Ebola in Texas

Jolie, BSN · Oct 22, 2014

http://www.politifact.com/punditfact/article/2014/oct/20/few-words-those-who-think-george-will-was-right-ab/
It is pretty clear when you read the thoughts and comments of conservative consumers of those media outlets that ignorance about ebola and about modes of disease transmission is rampant. Wouldn't it be nice if we had a Surgeon General who could address this with the public at large as would be the responsibility of that office? Unfortunately, the nominee for that post holds pretty typical views on gun deaths and ways to try to address that issue (his views are in line with the AMA and the majority of American citizens if you want to believe the data), but the NRA finds that too "radical". And so we are a nation scared spitless about a virus that has been known for almost 40 years, without our typical medical leadership in the government.

Thank you for prompting me to read your previous post again. I had missed your implication on my first read that conservatives have succumbed to Ebola hysteria. How have liberals escaped such an unfortunate fate?

You indicate that but for NRA opposition, we would have a Surgeon General who would be able to effectively guide the national response to Ebola. I didn't realize that the NRA held the power to prevent the approval of a nominee. Actually, they don't. Neither do the Republicans, who lack the votes necessary to block confirmation.

"There are 55 Democrats in the Senate. Since Majority Leader Harry Reid changed the rules to kill filibusters for nominations, it would take just 51 votes to confirm Murthy. Democrats could do it all by themselves, even if every Republican opposed. But Democrats have not confirmed Murthy."

http://www.washingtonexaminer.com/why-is-there-no-surgeon-general-ask-democrats/article/2555053

Perhaps a Surgeon General who is knowledgeable about the containment of infectious disease would be able to meet that challenge. But I suspect that Obama doesn't find that to be a priority, since his response to public criticism (by conservatives and liberals alike)was to nominate a political czar, rather than an experienced public health expert.

Jolie, BSN · Oct 22, 2014

We have an Acting Surgeon General. To my knowledge, the use of the word "Acting" in his title implies that he is the person to whom we look for guidance until a permanent job holder is confirmed. Yet I have not seen evidence of his leadership in this situation. I wonder why?

to answer your question, I suspect that very few hospitals are truly prepared to safely care for Ebola patients. As I stated before, that does not surprise me, as with EVERY new situation in patient care, standards, innovations & research based interventions come from academic medical centers & once tested, are disseminated to the field.

I have yet to hear a hospital CEO in my area other than the NE Med. Ctr. claim to be ready for Ebola. I believe that overly confident bluster came from the CDC or NIH, not from a local healthcare organization.

allnurses Guide · Oct 22, 2014

We don't have years to prepare for the care of people sick with the Ebola virus. Anyone working in a hospital, EMS, or outpatient area needs education, training, and practice to protect themselves and others.

There are plenty of excellent discussions here.

Disasters: Preparing & Responding

toomuchbaloney · Oct 23, 2014

Thank you for prompting me to read your previous post again. I had missed your implication on my first read that conservatives have succumbed to Ebola hysteria. How have liberals escaped such an unfortunate fate?
You indicate that but for NRA opposition, we would have a Surgeon General who would be able to effectively guide the national response to Ebola. I didn't realize that the NRA held the power to prevent the approval of a nominee. Actually, they don't. Neither do the Republicans, who lack the votes necessary to block confirmation.
"There are 55 Democrats in the Senate. Since Majority Leader Harry Reid changed the rules to kill filibusters for nominations, it would take just 51 votes to confirm Murthy. Democrats could do it all by themselves, even if every Republican opposed. But Democrats have not confirmed Murthy."
Why is there no surgeon general? Ask Democrats | WashingtonExaminer.com
Perhaps a Surgeon General who is knowledgeable about the containment of infectious disease would be able to meet that challenge. But I suspect that Obama doesn't find that to be a priority, since his response to public criticism (by conservatives and liberals alike)was to nominate a political czar, rather than an experienced public health expert.

I cited two conservative media outlets and the comments from conservatives on the articles. Conservatives are not the only folks becoming hysterical about the ebola scare but I wasn't reading liberal or progressive comments or commentary or reporting so I didn't include them in my remarks.

Yes we have an "acting" surgeon general, and I do not know why he is not fulfilling the requirements and duties of the office...unless he is very busy with the duties required of a Rear Admiral (Upper Half). Certainly the country could have used that leadership on guidance on this and many other matters (enterovirus comes immediately to mind). I would rather prefer that we have an actual, full time Surgeon General as is described in our government, wouldn't you?

It is not only Republicans who are fearful of the power that the NRA presumably has when it comes to elections. It is a sorry state of affairs when every Republican votes against something because of a threat by the NRA thereby requiring that every Democrat or INdependent vote for it regardless of the NRA threat, IMO.

Jolie, BSN · Oct 23, 2014

You're right, herring. But that doesn't justify half-assing it, either. We here all knew that local community hospitals were not prepared for Ebola. Did our "leadership" truly believe that statement, or was it just made to pacify a nervous public? Given that the CDC continues to issue almost daily revisions to its own Ebola policies and procedures, I have to wonder.

With this much I agree: Any hospital that is capable of isolating a potentially infectious patient should be able to receive a suspected Ebola patient and provide very short-term interim care while the transport team is en-route from a designated bio-containment center. That is what our officials should have communicated to healthcare organizations and the public months ago, along with procedural and equipment guidelines. But that was not their message. As a result, when Thomas Duncan was re-admitted in Dallas, the local hospital (which screwed up by discharging him after the first ER visit) should not have been expected to care for him any longer than it took for a transport team to arrive. That was the CDC's blunder. Sending an observation team a day or two after he was re-admitted was far too little support, far too late.

Let me give an example that I believe we can all understand: Virtually every hospital has the capability to assist a mother to deliver a baby, even those that don't typically care for OB patients. Every ER has rudimentary delivery packs, and frankly, most deliveries require very little intervention by the healthcare team. So the CDC saying that every hospital is capable of caring for an Ebola patient is about like saying that every hospital is capable of assisting a mother to deliver. On the surface, that may be true, but there are fine points that are not being addressed.

What if that mother happens to be 24 weeks along, and there is no pediatrician, respiratory therapist or anesthesia care provider available to intubate and establish mechanical ventilation? Delivering in a small, community hospital with minimal OB services will be better than being at home on the farm, but not the same as delivering in a tertiary care center, to which the baby needs an immediate transfer in order to have the best chance of healthy survival.

Same with our Ebola patients. Yes, they can be temporarily isolated in virtually any hospital. But their care requires equipment, know-how and experience that most U.S. doctors, nurses, ancillary staff and facilities lack. How many experimental Ebola drugs have any of us administered? How many of our local blood banks are experienced in obtaining and preparing plasma transfusions of Ebola antibodies? How many of our nursing units have sufficient staff to devote 2-4 nurses per shift to one patient? How many of our hospitals have multiple negative pressure isolation rooms?

There is a reason why bio-containment units were developed, and why patients treated in them have fared, and will continue to fare better than those treated elsewhere. Would you deny a NICU bed at a level III referral center to the above preemie, and keep him instead at a small, rural hospital with an occasional neonatal consult by phone? I doubt it. Makes no sense to do that to Ebola patients, either.

Jolie, BSN · Oct 23, 2014

It is not only Republicans who are fearful of the power that the NRA presumably has when it comes to elections. It is a sorry state of affairs when every Republican votes against something because of a threat by the NRA thereby requiring that every Democrat or INdependent vote for it regardless of the NRA threat, IMO.

To what are you referring?

WASHINGTON — Facing a possible defeat in the Senate, the White House is considering delaying a vote on President Obama’s choice for surgeon general or withdrawing the nomination altogether, an acknowledgment of its fraying relationship with Senate Democrats.

The nominee, Dr. Vivek H. Murthy, an internist and political ally of the president’s, has come under criticism from the National Rifle Association, and opposition from the gun-rights group has grown so intense that it has placed Democrats from conservative states, several of whom are up for re-election this year, in a difficult spot.

Senate aides said Friday that as many as 10 Democrats are believed to be considering a vote against Dr. Murthy, who has voiced support for various gun control measures like an assault weapons ban, mandatory safety training and ammunition sales limits.

The troubled nomination is the latest setback for a president who has struggled to get his nominees past members of his own party, even after Democrats changed filibuster rules to prevent repeated Republican blockades of Mr. Obama’s choices for cabinet jobs. Dr. Murthy is one of four nominees who has run into trouble this month after some Democrats have balked.

http://www.nytimes.com/2014/03/15/us/senate-balks-at-obama-pick-for-surgeon-general.html

This article was written in March of this year. As of the time it was written, Harry Reid, Senate Majority Leader had not brought Murthy's nomination up for a Senate vote.

Your blame of Republicans for "blocking" this nomination, if that is what you are referring to, is a bit disingenuous. Not a single Republican vote is necessary if he has the support of the President's own party, including the Senate Majority Leader's confidence in calling a vote.

allnurses Guide · Oct 23, 2014

You're right, herring. But that doesn't justify half-assing it, either. We here all knew that local community hospitals were not prepared for Ebola. Did our "leadership" truly believe that statement, or was it just made to pacify a nervous public? Given that the CDC continues to issue almost daily revisions to its own Ebola policies and procedures, I have to wonder.
With this much I agree: Any hospital that is capable of isolating a potentially infectious patient should be able to receive a suspected Ebola patient and provide very short-term interim care while the transport team is en-route from a designated bio-containment center. That is what our officials should have communicated to healthcare organizations and the public months ago, along with procedural and equipment guidelines. But that was not their message. As a result, when Thomas Duncan was re-admitted in Dallas, the local hospital (which screwed up by discharging him after the first ER visit) should not have been expected to care for him any longer than it took for a transport team to arrive. That was the CDC's blunder. Sending an observation team a day or two after he was re-admitted was far too little support, far too late.
Let me give an example that I believe we can all understand: Virtually every hospital has the capability to assist a mother to deliver a baby, even those that don't typically care for OB patients. Every ER has rudimentary delivery packs, and frankly, most deliveries require very little intervention by the healthcare team. So the CDC saying that every hospital is capable of caring for an Ebola patient is about like saying that every hospital is capable of assisting a mother to deliver. On the surface, that may be true, but there are fine points that are not being addressed.
What if that mother happens to be 24 weeks along, and there is no pediatrician, respiratory therapist or anesthesia care provider available to intubate and establish mechanical ventilation? Delivering in a small, community hospital with minimal OB services will be better than being at home on the farm, but not the same as delivering in a tertiary care center, to which the baby needs an immediate transfer in order to have the best chance of healthy survival.
Same with our Ebola patients. Yes, they can be temporarily isolated in virtually any hospital. But their care requires equipment, know-how and experience that most U.S. doctors, nurses, ancillary staff and facilities lack. How many experimental Ebola drugs have any of us administered? How many of our local blood banks are experienced in obtaining and preparing plasma transfusions of Ebola antibodies? How many of our nursing units have sufficient staff to devote 2-4 nurses per shift to one patient? How many of our hospitals have multiple negative pressure isolation rooms?
There is a reason why bio-containment units were developed, and why patients treated in them have fared, and will continue to fare better than those treated elsewhere. Would you deny a NICU bed at a level III referral center to the above preemie, and keep him instead at a small, rural hospital with an occasional neonatal consult by phone? I doubt it. Makes no sense to do that to Ebola patients, either.

My fellow nurses and I would be fine with a realistic policy to transfer patients to a facility with a bio-containment unit. That is IF there were an actual agreement with such facility to accept the patient. How many patients can be cared for in these facilities? Will there be enough?

We are near an international airport with two unprepared prestigious university hospitals. One I know of has started. They are preparing ER staff and the staff of one ICU to care for adults. There is no answer yet about what the plan is for a pregnant woman, a baby, or a child with actual or potential Ebola infection.

Because out neither our government nor our hospitals have been proactive direct care nurses stepped up to the plate.

During the recent summer nurses at our hospital and many other facilities asked their employers to plan for the possibility of an actual or potential Ebola patient who may come to the ER or outpatient department. Our contracts require an answer to such written requests. When told just told they are prepared nurses explained that that can't be because staff has not been trained.

The we began surveying our members. We held publicity events that were covered locally. No real planning by hospital management.

Requested policies and procedures simply stated that CD guidelines would be followed. For training staff was to use the CD web site on our own time.

We have prepared an Ebola toolkit to help nurses.

http://www.nationalnursesunited.org/pages/nnu-nurses-toolkit

RN Survey Says Hospitals Fall Far Short in Emergency Planning as First Ebola Case Reported in the U.S.
9/30/14
In the wake of the first confirmed case of a patient in the U.S. who has been infected with the Ebola virus, the largest U.S. organization of nurses today warned that U.S. hospitals are far from ready for the Ebola outbreak, are sorely lacking in other disaster planning, and everyone needs to do more to stop Ebola.
Several weeks ago, National Nurses United (NNU) began surveying registered nurses across the U.S. about emergency preparedness. In preliminary results from more than 400 RNs in more than two dozen states released today:
* More than 60 percent of RNs say their hospital is not prepared for the Ebola virus.
* 80 percent say their hospital has not communicated to them any policy regarding potential admission of patients infected by Ebola
* 85 percent say their hospital has not provided education on Ebola
* 30 percent say their hospital has insufficient supplies of eye protection (face shields or side shields with goggles) and fluid resistant gowns
* 65 percent say their hospital fails to reduce the number of patients they must care for to accommodate caring for an "isolation" patient
Just last week, more than 1,000 U.S. RNs, joined by nurses and other health workers from around the world, held a die-in on the strip in Las Vegas to register their concern about inadequate preparation in U.S. hospitals, as well as calling for a significant escalation in global efforts to stop the Ebola outbreak in West Africa...
... "This potential exposure of patients and healthcare workers demonstrates the critical need for planning, preparedness and protection at the highest level in hospitals throughout the nation," says Bonnie Castillo, RN, director of NNU's Registered Nurse Response Network, which is coordinating the RN response.
"The clock is ticking. It is long past time to act," Castillo adds. Preparedness for disease outbreaks is a long standing problem, note the nurses, citing the death of a U.S. nurse in a California hospital infected during the H1N1 outbreak in 2009.
NNU is calling for:
* All U.S. hospitals to immediately implement a full emergency preparedness plan for Ebola, or other disease outbreaks. That includes full training of hospital personnel along with proper protocols and training materials for responding to outbreaks, adequate supplies of all personal protective equipment, properly equipped isolation rooms to assure patient, visitor and staff safety, and sufficient staffing to supplement nurses and other health workers who need to care for patients in isolation.
* Significant increases in provision of aid, financial, personnel, and protective equipment, from the U.S., other governments, and private corporate interests to the nations in West Africa directly affected to contain and stop the spread of Ebola.
* Proper funding of international disaster relief and global health agencies whose budgets have been cut as a result of austerity measures implemented by the wealthiest nations.
* Stepped up action on the climate crisis which has contributed to the spread of disease outbreaks. Scientific American in 2008 named Ebola, which is directly affected by drought-related deforestation, as one of a dozen epidemics likely to be spurred by climate change...
http://www.infectioncontroltoday.com...in-the-us.aspx

allnurses Guide · Oct 23, 2014

A delegation of nurses met with the governor today.

One of our presidents will testify before Congress tomorrow. They take turns because our elected officers and board of directors members are all direct care RNs.

Nurses Leader to Testify to Congress on Ebola Friday | National Nurses United

heron, ASN, RN · Oct 23, 2014

I'm impressed. Guess it's true that if you want something done, do it yourself.

toomuchbaloney · Oct 23, 2014

To what are you referring?
WASHINGTON-Facing a possible defeat in the Senate, the White House is considering delaying a vote on President Obama's choice for surgeon general or withdrawing the nomination altogether, an acknowledgment of its fraying relationship with Senate Democrats.
The nominee, Dr. Vivek H. Murthy, an internist and political ally of the president's, has come under criticism from the National Rifle Association, and opposition from the gun-rights group has grown so intense that it has placed Democrats from conservative states, several of whom are up for re-election this year, in a difficult spot.
Senate aides said Friday that as many as 10 Democrats are believed to be considering a vote against Dr. Murthy, who has voiced support for various gun control measures like an assault weapons ban, mandatory safety training and ammunition sales limits.
The troubled nomination is the latest setback for a president who has struggled to get his nominees past members of his own party, even after Democrats changed filibuster rules to prevent repeated Republican blockades of Mr. Obama's choices for cabinet jobs. Dr. Murthy is one of four nominees who has run into trouble this month after some Democrats have balked.

http://www.nytimes.com/2014/03/15/us/senate-balks-at-obama-pick-for-surgeon-general.html
This article was written in March of this year. As of the time it was written, Harry Reid, Senate Majority Leader had not brought Murthy's nomination up for a Senate vote.
Your blame of Republicans for "blocking" this nomination, if that is what you are referring to, is a bit disingenuous. Not a single Republican vote is necessary if he has the support of the President's own party, including the Senate Majority Leader's confidence in calling a vote.

'

You are welcome to consider it disingenuous, but the notion that Democrats are less fearful of losing elections because of NRA power is not a reasonable one, in my opinion. All of them want to get reelected and not all Democrat Senators serve primarily liberal constituencies.

Is there some be some notion that Democrats inherently do or should vote party lines, regardless of the issue, regardless of their personal opinions, or regardless of the desires of the folks they represent. Is that why it is so interesting to conservatives when Democrats vote their conscience rather than with a party?

Clearly I am not the only person who feels that the obstruction in this matter is related to the NRA and to eagerness of Republicans to further the agenda which was established vocally by McConnell when Obama was first elected.

In reality, Obama could simply appoint the SG now, while Congress is on it's extended vacation shirking all legislative responsibilities while attempting to save their own sorry orifices in the upcoming elections rather than to serve the nation and the people.

Jolie, BSN · Oct 23, 2014

'
You are welcome to consider it disingenuous, but the notion that Democrats are less fearful of losing elections because of NRA power is not a reasonable one, in my opinion. All of them want to get reelected and not all Democrat Senators serve primarily liberal constituencies.
Is there some be some notion that Democrats inherently do or should vote party lines, regardless of the issue, regardless of their personal opinions, or regardless of the desires of the folks they represent. Is that why it is so interesting to conservatives when Democrats vote their conscience rather than with a party?
Clearly I am not the only person who feels that the obstruction in this matter is related to the NRA and to eagerness of Republicans to further the agenda which was established vocally by McConnell when Obama was first elected.
In reality, Obama could simply appoint the SG now, while Congress is on it's extended vacation shirking all legislative responsibilities while attempting to save their own sorry orifices in the upcoming elections rather than to serve the nation and the people.

In the first paragraph, you bemoan that Democrats are beholden to the NRA in order to get re-elected. In the second, you claim that they are voting their conscience. (Although I'm not clear on which issue they are voting their conscience.) May it perhaps be that they are representing the will of their constituents, which, by the way, is what they are elected to do?

Again, I am amused by your use of the term, "obstruction" when the Republicans lack sufficient numbers to obstruct anything. How can Republicans be responsible for obstructing a vote that Harry Reid has not called, especially when the White House has asked that the vote be delayed.

You are correct that Obama could appoint Murthy tomorrow. After all he has a pen and a phone, as he proudly proclaims. Why do you suppose he has not done so?

toomuchbaloney · Oct 23, 2014

In the first paragraph, you bemoan that Democrats are beholden to the NRA in order to get re-elected. In the second, you claim that they are voting their conscience. (Although I'm not clear on which issue they are voting their conscience.) May it perhaps be that they are representing the will of their constituents, which, by the way, is what they are elected to do?
Again, I am amused by your use of the term, "obstruction" when the Republicans lack sufficient numbers to obstruct anything. How can Republicans be responsible for obstructing a vote that Harry Reid has not called, especially when the White House has asked that the vote be delayed.
You are correct that Obama could appoint Murthy tomorrow. After all he has a pen and a phone, as he proudly proclaims. Why do you suppose he has not done so?

Very clearly some Democrats are voting their conscience as not all of them are concerned enough about that particular threat to cause them to deny that SG nomination. Conversely, all Republicans have a fundamental problem with the guys views because of the NRA opinion (even though his views are consistent with AMA and public opinion).

Delaying votes that have little to know hope of passing is politics, that's how it has been done forever. You may not feel that the Republican members of Congress are obstructing but I would be willing to bet that history will disagree with you. We will have to agree to disagree on that topic.

I suppose the POTUS chooses his battles with some care as everything is a battle and he is currently being sued by Congress for doing exactly what they ask and dare him to do with regularity. Seriously, they ask him to go to war without bothering to take the appropriate and constitutional actions required of them in these times. They stand on the sidelines with plenty to say to the press and on the campaign trail and not one moment to actually serve the country in a significant and difficult time. So, I don't know why he doesn't just appoint one unless maybe he is just reluctant to use that constitutional option, his record on the practice seems to support that notion.