Medical Adjustments

This post may be more appealing to healthcare workers. In full PPE zero skin is exposed. Nada. Which means auscultating lungs, heart sounds, and bowel sounds is not possible, as you cannot hear well while under the hood. (Auscultating is the fancy way of saying listening and is usually done with a stethoscope.) There are no stethoscopes. That is a weird thing to get used to. You truly only have your visual clinical assessment skills at your disposal and your gut feeling. Well, we do take vital signs: temperature, heart rate, and respiratory rate. (Palpating heart rate is loads of fun for a full minute while double-gloves on the sicker patients that already have weak pulses...) We don't routinely take blood pressures cuffs nor do we use pulse oximetry often. We did have one lady with a recorded pulse ox of 85% in no acute distress, however, we have no oxygen to place her on. Zero ekgs (shows heart rhythm), zero CT scans, zero chest x-rays (CT scans and x-rays help us make decisions based on the results of the test). We don't have the ability to test blood chemistries and if we did it wouldn't change the course of treatment. We give IV fluids and some potassium in the IV fluids and encourage each patient to drink their oral rehydration solution (ORS). Think sports drink that does not taste sweet. We mix it with juice to try to make it more palatable.

We truly only treat Ebola and malaria at our ETC. We have discharged patients that clinically look sick--but we do not have a safe place to keep them nor the drugs they would need for chronic illnesses--i.e. hypertension. We can't treat TB and right now TB clinics are closed. We have gotten one clinic up and running half days so far but that is all for the local area. We can't keep Ebola negative patients that have chronic illnesses because we could expose them to Ebola while they are in the high risk zone. As you move through the 3 wards you may not back-track. If you place a patient in triage into probable you must stay in probable or move to confirmed, never back up the cement walkway to suspect. An ETC is meticulously run and full washes with 0.5% chlorine are down frequently by our WASH team. The outside of each ambulance is sprayed down upon arrival. Once all the patients are in triage-where we can take two at a time only, any others must wait in the back of the ambulance until those two are moved. If we believe one or both of first two are "probable" we will move them to a corner of triage and work on the next patient from the ambulance since you cannot return from probable, except to pick up another probable from triage.
Sorry, that was confusing. The goal is to avoid the possibility of cross-contamination.

Once the ambulance is empty, the inside is also doused in 0.5% chlorine, which is only stable in the sun about 12 hours, even in dark containers. We go through a TON of water.