I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About Ebola

Note: In response to some comments, I would like to clarify that I am FEMA-trained in level 3 hazmat in a hospital setting. I am a student, health guide and writer, but I am not a nurse.

I've worked in health care for a few years now. One of the first things I took advantage of was training to become FEMA-certified for hazmat ops in a hospital setting. My rationale for this was that, in my home state of Maine, natural disasters are almost a given. We're also, though you may not know it, a state that has many major ports that receive hazardous liquids from ships and transport them inland. In the back of my mind, of course, I was aware that any hospital in the world could potentially find itself at the epicenter of a scene from The Hot Zone. That was several years ago. Today I'm thinking, by God, I might actually have to use this training. Mostly, though, I'm aware of just that -- that I did receive training. Lots of it. Because you can't just expect any nurse or any doctor or any health care worker or layperson to understand the deconning procedures by way of some kind of pamphlet or 10-minute training video. Not only is it mentally rigorous, but it's physically exhausting.

PPE, or, personal protective equipment, is sort of a catch-all phrase for the suits, booties, gloves, hoods and in many cases respirators worn by individuals who are entering a hot zone. These suits are incredibly difficult to move in. You are wearing several layers of gloves, which limits your dexterity to basically nil, the hoods limit the scope of your vision -- especially your peripheral vision, which all but disappears. The suits are hot -- almost unbearably so. The respirator gives you clean air, but not cool air. These suits are for protection, not comfort. Before you even suit up, your vitals need to be taken. You can't perform in the suit for more than about a half hour at a time -- if you make it that long. Heat stroke is almost a given at that point. You have to be fully hydrated and calm before you even step into the suit. By the time you come out of it, and your vitals are taken again, you're likely to be feeling the impact -- you may not have taken more than a few steps in the suit, but you'll feel like you've run a marathon on a 90-degree day.

If you're wearing a respirator, it needs to be tested prior to donning to make sure it is in good condition and that the filter has been changed recently, so that it will do its job. Ebola is not airborne. It is not like influenza, which spreads on particles that you sneeze or cough. However, Ebola lives in vomit, diarrhea and saliva  -- and these avenues for infection can travel. Projectile vomiting is called so for a reason. Particles that are in vomit may aerosolize at the moment the patient vomits. This is why if the nurses in Dallas were in the room when the first patient, Thomas Duncan, was actively vomiting, it would be fairly easy for them to become infected. Especially if they were not utilizing their PPE correctly.

The other consideration is this: The "doffing" procedure, that is, the removal of PPE, is the most crucial part. It is also the point at which the majority of mistakes are made, and my guess is that this is what happened in Dallas.
The PPE, if worn correctly, does an excellent job of protecting you while you are wearing it. But eventually you'll need to take it off. Before you begin, you need to decon the outside of the PPE. That's the first thing. This is often done in the field with hoses or mobile showers/tents. Once this crucial step has occurred, the removal of PPE needs to be done in pairs. You cannot safely remove it by yourself. One reason you are wearing several sets of gloves is so that you have sterile gloves beneath your exterior gloves that will help you to get out of your suit. The procedure for this is taught in FEMA courses, and you run drills with a buddy over and over again until you get it right.

I'm a Hazmat-Trained Hospital Worker: Here's What No One Is Telling You About Ebola

I know I may have quoted a bit more than what people like but it is for a good reason. This guy knows what he is talking about and has gone through the proper training for being a Hazmat specialist. The nurses in the States and up in Canada aren't being properly trained. Is it any wonder those nurses got sick in Dallas? I mean let's be realistic here, this is a situation that was meant to get out of hand and it is right on course.

And the three thousand or so soldiers who are being taught one four hour class in groups of fifty? How well trained are they?

originally posted by: charles1952
And the three thousand or so soldiers who are being taught one four hour class in groups of fifty? How well trained are they?

My guess is well trained, after all

The procedure for this is taught in FEMA courses, and you run drills with a buddy over and over again until you get it right.

I would also like to know how you know that each class has 50 people in it.

a reply to: charles1952

we get sh1t done

a reply to: Sabiduria

Dear Sabiduria,

Good question. I read it in one of the government press releases on the subject. If you would like, I'll start searching for it again, but I'd rather not tackle it tonight (rather, this morning).

With respect,
Charles1952

a reply to: Sabiduria
I've been through HazMat training - 25+ years ago...
Even then, and even graduating top of the class...I emerged thinking that if I ever had to use that training...I would be a 'goner' - 'cause I would doubtless forget half-or-more.
For the healthcare workers' sakes - I hope they've had some recent refresher courses...and everyone took it seriously.

a reply to: Sabiduria

The nurse asst. in Spain that got infected only had about 30 minutes training according to her husband

from her husband:

In a scathing letter, Javier Limon, her husband, said she received only 30 minutes of training in putting on protective gear and called for the resignation of Madrid's regional health minister over how the case has been handled.

"Please explain to me how one puts on a protective suit, since unfortunately my wife doesn't have a master's degree in that," Limon wrote in a letter distributed by a family spokeswoman. "Teresa had 30 minutes or a little more to learn how to do so through a colleague."

So much can be prevented with proper care and training
But to say a 30 min. training drill will do it, is ignorant at best

Bless the medical staff for trying, it's not their fault that they are having to learn as they go
Just hope the next mistake doesn't cost someone their life

a reply to: charles1952

Whenever you have the time would be nice. No rush

a reply to: snarky412

Yes I know 30 minutes is not enough, I didn't say it was.

Nor did I say that it is the nurses fault for getting sick, they were supposed to get Ebola. That's why they aren't being trained properly.

originally posted by: Sabiduria
a reply to: snarky412

Yes I know 30 minutes is not enough, I didn't say it was.

Nor did I say that it is the nurses fault for getting sick, they were supposed to get Ebola. That's why they aren't being trained properly.

I was only adding to your OP, not arguing

Just showing what the guy in the article was saying was true
It takes time and practice to get the correct procedure right, as shown with these mishaps with the nurses that only had little to no training


Much respect~
snarky

link to the main article.

Good write up on the PPE, but I'm not sure it's anything we didn't know. I thought we knew most hospitals aren't doing it correctly, poor training, if any, and lack of proper hazmat suits etc.

The headline is misleading but none the less a good job explaining how to suit up in the. PPE and removal of it.

I use to enforce protocols in the gown up/down and decon area's. Some cases write up repeaters. Inspect and write hazard reports. People without thinking touch their faces, forget to double glove, forget procedures how to properly take gloves off. Yes, there is a proper way to take gloves off believe it or not. They snap their gloves as they take them off, which flings stuff around. Forget their footwear and booties. Forget eye protection and face shields. They would try to grab for new gloves out of boxes with contaminated gloves on. I could go on and on, but you get the point. You wouldn't believe some of the idiot stuff I have seen. So nurses and doctors getting Ebola? Yep, I believe it. Protocol is worthless if you don't have someone standing over their shoulders reminding them.

reply to: Sabiduria

I hope you won't mine me making copies of your post and disseminating them to my co-workers and friends. You made all the points that I have tried to stress.

I too was given what used to be called chemical warfare training, as a healthcare worker in the military. I thought the training was excellent. Having said that, I have to add that after my meager one week of training I came away fully aware that I had been educated, "not" trained.

The training was an education. It did not make me skilled or proficient. Any real expert in anything, will quickly tell you, it is not the ordinary, the sandard or mundane that is going to win the moniker of "expert" or even the label of experienced. It is having put in the time and having to come face to face with the unexpected and the unknown enough times to recognize the limitations and dangers of the process while having to stay ten feet ahead of the next deadly surprise.

I keep reinforcing this fact with my co-workers, that those lectures and videos are nothing more than information. The lie that they are going to make it safe for them to work with Ebola patients in a hospital setting can get them killed, along with possibly a few other people. It will never be "safe". It will only serve to make you aware and hopefully careful. It does not make you ecperienced and as many people say, "A little bit of knowledge can be dangerous."

I think your post will drive home the concerns that I have tried so hard to get them to see. I don't want them to be afraid, but I don't want them walking around with a false sense of security believing they are safe because they listened to a lecture and watched a video.

a reply to: sean

Probably the most important part of the safety process that is overlooked, and the position that can be the most stressful jobs in the safety process, is the observer.

Take 80 people all trained for a week. At some point one person will make a mistake. All it takes is 1 mistake. It seems the best way is to limit how many people are exposed to that area of contamination. I think they said 78 people came in the contact area of Mr Duncan, the first case. Seems like way too many.

a reply to: violet

The giant pink mastadon in the room, is that training without experience is useless.

You wouldn't let a doctor do brain surgery on you after he read a book, watched a couple youTube videos and practiced on a few dogs and cats.

The emergency training is great but is it sufficient?

Remember these workers will be returning home and to their communities.

a reply to: Sabiduria

Thanks. I especially like that bit in the last paragraph.

....We have the technology, and we certainly have the money to keep Ebola at bay. What we don't have is communication. What we don't have is a health care system that values preventative care. What we don't have is an equal playing field between nurses and physicians and allied health professionals and patients. What we don't have is a culture of health where we work symbiotically with one another and with the technology that was created specifically to bridge communication gaps, but has in so many ways failed. What we don't have is the social culture of transparency, what we don't have is a stopgap against mounting hysteria and hypochondria, what we don't have is nation of health literate individuals. We don't even have health-literate professionals. ....

F&S&

a reply to: Sabiduria

I am as well. Very well said. Thanks for explaining our training.
MS
ERT/EMT
ADLS Life Support
Bio-Defense Network
FEMA Region 2 South

a reply to: Sabiduria
I was trained in NBC, MOPP, and Hazmat during my military time.

Sadly I can state that less than 30% Of my fellow soldiers passed the tests needed to show competancy in the areas. However the army passed them anyway(test them until they might accidentally pass).

This is kinda the norm. Makes the schools look better on paper.

So out of every group of 20 soldiers only 5 or so even paid attention or learned anything.

When I spoke to my supervising NCO about this I was told that how it appeared on paper was the important thing.

originally posted by: Sabiduria
a reply to: snarky412



Nor did I say that it is the nurses fault for getting sick, they were supposed to get Ebola. That's why they aren't being trained properly.

That little statement requires some explanation.

Why were the nurses supposed to get Ebola?