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IAEM questions whether crowded Emergency Departments can provide Ebola infection control

The Irish Association for Emergency Medicine welcomes ongoing development of plans by the Department of Health and HSE to address issues relating to the Ebola threat. While excellent clinical care may well be provided to these patients, we must ensure that Ireland is in a position to safely manage the infection risks presented by a patient with Ebola Virus Disease (EVD) should one present to any of the country’s 29 Emergency Departments (EDs).

We have serious safety concerns including the continued crowding of EDs with admitted inpatients on trolleys; insufficient isolation facilities and the HSE’s national dependence on locum staff who are less likely to be aware of procedures and have undergone specific training.

We know that infectious diseases spread amongst patients and staff in crowded EDs. Such spread has happened with norovirus (winter vomiting bug), TB and most devastatingly with SARS. The Association is therefore not reassured by Department of Health or HSE claims of full preparedness given the current crowding situation in most EDs. Particularly significant is the fact that hospitals serving our major national airports, namely Beaumont Hospital, University Hospital Limerick and Cork University Hospital, are most at risk as they have particularly high rates of crowding.

It is internationally recognised that ED crowding with admitted inpatients increases the mortality rates for these and other patients. Put simply, the very immediate and daily reality is that ED crowding is resulting in more deaths and greater morbidity right now than the risk Ebola presents in this country. Ebola will simply add to this reality.

IAEM advises that to reduce this risk the HSE must implement the Full Capacity Protocol (to relieve ED crowding by sharing the inpatient load with the whole hospital) and do so in all hospitals.

With regard to EVD preparation we suggest that the HSE and all hospitals immediately:

  • identify areas to receive and treat these patients away from crowded EDs;
  • provide a suitable pathway for patients referred by GPs, Public Health and the Ambulance Services;
  • introduce mandatory training for frontline staff in the use of personal protective equipment and other infection control measures.

IAEM advises the Chief Medical Officer, Dr Tony Holohan and the Assistant National Director for Emergency Planning, Gavin Maguire to urgently visit Irish EDs to observe the intolerable levels of crowding and to decide whether this – and general preparation to date – are in fact compatible with the EVD assessment and treatment protocols issued by the HSE and Health Protection and Surveillance Centre. In our view, they are not.

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