The first week of November the Central and the West Central regional hospitals participated in a highly infectious disease exercise. A patient presented to the ER with fever, cough, coughing up blood, nausea, pale skin, and diarrhea. How was this patient received?  Did they walk right through the front door? Did they expose the staff and other patients to their disease?  What type of screening questions were asked? Was isolation used?

This exercise was focused on hospitals using effective patient screening mechanisms and utilizing the appropriate isolation precautions. The hospitals were unable to transfer these patients to alternate facilities and were responsible for caring for the patient for up to 24 hours. Discussions took place regarding the appropriate PPE and the availability of PPE.  Recognizing that this patient is going to be in the hospital for a longer period of time and the recommended PPE was atleast the use of N95 masks – did hospitals need to initiate just in time training for fit testing?  Lab work and radiology tests were recommended….the hospitals needed to brainstorm to identify how to fulfill this request and still maintain isolation precautions.

Staffing was an issue during this exercise. Some staff expressed concern about taking care of a patient with an unknown disease that could be highly infectious. Hospitals needed to review their plans to address how to handle that type of situation.  Hospitals needed to review their policies to identify how they are going to take care of staff that were exposed to the patient and how they would monitor their staff.

Waste management plans were reviewed.  How does housekeeping clean a room and the equipment that the patient was in? Do the hospital plans cover the processes in place on how to deal with Category A waste?

How about transporting this patient?  Can the local ambulance service provide transportation or does the State need to assist in contacting an agency that has agreed to transport a Highly Infectious patient.

Communications were tested. When to contact MDH or the local public health…when to contact the Regional Healthcare Preparedness Coordinator?  What type of resources need to be available for the EOC to adequately assist with the care of the patient, the concerns of the staff, and the responsibility to the general public?  Does the EOC have a Public Information and how do they handle concerns from the public and the media.

This was just an exercise however, all our hospitals did very well. Lessons learned will be incorporated into future planning and exercising.