U.S. state public health departments, in partnership with the Centers for Disease Control and Prevention, played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units (HLIUs) for EVD treatment in conjunction. Researchers from the University of Nebraska Medical Center (UNMC) College of Public Health conducted a study published in the current issue of the Journal of Public Health Management and Practice to identify guidelines and perspectives of state health departments as they relate to the management and transport of patients with EVD and other highly hazardous communicable diseases (HHCDs).
The researchers surveyed 36 state health departments in the U.S. “A majority of states reported that they would prefer patients confirmed with viral hemorrhagic fevers (e.g., EVD, Marburg fever) and smallpox be transported to an HLIU for treatment rather than remain at the initial hospital of diagnosis. While most (89 percent) states had written guidelines for the safe transportation of patients with HHCDs, only 6 (16 percent) had written protocols for the management of accidents or other travel disruptions that may occur during HHCD transport within the state. Twenty-two state health departments (59 percent) had operationally exercised transport of a patient to an HLIU.”
[Photo: Ms. Jocelyn Herstein]
Nearly half of states in the United States lack an HLIU, yet most prefer to have patients with HHCDs treated in high-level isolation. Transport to a geographically proximate HLIU may be complicated in states without HLIUs, particularly for the four states reporting laws restricting ground transport distance. Ms. Jocelyn Herstein and colleagues conclude that “[R]ecent budget cuts and uncertainty of future funding threaten the abilities of health departments to devote the necessary resources and staff to prepare for and deliver the desired care to HHCD cases. The lack of HLIUs in some states may complicate transport to a geographically proximate HLIU. Moreover, limited guidance on diseases that warrant high-level isolation may cause disagreement in HHCD patient placement between health departments, diagnosing facilities, and HLIUs.”