Committee Releases Dallas Ebola Timelines

As per request I have made my original post a thread. I would also like to apologize for another Ebola related thread, in advance. This may have already been posted elsewhere, forgive me if it has. There are just too many Ebola threads to keep up with. ( I did search and couldn't find this. )

I found what looks like the initial timeline of Duncan's care from the Energy of Commerce on the House's website.

Committee Releases Dallas Ebola Timelines
October 17, 2014
Timelines of Events Surrounding Ebola Preparedness Efforts and First Emergency Room Visit of Thomas Duncan in Dallas Raise Concerns About Implementation and Quality of Treatment Plans
WASHINGTON, DC – The House Energy and Commerce Committee today released documents obtained in its investigation of the ongoing Ebola outbreak. The documents were submitted to the committee by Texas Health Resources. One outlines the preparedness timeline from August 1, 2014, through September 24, 2014, and the other document details the sequence of events at Thomas Duncan’s first visit to the Emergency Department on September 25, 2014.

PREPAREDNESS TIMELINE
The preparedness timeline indicates that on August 1, 2014, one of the components of the response plan includes, “Electronic Health Record includes a travel history question that should be completed on every patient.” The preparedness timeline goes through September 24, 2014, just one day before Duncan first arrived at the Texas Presbyterian Hospital Emergency Department.

DUNCAN EMERGENCY ROOM TIMELINE
The second document indicates that Duncan first arrived at the Emergency Department at 10:37 p.m. Triage began for Duncan at 11:36 p.m., at which point, “Obtaining the patient’s travel history was not part of the triage nurses’ process on September 25, 2014.” The timeline later showed that there was an RN assessment from 12:33 to 12:44 a.m. At that point, “The nurse documents that Mr. Duncan ‘came from Africa 9/20/2014’” and “RN states she recalls the discussion because of how long the plane flight was. (She had personal experience with very long plane flights). Attached no further significance to this travel history.”

The detailed timeline of events continues, “This information was not verbally communicated to the physician, as prompted by the EHR.” The Emergency Department physician performed his evaluation of Duncan from 12:52 to 1:10 a.m. The timeline recalls that the physician did access the EHR, but, “The record does not show which information the physician read, only which information was available.”

These data, as reflected in the EHR, reveal that Mr. Duncan and his companion advised
that he was a “local resident”, that he had not been in contact with sick people, and that
he had not experienced nausea, vomiting or diarrhea.

It looks like he didn't go into great detail about his travel history. If he stated just "Africa", and not a country IN Africa, it could be why he slipped through the cracks. Africa is a big continent with 47 countries. It seems it was Mr. Duncan and his "companion" are the ones who lied. Only if they had been honest the staff, they may have caught it giving him a better chance. All they had to do was say, "Yes, I'm from Liberia. My neighbor got sick and died a few days before I came here." Hopefully the staff would have, then, tested him. It's that lie that cost him and exposed American citizens.

However, the staff wasn't thorough, either. They should have inquired and documented the exact country visited. (It's not like the Ebola outbreak hasn't been on the news for months.) Maybe the CDC rhetoric about Ebola not coming here had a play in it. Who knows. But hindsight is 20/20.

There was also a hearing on the whole Ebola response, if you have the time. (I didn't see this pop up in a search. Apologizes if already posted. )


If for some reason the links above don't work, try here: 1. preparedness timeline 2. sequence of events

a reply to: blackcatmagic

Glad you started this thread. I haven't read them all because I get frustrated at the level of misinformation. This man is condemned and not given the benefit of the doubt.

The timeline later showed that there was an RN assessment from 12:33 to 12:44 a.m. At that point, “The nurse documents that Mr. Duncan ‘came from Africa 9/20/2014’” and “RN states she recalls the discussion because of how long the plane flight was.

Looking at this Africa is a big country and ebola is only in 3 countries in west Africa.

I have looked for an official checklist from the CDC and found none. This is as close as I can find

cdc

Person Under Investigation (PUI) A person who has both consistent symptoms and risk factors as follows:
Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND

epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.

So it appears hospitals have to make up their own checklist. Nowhere does it mention West Africa or specific countries.

As I have said before, I am a news junkie.

According to CNN, who seems to have broke this story of his lying, he took the young woman to two hospitals where she was not admitted, thus no ebola test. Then took her home where she died overnight.

According to a much later CNN report by a reporter who seems to be from that country, everyone thought the problem had to do with her pregnancy as she was 7 months pregnant. She died the next day and was buried. She never had an ebola test. The diagnosis was made by contact tracing. This was highly unlikely to have been completed prior to Duncan's flight to America.

Mr. Duncan didn't lie if they didn't ask the proper question. And it appears to me he didn't know the woman was sick.

Excellent. Glad you took my suggestion and ran with it. Well done.

a reply to: liveandlearn

Only in three countries in Africa?

It is officially in five.

One would think that a self-described "news junkie" would have at least that basic fact right.

He lied.

a reply to: blackcatmagic

We did a walk through scenario today at one of our EDs and we identified issues with our electronic records similar to what this is reporting.

Firstly there are major issues with treating an EVD if they just show up unannounced at an ED and i wont go in to them all but regarding electronic records we have the follow issue.

A person comes into ED gets assessed by a nurse using our triage system, this is electronic and automatically save all the information to a file, its about 2 pages when complete which includes travel history. However after the initial triage assessment they have to be assessed medically by a doctor. When the doctor comes to see the patient generally they will only have the most needed information from the triage assessment, this is 1 page that is automatically printed out - it does not contain the travel history. We have changed this now so that it does have it on the medical form the doctor will be relying on otherwise they are essentially going in blind.

Having said that i dont think it would be an issue anymore.. just mentioning that youve been in Africa is likely going to get the ED locked down before anything else happens... we have 2 ED lock down now because nurses panicked at hearing Africa and immediately thought EBOLA!!! in reality the patients were no where near any danger of ebola and have both been properly assessed treated and discharged. At the end of the day its better safe then sorry however as time goes on its not practical to have a major ED closed for over an hour because of fear.

a reply to: Deny Arrogance

Only three now. Liberia, Sierra Leon and Guinea.
Senegal and Nigeria both have now passed through 42 days without a cases with WHO declaring them EVD free which is a bit of good news to come out of this whole thing.

Although at the time of his presentation to the ED it would have been 5.