General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsClearly something went very wrong in Dallas re the ebola patient
The ebola patient there was sent home with antibiotics the first time he went to a healthcare facility feeling ill. We don't know for sure if he initially went to Texas Health Presbyterian Hospital or another hospital/healthcare facility. The CDC has told us that hospitals and health care providers have been instructed how to handle potential ebola cases and one crucial element of that involves determining if the patient has recently been in an ebola hotspot or had contact with someone who was. This was not done with this patient. The patient had arrived in Dallas on September 20th. He initially sought care on September 26. He was admitted to the hospital on September 28 and placed in isolation at that time.
The Traveler
(5,632 posts)Blessedly, our health care pros have little to no experience with this disease. The downside ... these protocols are unfamiliar to them, and it is an easy thing to overlook. You just don't run into this every day.
Hoping it stays that way ... and at this point the odds our in our favor. Though virologists seem to think this virus is evolving rapidly.
Trav
cali
(114,904 posts)and publicity that it should be very hard to overlook.
The Traveler
(5,632 posts)I'm not a medical guy ... physical sciences and software engineering. Worked in the aerospace biz for a long time. Trust me ... I've seen lots of smart people commit analogous errors. I've made a few myself. (Grateful no one died as a result!)
My boss and I coined a phrase to describe that phenomenon back then: "Judgement comes from experience. Experience comes from poor judgement."
Trav
cali
(114,904 posts)this is one where lapses of judgment can prove deadly.
The Traveler
(5,632 posts)But realistically, it still happens. Even when it cannot be afforded.
Trav
panader0
(25,816 posts)That should have set off an alarm. Could it be the hospital didn't ask?
pnwmom
(108,976 posts)After the patient was finally diagnosed on the 28th, it was another 2 days before they took the ambulance and the exposed medics out of circulation.
OLDMADAM
(82 posts)The problem started with the patient. He knew he came in direct contact with an Ebola victim. He had a moral duty to alert the airline and the hospital that he has been exposed to this killer.. Second Liberian airline terminal, and the originating flight should be questioning the departing passengers as to their activities the the recent past, as should each adjoining flights..
Last, our immigration department at the arrival destination, should have been sure that the question should have alerted them that the traveler hadn't been in any contact with this disease..
Sherman A1
(38,958 posts)but, you may very well be correct in that it is part of this one.
rainbow4321
(9,974 posts)A reporter asked him directly about the patient being sent home when he first went to the ER. CDC guy kinda mumbled and quickly gave a very short answer like "vague symptoms" and he then QUICKLY asked for another question.
CDC knew Presby fucked up and it was left to the hospital docs to take the grilling questions at THEIR press conference for the fuck up to be talked about more.
CDC prob couldn't bring themselves to say "yeah the guy was out there for an additional 48hrs when he really should not have been".
And now there are 2 EMTs being quarantined because of the hospital stupidness. Had the patient not been sent home, he wouldn't have needed to be brought back in an ambulance.
cali
(114,904 posts)and it makes one wonder if this kind of stupid error (yes, stupid) could happen in other hospitals in the U.S.
CoffeeCat
(24,411 posts)The CDC, just a few weeks ago, gave the public assurances that Ebola was contained in Africa and was unlikely to spread to the US.
Most people did not really believe that the disease would come here. Until now.
When you're not expecting a certain outcome, it's sometimes difficult to see that outcome--even when it's staring you in the face.
cali
(114,904 posts)what to do if a patient comes in with symptoms that could be ebola. And hospitals are NOT most people.
CoffeeCat
(24,411 posts)...is that all of the healthcare workers who triaged and examined this man, were exposed to a man who was contagious. He was clearly symptomatic, thus contagious.
So, these exposed medical personnel saw many patients fur days. Is this a risk?
This was not addressed during the presser.
eShirl
(18,490 posts)HereSince1628
(36,063 posts)Infection control practices make the possibility of nosocomial transmission low, but nonzero. With an illness like ebola, I am sure that the state, county and local public health workers are working to build a surveillance net that takes that nonzero risk seriously.
magical thyme
(14,881 posts)and are being monitored for symtpoms. But I haven't read anything about the other health care workers that contacted him that first visit.
Presumably they are also quarantined and being monitored. If it were me, I'd probably be taking my temperature every hour on the hour, and shitting my pants at any uptick...
muriel_volestrangler
(101,306 posts)The crew members have been quarantined. They will be closely monitored for the next 21 days, the city said on its Twitter feed.
http://af.reuters.com/article/drcNews/idAFL2N0RW0TJ20141001
And sent home, according to that tweet: https://twitter.com/1500Marilla/status/517289719034421248
DeadLetterOffice
(1,352 posts)Ebola is contagious only when the infected person is symptomatic, NOT during the incubation period. So even if the exposed health workers do in fact develop ebola, they wouldn't be able to pass it on until they were actively symptomatic. (It's not like a disease such as typhoid, where you can be a non-symptomatic carrier and get other people sick without getting sick yourself.)
Also, again, ebola contagion requires close contact with bodily fluids to spread. While medical personnel aren't perfect about contamination precautions, since HIV they've gotten MUCH better, and standard contamination precautions would be enough to prevent ebola transmission.
underthematrix
(5,811 posts)There's a lot of stupid in Texas
NutmegYankee
(16,199 posts)This really wasn't even on most medical practitioners minds.
cali
(114,904 posts)with them. Establishing where a patient with symptoms that match ebola's, has been is supposed to be standard protocol. It's sure should be on most medical practitioners' minds.
NutmegYankee
(16,199 posts)They go with what they know in the 5 minute visit of the endless assembly line that is American healthcare. With such limited time, a doctor will focus on what is likely given that no cases had been reported here previously.
While it was widely broadcast, watching flapping gums on cable news is a far cry from the daily routine.
cali
(114,904 posts)NutmegYankee
(16,199 posts)I'm an engineer also (Mechanical) and have seen people make simple errors because it just wasn't on their "radar". In the engineering world, this is usually solved by having another peer independently review the calculations or solution.
The medical world doesn't really have that kind of check. In the common medical setting, there is so much to be ruled out in so little time that doctors will often default to what they've usually seen. It's not like every patient answers a 40 minute interview on their symptoms and previous visits in a typical checkup that takes 5 minutes.
Blaming a doctor won't fix the real issue, which is our rushed and cluttered health system.
sendero
(28,552 posts)..... early on ebola presents with the same symptoms as any number of other maladies. Nobody expects an ebola case in Dallas.
This is such a typical human error I totally expect it to happen many times before hospitals get serious about it all.
cali
(114,904 posts)It's a major city with a a major airport and there's a sizable Liberian population in N. Texas.
There's no excuse for this to happen "many times before hospitals get serious about it all". None.
NutmegYankee
(16,199 posts)The concept that if you tell a person to look out for something (one of many many things) and that they always will is just a complete failure. Always has been, always will be. If you want to stop mistakes like this, you have to create a system that doesn't allow them. What we have now with half asleep residents checking up on people in emergency rooms just isn't it.
To stop this, the health system needs a complete overhaul.
cali
(114,904 posts)A complete overhaul of the system is not going to happen in time to ensure this doesn't happen again. I would guess that hospitals need to hold training sessions to ensure that patients with symptoms that may be ebola, have a thorough history taken.
HereSince1628
(36,063 posts)as background context...
Number of visits: 129.8 million
Number of injury-related visits: 37.9 million
Number of visits per 100 persons: 42.8
Percent of visits with patient seen in fewer than 15 minutes: 25.1%
Percent of visits resulting in hospital admission: 13.3%
top 10 causes of ER visits
chest pains
abdominal pain
toothaches
sprains and broken bones
upper respiratory infections
cuts and abrasions
back pain
skin infections
foreign objects in the body
headaches.
DeadLetterOffice
(1,352 posts)I think some people have an unrealistic idea about what a hospital emergency department actually looks like and what it deals with.
TexasMommaWithAHat
(3,212 posts)There's no reason to believe any medical personnel who saw this patient was "stupid."
Now, if you want to say that someone royally screwed up, be my guest .
snooper2
(30,151 posts)Ishoutandscream2
(6,661 posts)We have some of the finest health facilities in the world. Heard of MD Anderson in Houston? Many folks move there from other states for cancer treatment.
This Texas bashing shit on DU needs to end.
SoCalDem
(103,856 posts)His care might have been routine.. It is cold & flu season here..
I am wondering when he purchased his ticket.. It could be that he feared he had been infected, and this was his way of getting better care..
time will tell
I hope he recovers and did not infect anyone in his family here..
dixiegrrrrl
(60,010 posts)Texas health official Dr. Mark Lester says when Ebola patient initially came to hospital, he told nurse he'd been to Africa; says that information was not passed on to others - @dallasnews
Javaman
(62,517 posts)he may not have been showing signs at first.
cali
(114,904 posts)because he was sick.
morningfog
(18,115 posts)first visit. Fever? Headache? Obviously he was not puking and shitting everywhere.
I do think it is time to ask patients whether they have recently been one of the three outbreak countries as a routine.
magical thyme
(14,881 posts)He may not have been forthcoming (and yes, patients are known to lie and mislead) or they may have not asked him if things were crazy at the ED at that moment.
Most of the time, the ED at my hospital is routine. Some days it looks like a teevee show in there, with patients stacked in cots in the aisles and everybody running around like crazy and even administration getting in the act and running equipment around.
dixiegrrrrl
(60,010 posts)Texas health official Dr. Mark Lester says when Ebola patient initially came to hospital, he told nurse he'd been to Africa; says that information was not passed on to others - @dallasnews
magical thyme
(14,881 posts)ReverendDeuce
(1,643 posts)We talk all day long about "patient care" matters but at the end of the day, everyone just wants to get paid for doing nothing. While there are some professionals out there that do it for altruism and are genuine, the majority of them see careers in medicine as a way to get buck.
Move 'em in, move 'em out is the SOP for hospitals because a) nobody truly gives a shit and b) nobody really knows what's going on.
The problem is that too few people in the field actually understand how the body works. They can't think on their own. They get taught where to stick the needle and how to sew up a cut.
Let me put it mechanically, as the human body is a big complex machine: 90% of healthcare workers are like the person in the auto repair shop who mumbles around and can shoe a tire and maybe perform a competent oil change. As them to diagnose a problem in the differential, they have no clue. To them it's just a big pumpkin under the car between the wheels that makes the car go somehow. Ask them how the thing works and you'll get blank stares.
I don't pretend I understand medical science or much about automotive engineering, but I understand the fundamentals and how they all piece together. And that's what's lacking in healthcare today.
/off the soapbox
magical thyme
(14,881 posts)but you know that nobody in health care gives a shit or wants to do any work?
ReverendDeuce
(1,643 posts)You know what they say when you assume.
magical thyme
(14,881 posts)don't give a shit.
LanternWaste
(37,748 posts)"You know what they say when you assume. .."
The same thing they say when a premise is based off little more than anecdotal evidence, I'd presume...
Scruffy Rumbler
(961 posts)FUCK YOU !
"We talk all day long about "patient care" matters but at the end of the day, everyone just wants to get paid for doing nothing. "
If that is your and your coworkers attitude, do us all a favor and tell your HR department how you feel and get your ass removed from your position and give it to someone that actually fucking cares about their patients!
ReverendDeuce
(1,643 posts)When I say I work in healthcare, it doesn't mean I am an MD, RN, PA, or anything of the sort.
You act like I made that comment with PRIDE. Was my frustration not apparent? LOL... Foolishness.
magical thyme
(14,881 posts)for the health care workers that you claim "don't give a shit" and don't want to do any work.
I work my fucking ass off. Personally, I don't need people around me who assume I don't give a shit and don't want to do any work. They tend to get in the way and cause more problems than they are worth.
likesmountains 52
(4,098 posts)I spend plenty of > 12 hour shifts giving a shit every minute....and so do the great majority of my co-workers.
ReverendDeuce
(1,643 posts)Institutional malaise is rampant.
likesmountains 52
(4,098 posts)Ikonoklast
(23,973 posts)You only speak for yourself then.
janlyn
(735 posts)of people he most assuredly infected in the ER waiting room. Just food for thought.
Logical
(22,457 posts)janlyn
(735 posts)neither have I ,that is why I worded my post the way I did.
HERVEPA
(6,107 posts)janlyn
(735 posts)of secondary contact is most certainly there. Patients in ERs sign in using communal pens, patients touching chairs etc. The risk is there.
How high of a risk is open, but it is still there.
HERVEPA
(6,107 posts)DeadLetterOffice
(1,352 posts)Stop making sense, you'll spoil the freak-out fest!
HERVEPA
(6,107 posts)Whiskeytide
(4,461 posts).... But... if it is so difficult to spread without close contact with the bodily fluids of an infected person, then how do you suppose this Dallas patient contracted it? To me, that's the troubling question.
He knew where he had traveled, right? He surely was made aware of the Ebola outbreak in Africa. He knows what he did while he was there. So, either he was involved in some activities that posed a risk (and he should have been monitoring himself or at least thinking "I might have Ebola" , or he contracted it in a way that was NOT on the list of high risk activities. That could mean it has mutated into a more easily transmittable strain. THAT is the biggest concern. That could get very deadly very quickly.
Pardon me if there has been published info on his activities and what was on his mind, and I missed it (I haven't had time to really catch up on the details of this story). But I really want to know more about how this went down.
dixiegrrrrl
(60,010 posts)the nurse did not pass that info along.
Texas health official Dr. Mark Lester says when Ebola patient initially came to hospital, he told nurse he'd been to Africa; says that information was not passed on to others - @dallasnews
Whiskeytide
(4,461 posts)... catching up a little and saw that. Yikes! I would have thought that would be handled a little better!
dixiegrrrrl
(60,010 posts)in handling problems like this.
Seen too much both as a provider and as a patient.
Avalux
(35,015 posts)I would really like you to explain why you think patients in the same room could become infected. Ebola is not transmitted through the air.
According to WHO website infection can occur from contact with contaminated surfaces.I mentioned in one of my posts that I did not know how high of a risk there was, but that there could be infection from secondary secondary contact. That was all.
Avalux
(35,015 posts)The ebola virus is spread by body fluids. If the patient had spit, bled or vomited all over a chair, then another person sat there and came in contact with it in a way that would have allowed the fluid to get in their body, it's remotely possible.
It's really not easy to get.
LisaL
(44,973 posts)From what his neighbor said.
He most likely puked over that ambulance as well.
newfie11
(8,159 posts)In fact all docs should be asking every patient this.
magical thyme
(14,881 posts)either the question was missed or the patient lied.
cali
(114,904 posts)magical thyme
(14,881 posts)or reports I've listened to. Only that he was treated and released and that Dr. Frieden ducked the question when asked and nobody has confirmed exactly where he sought care the first time. I've also seen that how he came to be released on the 26th is being investigated.
magical thyme
(14,881 posts)and this tidbit is nor reassuring either. They aren't checking temperatures when they arrive in the US. Only when they depart Africa.
"However, it's unclear what kind of screening someone arriving from West Africa might receive when arriving in the United States, said CNN's Senior Medical Correspondent Elizabeth Cohen. She and her crew recently reported in and flew from West Africa, where she said they were screened numerous times for Ebola by having their temperatures taken at the airport.
Should we worry?
But when they arrived back in the United States, and asked travel officials about whether their temperatures would be taken or they'd receive screening for Ebola, they were given unclear explanations about how the process worked and ultimately were not tested.
Regardless, the CDC maintains that passengers on the Texas man's plane were likely not at risk because the man was not displaying active symptoms on the flight.
LisaL
(44,973 posts)Hospital admitted it.
newfie11
(8,159 posts)I've worked ERs in LA, Washington DC, MI,VA,IL and I can tell you many many times that question is not asked especially if the patient has vague symptoms as oppose to bloody diarrhea.
LiberalArkie
(15,713 posts)cali
(114,904 posts)Ms. Toad
(34,062 posts)But the early sings of Ebola are:
Fever
Severe headache
Joint and muscle aches
Chills
Weakness
The signs which distinguish it from influenza - or even the common cold - come later. This is the beginning of cold and flu season - it is not realistic at this stage to expect every doctor in every health care facility to be perfect in changing their routine and question every person who comes in with vague flu-like symptoms about recent travel. There will be a few who slip by - just as there were with a less serious illness which initially came in via travel a few years ago that started with vague flu-like symptoms and recent travel to certain countries - until everyone ingrains a new habit.
cali
(114,904 posts)on September 20th, he would have immediately been quarantined. That should be a standard question for someone coming in with flu-like symptoms.
Ms. Toad
(34,062 posts)It has never been a universally standard question, except when there is a new condition which is related to travel. In nearly 6 decades of living, I can recall perhaps two other times when it became a standard question. The process of making something a standard question is not instantaneous.
Universal precautions are (mostly) routine now - and should have been all along. It's not like we didn't know how diseases, generally, are transmitted long before the AIDS crisis. But making them universal took time - and it took lots of deaths even once it became clear how AIDS was transmitted. And people still screw up. Most of the time it isn't deadly. But it is human. It happens all the time - and 999 times out of 1000 we never know because nothing bad happens (and even that is likely an exaggeration of how frequently something like forgetting the travel question in the early stages of making something a habit has consequences that bring it to anyone's attention).
LisaL
(44,973 posts)The first time and the second time.
So they knew. Or should have known.
seabeyond
(110,159 posts)dont you think that would be uppermost in this persons mind? he knew where he was. he knows how he feels. a simple look at symptoms would tell him he was right to be concerned. and then oh, say.... mentioning it to the doctor?
we do have some responsibility for our own health
cali
(114,904 posts)in this situation.
seabeyond
(110,159 posts)Tatiana
(14,167 posts)This is why the CDC immediately dispatched workers to track down everyone this patient came into contact with. What they didn't come out and say was that they are probably concerned with the number of people this patient came into contact with AFTER he was sent home from the first time he went to a health care facility (whatever facility that was) with the wrong diagnosis.
I think it should be standard to ask (at least at this point) if anyone has recently traveled outside of the country. And if so, where?
Zorra
(27,670 posts)that generally treats patients like cattle.
What went very wrong in Dallas was simply standard procedure in our health care system.
Health Care professionals are generally employed by for profit corporations, who make money off sick people. The more sick people they treat in a day, the more money their company makes.
Avalux
(35,015 posts)Vigilance and infection control are mainstay strategies in hospitals; all healthcare professionals know what it means and are taught it's their obligation to act in ways that are aligned with these.
Clearly someone did not do their job, did not question the patient when he presented to the ER with a constellation of symptoms that *could* be ebola. Maybe the ER was super busy and understaffed, so the patient wasn't questioned appropriately, but given an antibiotic to get rid of him (this happens all the time). Simply asking if he had traveled out of the country recently and getting the answer "yes, Liberia" would have been all that was needed to place him in immediate quarantine and a blood test.
If this patient infected others, or dies, it's the fault of the various ER staff who were in contact with him. Any one of them could have questioned him but none did. They're all negligent.
Catherine Vincent
(34,488 posts)I'm just nervous because I am on anti-rejection meds. I may start wearing the mask and gloves again as a precaution. And I'm in Texas.
cali
(114,904 posts)bullwinkle428
(20,629 posts)with essentially the common cold (VIRALLY-based), and was given anti-biotics, which are ONLY effective against bacteria, NOT viruses.
I've made plenty of trips to doctors' offices over the past 25 years when I've dealt with serious cold or flu-like symptoms, and have ALWAYS been told that they absolutely will not treat with anti-biotics unless they have specific confirmation of a bacterially-based condition, like strep.
TorchTheWitch
(11,065 posts)No reason whatsoever for him to have gotten antibiotics when they suspected a virus. Doctors have been handing out antibiotics like candy for decades.
Patients should never be given antibiotics or any other medication just to make them feel like taking a pill will fix it when it isn't medically warranted.