.The ETU was equipped to allow medical personnel to provide a higher level of care than witnessed in many existing ETUs. This assured personnel working as part of the international response that they would receive as close to Western treatment standards as possible if they were to contract Ebola virus disease (EVD). PPE also enabled clinical interventions that are not seen routinely in West African EVD treatment regimens, whilst providing a robust protective barrier. Competency in using PPE was developed during a nine-day pre-deployment training programme. This allowed over 60 clinical personnel per deployment to practice skills in PPE in a simulated ETU and in classrooms. Overall, the training provided: (i) an evidence base underpinning the PPE solution chosen; (ii) skills in donning and doffing of PPE; (iii) personnel confidence in the selected PPE; and (iv) quantifiable testing of each individual's capability to don PPE, perform tasks and doff PPE safely.

The healthcare workers’ clinical skill set requirements for a uniformed international response to the Ebola virus disease outbreak in West Africa: the Canadian perspective

Since December 2013, the Zaire Ebola virus disease (EVD) epidemic has ravaged West Africa. In collaboration with the Public Health Agency of Canada, healthcare workers (HCWs) and support staff from...

Operation GRITROCK: the Defence Medical Services’ story and emerging lessons from supporting the UK response to the Ebola crisis

This paper is a record of the UK Defence Medical Services (DMS) contribution to the UK response to the Ebola crisis in West Africa from the start of planning in...

132 Targeted Resuscitation Using Echocardiography in a Military Ebola Virus Disease Treatment Unit

<h3>Introduction</h3> Patients with Ebola virus disease (EVD) frequently suffer from haemodynamic instability and shock, leading to multiple organ failure and death. Clinical assessment of circulatory status is extremely challenging in these patients, hampered by the need for physicians to wear restrictive personal protective equipment, and adverse environmental factors within the EVD treatment unit (EVDTU). No EVDTUs currently use invasive cardiac output monitoring. Transthoracic echocardiography (TTE) can be used to assess haemodynamic status in critical care resuscitation. Additionally, the incidence of pericardial effusion in Ebola virus disease (EVD) is unknown. We describe the use of focused TTE (fTTE) in a military EVDTU in Sierra Leone. <h3>Methods</h3> Baseline fTTE was performed early during the admission of all patients presenting with confirmed EVD and haemodynamic instability. Studies were performed by either a consultant cardiologist or intensivist. The median duration of EVD was 6 days prior to initial fTTE (range 3–7). In some cases, serial studies were performed during admission. Data were collected on haemodynamics, TTE view availability, LV function, presence of pericardial effusion, IVC dimensions and variability with respiration. Where central venous catheter (CVC) insertion was performed, fTTE was used to check placement by visualisation of the CVC tip, and modified views were used to exclude pneuomothorax, as no radiology facility exists within the EVDTU. <h3>Results</h3> During the first 4 weeks of operation, 8 patients with Ebola virus disease and haemodynamic instability underwent fTTE examination. TTE windows available were as follows: parasternal long axis 60%, parasternal short axis 60%, apical 4 chamber 90%, subcostal 100%. IVC imaging was possible in 80% of cases. All hearts examined were structurally normal. LV function was normal in all cases (EF &gt;55%). Small pericardial effusions (mean 0.58 cm,) were found in 3 cases (37.5%). In 3 cases, hypovolaemia was so profound that LV systolic cavity obliteration was noted. The mean maximal IVC diameter in studies performed during inital resuscitation was 1.73 (±0.05) cm, compared with 2.10 (±0.18) in a partially resuscitated cohort. In 90% of studies, fTTE findings supported continued intravascular volume expansion. In one case, fTTE values suggested that further filing was not required, resulting in a change in management strategy. In studies following CVC placement (n = 9) the tip of the device was visualised in all cases, and lung imaging confirmed no cases of pneumothorax. <h3>Conclusions</h3> This study demonstrates, for the first time in a deployed military Ebola virus disease treatment unit, that fTTE can assist with assessment of volume status during the resuscitation phase. In addition, the incidence of pericardial effusion appears to be low.

Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit.

Early central venous catheter (CVC) insertion in Ebola virus disease (EVD) is a novel approach and has not previously been described. This report delineates the safety, feasibility and clinical implications of early CVC insertion as the optimum means of vascular access in patients with EVD, in the setting of a deployed military Ebola virus disease treatment unit in Sierra Leone. In the gastrointestinal phase of EVD, a 7-French 20-cm triple-lumen CVC was inserted using aseptic technique. Data were collected prospectively on all cases to include baseline and subsequent blood test variables, insertion site and technique, and complications associated with CVC placement. Twenty-three patients underwent CVC insertion as follows: subclavian, 21 (88 %); internal jugular, 2 (8 %); axillary, 1 (4 %). The mean duration of CVC placement was 5 days. There were no significant procedure-related adverse events. Despite coagulopathy being present in 75 % of cases, CVC insertion was safe, and there was only 1 case of significant catheter site bleeding. A total of 152 needle venepunctures were avoided owing to the presence of a CVC, a mean of 7 (±3.8) per case over the average stay. The early use of CVCs in Ebola virus disease is safe, effective and facilitates patient care. It should be considered a feasible additional route of venous access, where physician expertise and resources allow.