“Good evening sir, how may I help you?” asked the nurse at the front desk of TMC’s emergency department.
“I’m not feeling well. I feel like I’m coming down with the flu. My body aches. I have a headache that won’t go away. I had a fever, but I took some Tylenol a few hours ago, and that seems to be helping,” said Tucson resident Chuck Palm.
Right away, the nurse asked, “Have you been to West Africa – including Guinea, Liberia, or Sierra Leone within the past 30 days?”
“No,” said Palm.
“Have you had physical contact with anyone who has been to one of those countries within the past 30 days?” she asked.
“Well, I visited with my brother-in-law in Tucson last weekend. He just got back from Liberia, where he works,” he said.
Palm was immediately handed a surgical mask to put on while the nurse asked him a few more questions. “Here at TMC, there is a heightened awareness about possible Ebola contamination. We have a protocol in place, so we have to do a couple things, but I don’t want you to worry,” she explained.
Just seconds later, Palm was escorted through the double doors and into a room that’s right inside the emergency department. The door was shut, and the nurse told him she’d be right back. A few minutes later, she came in covered with protective gear from head to toe. “She listened to my lungs and guts, and asked me some more questions,” explained Palm. When she left the room, Palm looked through the window in the door and saw her taking her gear off with the help of a buddy.
He opened the door and pulled his mask down to ask a question. But before he could even ask it, a second nurse quickly said, “Sir – please put your mask on, go back into that room, shut the door and wait.”
A real scenario.
Except in this case, it was just a drill.
Palm wasn’t a “real” patient. In fact, the Air Force veteran has nearly 20 years of public health experience and currently manages the Life Enhancement Program at Canyon Ranch Institute (CRI). This drill was one of a handful of “secret shopper” drills TMC’s infection control staff have done in recent weeks to test the readiness of employees who are on the front line of the Ebola public health threat.
In this case, Palm’s “job” was to trip a protocol wire.
He did as he was instructed; went back into the room, shut the door and sat down. Just minutes later, the drill was called. The infection control team swooped in and started debriefing. Was the hospital’s plan followed correctly? Were all the appropriate people notified? Was the patient asked all the appropriate questions, and treated with compassion and respect? Was the proper protocol followed for personal protective equipment?
Palm’s feedback was invaluable. “I wanted to give them honest, relevant feedback from a ‘patient’ perspective. I was amazed at the professionalism that was exhibited from start to finish. As a ‘patient,’ it felt reassuring. When I was quarantined, I do wish that I was in the loop a little bit more about what was going on outside that door, but other than that, I felt like the staff was in complete control of the situation. They were communicating with each other. They weren’t loud, hysterical or overly excited. I never questioned whether they knew what they were doing,” he explained.
And if he were to give the night shift a letter grade? “I’d give them an A,” he said. “I felt like they did a great job.”
A few days later – the same drill. But this time, the day shift was put to the test.
And again – the same calm, organized response.
“The physical exam once I was quarantined was very thorough, and everything was handled with the same professionalism the night shift showed,” he said.
While Palm and the infection control staff were relieved everything went so well, the emergency department staff was less than thrilled about the timing of the tests. After all – TMC’s waiting room was full of patients both times. But as Dr. Richard Carmona, the 17th Surgeon General of the United States and President, CRI Board of Directors stressed, that’s the best time to drill. “If you really want to test a system, test it when everybody is busy and distracted. Test it when the emergency department is full, as a patient can show up anytime! I thought it was wonderful that even with all those distractions, staff picked up on everything right away and acted appropriately.”
Palm said, “In the Air Force, we would constantly drill to make sure we were ready for all kinds of contingencies. It made sense to me to do this kind of readiness training. At CRI, we use simulated participants as part of our training. So I was completely confident and excited to play the patient. In fact, it was fun for me to be a part of it.”
Reassurance for Southern Arizonans
“This ‘secret shopper’ drill is perfect because we can assure the public that if a suspected Ebola-infected patient shows up at TMC, the nurses and doctors there are going to ask the right questions, right away, and handle everything correctly. The community needs to know that this facility is ready for this. If something happens, TMC is on top of it,” said Dr. Carmona.
TMC is following all guidelines from the Centers for Disease Control & Prevention and has an updated response plan that ensures the hospital staff detects possible Ebola cases, protects employees, other patients and their families or visitors, and responds appropriately. TMC administration is working diligently with TMC’s infection control, as well as officials at the county, state and federal level. Please click here to read more about how TMC is maximizing preparedness efforts.
Our local Ebola risk
Dr. Carmona believes that Southern Arizona remains at low risk for getting an Ebola-infected patient, and that the flu will pose a much more significant risk to our community. “We lose between 30,000 and 35,000 people a year to the flu in this country, and many people still don’t get immunized,” he said.
Even if TMC never cares for an Ebola-infected patient, all of this training and preparation is incredibly valuable. As Dr. Carmona explained, it’s Ebola today, but six months from now, we could be dealing with a new germ or mutation. This Ebola threat has strengthened the screening processes that are in place and staff’s ability to quickly identify a patient who may be at risk for a communicable disease. He uses this analogy: “We don’t have many fires in town, but we have many fire departments. Why? Because we know stuff will burn. It doesn’t burn every day, but when it does, we want to have people available. There is an expectation in society that trained and equipped brave young men and women will respond to keep us healthy and safe. It’s similar with Ebola. We have to continue to build that capacitance into our emergency management systems. Having the infrastructure in place to respond appropriately will keep morbidity and mortality down and hopefully prevent catastrophic consequences.”
TMC and CRI – partners in wellness
TMC and CRI have been partners for years, working to improve the lives of Southern Arizonans by encouraging wellness. But their commitment also expands to a collaboration with public health readiness and prevention – which is why aligning together for Ebola preparedness efforts “just made sense,” according to Palm. “TMC is a leader in health and wellness, and part of that obligation is to be a leader in public health as well. I’m thrilled with how TMC is informing, preparing and training its staff, and how they’re using community partners to test its readiness. TMC took a big risk in testing their employees in this way, and that is perhaps the most impressive to me.”