Although Chattanooga's health care systems have never treated anyone for Ebola virus, Africa's latest outbreak is a reminder that in today's world, emerging infectious diseases are only a plane ride away.
In the event that a rare, deadly pathogen should strike the region, there's a network of behind-the-scenes health care professionals — hospital workers, emergency medical services providers, health department staff — trained and prepared to handle the situation. They also know that there's risk involved.
"We're putting our lives on the line, potentially," said Suzanne Hornsby, special pathogens team lead at Erlanger. "They're very passionate about making sure that we are as prepared as possible, that we are keeping ourselves safe and our patients safe, and this is not something that they take lightly."
In her day-to-day work, Hornsby helps manage medical intensive care units at the hospital. But she's also poised to lead Erlanger's special pathogens team of 24 nurses, technicians and physicians who voluntarily trained and committed to care for patients with highly-contagious pathogens like Ebola, Marburg virus, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
Following the 2014 Ebola outbreak in West Africa, the United States government sought to beef up the nation's ability to respond and treat patients infected with Ebola and other emerging infectious diseases in the event they traveled into the country.
Every hospital in Tennessee became a "front-line" facility, and six hospitals around the state — one of which is Erlanger's main campus — were chosen as assessment facilities, meaning the hospital would provide the first 96 hours of supportive care to patients with suspicious symptoms and diagnose the illness through screening and lab tests. If test results are positive, EMS would transport the patient to a treatment facility in Atlanta.
From there, providers worked with the Chattanooga-Hamilton County Health Department, state department of health, the Centers for Disease Control and Prevention and other institutions to develop ways to handle such a patient.
Dr. Jay Sizemore, an infectious diseases specialist and medical consultant for the team, said the first step is to know current pathogen activity around the world and where and when the patient traveled.
"Then you can start matching up the travel history with incubation time and a potential exposure, and that's how we would identify a suspect case, of course along with clinical signs and symptoms," Sizemore said, adding that malaria is one of the first diseases for which travelers should be checked.
More often than not, that process rules out the rare diseases.
"Africa's a big place, so early on we were having a lot of false alarms that were primarily being driven by people who returned from Africa and had a fever. They may have been 1,000 miles away or more from where Ebola was endemic," Sizemore said. "It's important to have a high index of suspicion, but you need to have a reasonable index of suspicion, too."
Staying abreast of what's happening in the world to know what could potentially come into the hospital is also key, said Silvia McCray, a team member and infection preventionist at Erlanger. Pandemic influenza is another virus she considers.
"We see our routine influenza every winter, but we're always looking out," McCray said. "For example, if you had 10 people come into the ER with a high fever and respiratory symptoms and something's going on, we may need to dig deeper and see if this is a new, novel influenza because there's always that possibility."
The team also undergoes extensive training from the National Ebola Training and Education Center, which is comprised of faculty and staff from Emory University in Atlanta, the University of Nebraska Medical Center/Nebraska Medicine and the New York Health and Hospitals Corporation, Bellevue Hospital Center — three hospitals that have successfully treated Ebola patients.
A large part of the training is teaching health care workers to properly put on and take off their personal protection equipment, which protects them from exposure to infectious fluids. Applying the multiple layers of eyewear, gloves, boots and coveralls must be done under the supervision of a team member and averages 45 minutes. Workers, who are typically critical care nurses, also wear a personal respirator and sometimes a cooling vest.
"It gets pretty hot in there while you're doing things in the room and tensions are high," Hornsby said.
Four nurses complete three-hour long shifts before rotating out to prevent fatigue. Each member also wears an encrypted bluetooth earpiece to talk from inside the completely isolated, negative pressure room.
"One of the things we discovered when we started training is that we had a really hard time communicating when we had all this gear on," she said.
In the case of a positive diagnosis, patients would be transported from the room to EMS in an individual isolation unit known as the ISO-POD that has its own oxygen supply and ability to reach the patient without breaking the seal.
Kristy Headrick, an infection preventionist and consultant for the special pathogens team, said she hopes increased awareness of the special pathogens team will ease any fear in the community.
"Even if we unfortunately had some type of outbreak here, it is in a certain area of the hospital and it's highly monitored," she said. "If you use proper isolation and your proper [personal protection equipment], everyone should be completely safe."
Contact staff writer Elizabeth Fite at email@example.com or 423-757-6673.