Arkansas, Oklahoma state and medical officials talk ebola prep

With the first confirmed human to human transmission of the ebola virus within the United States having been confirmed in Dallas, officials in the two state region are reviewing procedures in preparation for possible ebola cases in Arkansas and Oklahoma.

Dr. Dirk Haselow, state epidemiologist at the Arkansas Department of Health and Human Services, said Arkansas has been working on preparedness since before the first diagnosed case of the now-deceased Thomas Eric Duncan, who flew from Liberia to Dallas where he was the first case ever diagnosed with the virus in the U.S. He eventually died. A nurse who treated Duncan now has the first human transmission of the virus in the United States.

"The state has already been working to prepare for an outbreak of any kind for a long time. We have a preparedness and emergency response branch in our health department established shortly after 9/11," Haselow said.

Part of the infrastructure in place includes streamlined communications between hospitals, physicians and the state health department, he said.

Matt DeCample, spokesman for Arkansas Gov. Mike Beebe, said the governor was keeping abreast of the situation and was in contact with state and federal officials, though no formal cabinet meetings or emergency sessions were planned. He added that the state was prepared to take action similar to how it responds to tornadoes and other natural disasters should the need arise.

"I think that as the administration, we have the ability to coordinate state resources as needed with anything. Depending on the specific circumstances, especially having been (in office) as long as we have, we can get people up and moving pretty fast for whatever assistance may be needed whether response, education, coordinating or advising on protocol.”

DeCample noted that this was not the first health scare the state has prepared for during Beebe's nearly eight years in office, giving the state practice for this potential situation.

In Oklahoma, Gov. Mary Fallin held a meeting of officials from mayors of the state's largest cities to cabinet officials Monday (Oct. 13), according to Press Secretary Michael McNutt.

"Governor Mary Fallin called together state agency heads and representatives from health groups and from Tulsa and Oklahoma City on Monday to discuss ongoing preparations for a potential Ebola threat," he said. "Oklahoma health officials said there are no cases of Ebola virus infections in the state — but that emergency response plans are in place in case a person is diagnosed with the disease. Secretary of Health and Human Services Terry Cline said the governor and others have been discussing the Ebola threat for the past couple months.”

He said much like Arkansas, the state is in constant contact with hospitals even before the governor's Monday meeting of more than 40 officials at her state capitol office.

"On July 29, the Oklahoma Department of Health sent its first health alert on Ebola to about 3,200 health officials in the state, including about 1,700 health care providers. … Those attending included Craig Jones, president of the Oklahoma Hospital Association, Ken King, executive director of the Oklahoma State Medical Association, State Epidemiologist Kristy Bradley, State Veterinarian Rod Hall, Tulsa Mayor Dewey Bartlett and Jim Couch, Oklahoma City’s city manager.”

Regional hospitals indicated to The City Wire that they are following CDC and state-issued guidance on how to deal with a potential ebola patient.

Laura Keep, a spokesman for Mercy, said the health system's hospitals in the region are taking extra precautions to keep staff and patients safe.

"(We) do have patient isolation rooms (at Mercy hospitals in Fort Smith and Rogers). Yes, we are following the guidelines from the state health department and the Centers for Disease Control and Prevention (CDC). Mercy facilities across Arkansas, Kansas, Missouri and Oklahoma are taking every precaution in evaluating patients for possible Ebola Virus Disease.

"Patients are being screened upon arrival for symptoms and questioned about travel to West Africa and contact with people who have been to West Africa," Keep continued. "Mercy co-workers are undergoing continuing education regarding the disease including how to identify patients at risk and precautions necessary if there is a patient with possible virus symptoms.”

Donna Bragg, director of marketing and communications at Sparks Health System in Fort Smith and Summit Medical Center in Van Buren, said even though its doctors believe it is highly unlikely ebola will make its way to the Fort Smith region, the hospital is prepared to follow CDC guidance. Patricia Driscoll, director of business development and marketing with Northwest Health System in Springdale, offered a similar assessment. Both hospital systems are owned by Franklin, Tenn.-based Community Health Systems.

The statement from both hospitals noted that they are “dedicated to providing patients with high quality care in a safe environment. Although the risk is low, if a patient exhibits symptoms of Ebola, we are prepared to follow infection control protocols established by the Centers for Disease Control and Prevention beginning with placing the patient in isolation. Medical personnel who enter the room would be protected with gowns, masks, face shields and gloves, and nonessential staff and visitors would be restricted from entering. The suspected case would be reported to local and state health departments and the CDC and we would continue to follow their guidance.”

Haselow of Arkansas' health department said all hospitals are being advised on how to train for wearing protective garments. He said the risk can exist even after leaving a patient's quarantine if bodily fluids of any kind have come in contact with the protective outfits worn by medical staff. Ebola is only transmissible through direct contact to bodily fluids, not through the air.

To know proper procedures for removing such garments without getting any fluid on a healthcare worker and possibly risking exposure to ebola, he said hospitals have been advised to suit up doctors and nurses.

"We've learned from experiences in other hospitals, particularly Dallas, that talking about it is not enough. We need to have hospitals practice it and drill it and actually have evaluation of how well to put on and take off protective equipment. Just try putting your clothes on without ever touching the outside of them. It's hard. There are specific protocols to make sure you don't accidentally contaminate yourselves. We are advising people to practice removing protective gear after smearing it with chocolate sauce or ketchup to show how easy it is to get that on you.”

Should an ebola case be diagnosed in Arkansas, Haselow said it would largely be dealt with locally with state support.

"The (Arkansas state) health officer does have a great deal of authority, but what we'd do is hope to be involved at the front end. If a physician is concerned, isolate that person and call us to bring us up to speed and we can give them additional guidance on the level of risk and what to do with that person in terms of isolation.”

Haselow said testing for ebola can be arranged by the state through the CDC and individuals from the state, including himself, would interview the patient in person regarding travel and other risk factors that could isolate not only where the individual could have contracted ebola, but also who else may be at risk.

DeCample said while the state's role is generally coordinating response, it is not out of the question to consider the deployment of the National Guard to help deal with any potential widespread ebola outbreak should it occur in Arkansas, though again he stressed that it was not expected to become an outbreak should any cases be diagnosed.

"The state's role is generally coordinating that response. … But that's not something I could tell you with certainty one way or another. Just like every time we have a natural disaster, is it to the level of deploying the National Guard? We have a fantastic National Guard, but it always depends on the situation.”