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Environmental Factor

Environmental Factor

Your Online Source for NIEHS News

November 2017

Learning from the past, training for the future

Lessons from the Ebola outbreak suggest intensive preparation will be critical to confronting a major epidemic, according to Shawn Gibbs.

Shawn Gibbs Gibbs described himself as a contingency guy. “My entire career is built on what is Plan A, Plan B, and Plan C,” he said. (Photo courtesy of Steve McCaw)

The Ebola outbreak of 2014–2015 claimed thousands of lives in Africa, and for a time, threatened to spread to the United States. That experience taught experts that intensive preparation through worker training and distribution of resources will be critical to confronting a major epidemic, should that threat return or another highly infectious disease break out.

Shawn Gibbs, Ph.D., from Indiana University, discussed such past efforts and the need for future preparations at a Keystone Science Lecture Seminar Series talk Oct. 18. His presentation followed the annual NIEHS Worker Training Program (WTP) awardee meeting and workshop(https://tools.niehs.nih.gov/wetp/events.cfm?id=2579) (see sidebar).

Gibbs is the former research director of the Nebraska Biocontainment Unit (NBU), where American patients transported from Africa were treated. Today, he shares leadership of the Biosafety and Infectious Disease Training Initiative (BIDTI), with John Lowe, Ph.D., who is the current research director of the NBU. BIDTI is a three-year project funded by WTP that involves five institutions.

  • Indiana University.
  • University of Nebraska Medical Center.
  • University of Texas School of Public Health.
  • Dillard University.
  • Harvard T.H. Chan School of Public Health.

BIDTI develops programs and materials to train non-health care workers who may be exposed to Ebola and other serious infections. Facility workers who deal with biohazardous waste materials, emergency responders, death sector workers, and law enforcement employees are some of the employees targeted. In its first year, BIDTI trained more than 2,000 people.

Many challenges

ambulance transport Ground transport of Ebola patients, like the one shown above, involved meticulous planning and follow-up, with careful decontamination of the ambulance and workers. (Photo courtesy of Shawn Gibbs)

Gibbs described several research studies published before, during, and after the Ebola epidemic that focused on anticipated needs and lessons learned. Issues such as patient transportation, decontamination procedures, and the processing and disposal of human remains must be dealt with safely and effectively in an outbreak such as Ebola, to protect the patients, the workers who are involved, and the public.

For example, transport and management of Ebola patients is extremely challenging. “We worked very heavily with our colleague at Emory University, Alex Isakov, M.D., on the patient transportation experience,” Gibbs said, noting that the lessons learned were published in 2015.

Fortunately, NBU had already set out and practiced the operating procedures when the outbreak occurred, and highly infectious patients arrived in the U.S.

“We had already written up and published a couple of studies on issues we had run into during our exercises,” he explained.

Lessons were also learned during the actual transportation of Ebola patients to the NBU. “We had been working with the Omaha Fire Department developing these policies and procedures,” Gibbs said. “So when it came to implementing them in reality, we were able to capitalize on our experiences and later share them with the community.”

Consortium research

One of the most important aspects of BIDTI is the gap analysis that the research group performed to guide the trainings. They analyzed unmet needs and potential weaknesses in the national infrastructure for dealing with highly infectious diseases such as Ebola.

One study looked at the current capabilities and capacity of Ebola treatment centers in the U.S., and discovered that there are just 97 isolation beds in the country. “Germany likely has a higher bed capacity than we do,” Gibbs observed, noting the smaller size of the country.

Another survey assessed practices for personal protective equipment. “One of the big issues is that there is no consistent approach to any of this,” he said. “It varies by facility, by state, by everything,” said Gibbs. As a result, BIDTI now asks many questions about local practices when preparing for a training.

airplane This photo shows a drill for international transport of an Ebola patient. Lessons learned during the 2014–2015 outbreak are helping to address challenges while protecting workers and the public. (Photo courtesy of John Lowe)

Lowe JJ, Jelden KC, Schenarts PJ, Rupp LE, Hawes KJ, Tysor BM, Swansiger RG, Schwedhelm SS, Smith PW, Gibbs SG. 2015. Considerations for safe EMS transport of patients infected with Ebola virus. Prehosp Emerg Care 9(2):179–183.

Isakov A, Miles W, Gibbs S, Lowe J, Jamison A, Swansiger R. 2015. Transport and management of patients with confirmed or suspected Ebola virus disease. Ann Emerg Med 66(3):297–305.

(Ernie Hood is a contract writer for the NIEHS Office of Communications and Public Liaison.)

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