Establishing Feasibility & Safety of Providing Critical Care for Patients with Ebola through Design of a Simulated Ebola Treatment Unit.
CCCF ePoster library. Kiiza P. Nov 8, 2018; 233443
Dr. Peter Kiiza
Dr. Peter Kiiza
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Abstract
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Introduction: The provision of basic and advanced medical care was not routinely available in countries affected by Ebola Virus Disease (EVD) during the 2014-2016 West Africa outbreak. Over the course of the outbreak, as systems of care became more organised and medical interventions increased, case-fatality rate dropped from 70% to 40%. Understanding the feasibility of and barriers to the application of supportive care for such patients is important to improve care in future outbreaks.

 

Overall Objective: To explore the feasibility and safety of delivering advanced medical care to patients in a simulated Ebola Treatment Centre. Pilot Objectives: To develop a protocol of advanced simulated medical procedures under two climactic settings (‘hot’: 35°C, 60% relative humidity; and ‘cool’: 20°C, 20% relative humidity).

                                                           

Methods: Healthcare workers were recruited and provided an information package and instructional videos of the study procedures. Participants completed a medical fitness checklist to identify exclusions to study participation. Study procedures included donning and doffing personal protective equipment (PPE), inserting a peripheral venous catheter, inserting a mid-line arm peripheral venous catheter, and endotracheal intubation. All medical tasks were performed on simulated patient mannequins. On site, heart rate (HR), respiratory rate (RR), skin temperature, and systolic and diastolic blood pressure (SBP, DBP) monitors were attached to each participant. Weight, height, and baseline vital signs were taken. After the participants entered the chamber, patient histories were provided via audio headset. Participant performance was measured according to a task-specific checklist, task duration, and total number of PPE breaches and near-miss incidents. During the simulation, vital signs were measured every 10 minutes. The threshold values for simulation cessation were HR > 85% of HR max or < 40 bpm, SBP < 90 mmHg or a drop > 40 mmHg below baseline SBP and a self-rated thermal comfort scale of ≥12.

  

Results: In the pilot study phase, one participant was excluded after medical assessment and four participants have participated (occupation: 3 physicians, 1 nurse, sex: 100% male, age: mean 40 (sd 10) years, weight: 71.8 (11.1) kg, height: 177 (6) cm. All participants had prior experience in donning and doffing PPE. All participants completed the three simulation tasks and spent an average of 73 (9) minutes inside the climatic chamber. Mean task completion times were 14 (2) minutes for peripheral intravenous insertion, 35 (2) minutes for mid-line insertion and 12 (3) minutes for intubation. Mean vital signs: SBP 131 (16) mmHg, DBP 83 (13) mmHg, HR 99 (24) bpm and RR 18 (4) breaths/min. Mean skin temperature was 34 (2) 0C. No safety thresholds were crossed.

 

Conclusion: The chosen tasks appear feasible for the objective of assessing performance and safety of advanced medical procedures for simulated patients with Ebola. A greater number of participants will be enrolled and randomized to two temperature/humidity conditions to complete pilot testing.
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