At the request of the Department of Health and Human Services, Defense Secretary Chuck Hagel ordered U.S. Northern Command to establish a military team that could respond quickly, effectively and safely in the event of new cases of Ebola in the country. The unit is composed of nurses, doctors and trainers who specialize in infectious diseases.
(U.S. Air Force video/Jimmy D. Shea)
When Capt. Stacey Morgan’s squadron commander sent her a text message saying that she needed to immediately call him, her first thought was, “Uh-oh. What did I do?”
But after a minute or two of talking to her commander, her apprehension was quickly replaced by anxious excitement, as he asked her to become a member of a 30-person military Ebola medical support team.
“I was thankfully in the car with my husband at the time, so he was already overhearing it, but he was super supportive and I said I would be happy to (join the team),” said Morgan, who’s an intensive care unit nurse at San Antonio Military Medical Center at Fort Sam Houston, Texas.
The team was created when senior officials at the Department of Health and Human Services requested assistance from the Department of Defense in late October. Soon after, Secretary of Defense Chuck Hagel ordered U.S. Northern Command to establish a military team of members from the Air Force, Army and Navy that could quickly respond to provide short-notice assistance to civilian medical facilities in the event of additional Ebola cases in the United States.
“I think the nation always turns to the military in difficult times. It’s up to us to live up to that trust,” said Navy Cmdr. James Lawler, the chief of the clinical research department at the Naval Medical Research Center’s Bio Defense Research Directorate at Fort Detrick, Md. “I think, in general, doing good patient care in difficult situations is what the military medical system always does, so that mission is not unfamiliar to us, and we’re ready to go if that call comes in for this particular instance.”
Morgan is one of 10 critical care nurses on the medical support team, which also has 10 non-critical care, in-patient nurses; five physicians with infectious disease, internal medicine and critical care experience; and five members who specialize in infection control. In all, there are six Air Force Medical Service members on the support team.
“They’re prepared to provide full spectrum Ebola patient care from the point [the patients] are diagnosed to when they are discharged from the hospital,” said Col. John DeGoes, the command surgeon for U.S. Northern Command and North American Aerospace Defense Command. “They could work side by side with a civilian medical staff and could relieve them if needed.”
Lawler has firsthand experience in treating Ebola patients. He worked in an isolation treatment unit in Conakry, Guinea, earlier this year, and he has shared his knowledge with the team.
“Things have evolved significantly because of this outbreak. We’re really rewriting the textbook on Ebola virus disease because we’ve seen so many more cases in this outbreak,” he said. “I think one feature of the disease which has been recognized more widely and appreciated more in contributing to the mortality and morbidity from the disease is the diarrhea and incredibly amount of fluid loss due to the disease and electrolyte abnormalities.”
According to the Centers for Disease Control and Prevention, the 2014 Ebola outbreak is the largest in history, with more than 10,000 total cases and nearly 5,000 deaths worldwide. To date, there have been four laboratory confirmed Ebola cases in the United States, and Lawler said having a military medical team with a variety of expertise is crucial in assisting civilian medical professionals.
“The multi-disciplinary team is essential for managing these patients. They’re complex patients that require a significant amount of care,” Lawler said. “As part of the team, we have a core of critical care nurses who are really the most important part of the team. That intensive nursing is what makes the biggest difference in patient outcome.”
To prepare the team, each member received lecture-based and practical training at SAMMC, organized by USNORTHCOM’s Army component, U. S. Army North (Fifth Army), and conducted by experts from the U.S. Army Medical Research Institute of Infectious Diseases in Frederick, Md.
The first two days of training were focused on familiarizing the team with signs and symptoms of Ebola, how it spread in West Africa, how humans transmit the disease and how medical officials are managing Ebola in the United States. The team spent the following two days learning the proper donning and doffing procedures of their personal protective equipment, along with demonstrating proficiency in safely caring for an Ebola patient in a simulated exercise.
“They’re not in a lecture hall putting on PPE, they’re here in an actual intensive care unit at San Antonio Military Medical Center where they’re training in an atmosphere that is almost identical to what they would see at a civilian hospital,” DeGoes said. “So they’re getting realistic training with the actual equipment that they would use to build confidence and proficiency when they’re under the stress of taking care of an actual Ebola patient.”
DeGoes said one of the lessons learned in Ebola patient care is the need for rigorous training and proficiency, and for medical professionals to follow a step-by-step approach, especially when they’re tired.
“The patients can be very time consuming, and with the time it takes to put on the gear and take off the gear, once you’re in gear, you’re ready to go in, and you’re going to be in that gear for a long while,” Morgan said. “A nurse’s shift is usually about 12 hours, but to be in PPE without eating or drinking or using the restroom would be too long, so using shorter shifts with nurse teams will allow us to provide safe care to the patient but also keep our nursing staff safe.”
Although the team members found themselves quickly tiring after wearing the PPE for extended amounts of time, they said it helped to get more comfortable wearing the equipment.
“The more we wear the protective gear, once you get comfortable, and you’re not thinking about how it’s heavy or hot, you go back into clinical mode, and you’re able to carry out what you do, and it’s been fine,” said Capt. Tanya Tsosie, an ICU nurse at SAMMC. “The only part that is very critical, obviously, is learning how to take care of the waste and learning how to take off the stuff properly. Everything in between that, we do every day.”
Even if the support team isn’t called in for assistance, DeGoes said the training and experience will benefit the military health care system for years to come.
“This training will improve the bio-response preparedness of the entire force. They will go back to their bases and likely become the trainers, and they will up the game of their colleagues at their bases that they go to,” he said. “That strategic aspect of improving bio-responsiveness will end up making our nation and Department of Defense forces safer going forward, and in the unlikely event there’s a new flu that we don’t have vaccines for, and we get asked to help, it will be valuable regardless.”
In the coming days and weeks, Morgan and the rest of the team will pay considerably close attention to their cellphones, because the next text they receive from their commanders might be an alert that the medical response team is assembling to provide Ebola medical assistance somewhere in the United States.