Dec 8, 2015 — When health concerns like H1N1 or Ebola become a public health issue, should you avoid the ER to decrease your chances of catching the virus? From the University of Utah, Dr. Tom Miller and emergency room physician Dr. Robert Stephen talk about ER safety protocols when there is an outbreak of a contagious illness.

Interview

Dr. Miller: How safe is the public during an outbreak of a contagious illness in the Emergency Department? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller, is on The Scope.

Dr. Miller: I'm here with Dr. Robert Stephen, and he's an Emergency Room physician here at the University of Utah. Robert, how safe is the ED for patients when they come in during a particular outbreak, and I think that probably varies between outbreaks. I mean, we've seen H1N1 in the last six years. We've had the Ebola crisis nationally here in the last year. We've had other scares as well. More recently, we've had a case of plague.

Dr. Stephen: Obviously, a lot of it depends on the nature of the infectious disease itself. Some are more infectious, or easy to get infected than others. I think, what the main thing we try to do is, we become aware of the situation. We ask that patients who come in who may be potentially infective put on masks.

We then try to ask them specific questions, trying to ascertain if they have risk factors to have whatever contagion is going around at the time. And if they do, then we start to enact protocols that isolate that patient until we can try to determine definitively whether they have the illness or not.

The main issue is in the waiting room, trying to get to those people and make sure they don't infect other people. The best way to do that is to have the public themselves take an active role in this. If they are coughing, if you do have a fever, consider putting on a mask, trying to contain your cough, not cough on other people, etc.

Dr. Miller: And the other thing is, if someone has a severe problem, they should still come to the ED, or the Emergency Department, and not worry about the infectious outbreak as much as they should worry about themselves and getting treated for something that could be potentially life-threatening.

Dr. Stephen: Correct, and if we are at all concerned once they come into the ED, to protect other patients in the Emergency Department, the patients are, again, in isolated rooms and we wear the appropriate protective gear when we go in, and that gear is then taken off and thrown away before we, obviously, go and see another patient. So again, we try to minimize the transfer of things as best we can.

Dr. Miller: So I would think that once the patient is inside the Emergency Department, in a room or on a gurney, that you're enacting, you have protocols to protect yourselves and others, as well as family members, from the patient infecting them. Is that correct?

Dr. Stephen: This is correct, and we even have certain rooms, that if it's considered a highly infectious agent or something that everyone's very concerned about, i.e., let's use the latest, the Ebola scare that we had in this country recently, we had a particular room that is isolated and can be isolated from the rest of the ER. It has its own air supply, has its own airflow, has its own way in and out of the room so that you don't run the risk of cross-contaminating the rest of the ER.

Dr. Miller: Now certain patients will come in during an outbreak and they can been screened, so a high percentage of them could be ruled out for the disease.

Dr. Stephen: Correct.

Dr. Miller: I think this was true during the Ebola crisis, that a number of people were quite worried that they might have this virus. But it turned out after some rather brief questions that they were not at risk.

Dr. Stephen: Right. Say, for example, with that one you had to have actually been in a country or been into contact with someone who had been in that country, and that vastly cut down on the number of people who might have the illness.

Dr. Miller: Now from my own experience, the more common outbreaks that we see in this country are related to influenza during the flu season, and for people coming into the Emergency Department, it might be wise for them to ask immediately for a mask so that they could put that on and prevent the spread of the possible virus, if they have it.

Dr. Stephen: Correct. Generally, with influenza, it's a highly contagious illness, it's quite miserable if you get it, and to wear a mask and then the usual good hand hygiene. Make sure you wash your hands and ask to wear a mask is probably the most appropriate thing to do.

Dr. Miller: Now I think in your Emergency Department waiting room you also have gel dispensers where they can wash their hands with an alcohol-based gel to keep the infection rate down.

Dr. Stephen: Correct. Yes, we do.

Dr. Miller: Anything else?

Dr. Stephen: Just, again, if you're feeling quite ill and you want to be seen, we're happy to see you. We just take steps to make sure that we keep people as safe and as unexposed to other people as possible. The last thing you want is someone who has a traumatic injury also getting an infection from someone close to them, and we try to make sure that we keep those things separate.

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