The Ebola challenge for the American emergency system has arisen very quickly, and provides us with another opportunity to refine the approach to contagious diseases. As emergency providers sit together to draft regional plans, there is a responsibility to take what we learned from Bhopal, SARS, H1N1, Anthrax, smallpox and Sarin.

It is uncomfortable to watch the criticism of the CDC and the emergency providers in Dallas. The CDC has clearly done an outstanding job. Over the course of a few weeks, it has provided a tremendous amount of guidance through its ability to conduct worldwide investigation, gather statistics, interview providers and apply known science about the virus.

Clearly it is the responsibility of emergency care providers, in the prehospital environment and in the ED, to figure out how to apply their knowledge. It is EMS leaders’ responsibility to build our algorithms, do our training, buy the right products and listen for more science. It is likely that emergency leaders will need to continue to make the quick, agile decisions needed to respond to this crisis.

In the past, emergency leaders have utilized a staged approach to this effort. The response and planning for Ebola will need a similar effort.

A three stage approach is a rational place to begin:

• Stage 1 is taking place now, when rare cases occur but local areas are affected in a major way.

• Stage 2 is when there are multiple small regional outbreaks.

• Stage 3 is needed when there are multiple significant outbreaks.

Stage 1

We are in a Stage 1 operation at this point, looking for very rare cases and screening a lot of people to try to find those few patients. We have our first region that is moving ahead, which is Dallas, home of excellent EMS systems and hospitals. Emergency leaders in the region have had to make action-oriented decisions right away to address concerns in public health, public safety and the emergency care system. They have very nice simple protocols for 9-1-1 centers, destination decisions, decontamination and use of PPE.

In other regions, many hospitals and EMS systems are meeting with public health providers, following the Dallas lead and publishing their practices. These early meetings help EMS and ED leaders build a rational staged approach if Stage 2 or Stage 3 should occur.

Stage 1 operations are a wonderful use of time. Even if Ebola progresses no further, Stage 1 planning operations allow providers to design good programs for many contagious diseases. This activity prepares the emergency system for routine occurrences of influenza, C. diff and other exposures.

This process is one that all leaders would like to do on an ongoing basis, but it often gets lost in other priorities. Ebola gives the system a focused opportunity to do so. Importantly, it allows leaders to build credibility with the emergency care work staff, not only for Ebola, but for the next outbreak of SARS, or H1N1 or whatever other infectious disease may arise.

With Ebola currently garnering national media attention, there are numerous opportunities to advocate at the local, regional and national levels for correct funding and preparatory work. Our lead organizations need to consider the following priorities:

• Reach out to the Offce of Assistant Secretary for Preparedness and Response (ASPR) and/or the Emergency Care Coordination Center (ECCC) for executive branch support for preparedness and funding.

• Cooperate with the CDC on gathering evidence and building credible preparedness programs. At this time of the year, emergency leaders should use this opportunity to ask all Americans to get a flu vaccine, so that if Ebola does expand we will not have a big flu population to confuse with a febrile illness. As CDC develops good science, it should be comfortable forming partnerships in emergency care to respond with information distribution.

• The criticism of individual hospitals, physicians, nurses and emergency providers is very disappointing. These providers are critical to supporting public health and distributing emergency care. Our emergency organizations need to make sure we are viewed as positive for the entire health system, as all emergency providers are “front line” providers.

• There are clearly opportunities to design and staff some “centers of excellence” as we move through Stage 1. This should be done region by region, and we should not wait for the government to have to designate that. This is just like a hazmat incident; the management of these incidents will require us to “dirty” only the smallest number of hospitals and keep the others clean. Do just-in-time training to get the staff at the designated centers functioning at a high level and equipped to properly handle the emergency.

• Emergency care cannot take place in front of the media. The healthcare system has not been granted tort protection.

• In planning for Stage 2 or Stage 3 operations, there must be an adequate supply of personal protective equipment (PPE). Past experience would suggest there will be shortages of protective gear, and that PPE will get incredibly expensive. The federal government needs to assure adequate supply at a fair price—we can further damage our economy by just asking for the federal government to pick up an inflated price. This is where regional centers may be a great idea, so that every hospital and EMS systems does not need to build a huge war chest of supplies.

• In Stage 2 and Stage 3, there is a critical need for the Hospital Incident Management System to work effectively. Now is the time to pull out the NIMS handbooks. Further stages will have critical roles for safety officers and logistics. This is another opportunity to get this training out and build algorithms and worksheets for those roles related to Ebola.

Stage 2

Stage 2 operations will occur when there is a spread of disease and fatalities in multiple regions of the country. At that point we will all need to staff our emergency care systems and public health programs for isolation and quarantine, and alter our algorithms for rapid rule-in and rule-out. Emergency organizations need to be more active in sharing best practices on emergency treatment and prevention.

Stage 3

Stage 3 operations occur when there is widespread disease and fatalities in multiple regions of the country. At that point there will be a need for massive public health efforts and a two-tier emergency care system: one tier for contagious disease patients, and one tier for everything else that still goes on. There is now a need to develop and build efficient algorithms for rapid rule-in and rule-out.

Visit the Document Repository at www.EMSInsider.com  for a chart that outlines the basic elements of a regional planning model for Ebola in a staged format. With each evolution, more agencies need to participate in the planning and operations, and already tight budgets need to be squeezed. Planning for Ebola can be matched to the timely responses to the pediatric enterovirus, C. diff, tuberculosis and seasonal influenza.

Don’t miss the opportunities.