1. Region 9 Healthcare Coalition Ebola Symposium April 23 rd, 2015

2. Navigating Readiness Went through countless drafts of policies/procedures/competencies Utilized the Emory Policies extensively Had the opportunity to visit Emory in February to hear first hand about their experiences 2

3. Pre-Hospital Transport Plans All potential Ebola patients from other facilities will be direct admit to the ICU. Patients arriving via EMS will be screened by the ambulance service prior to arrival in accordance with the Spokane County EMS and Trauma Care Council’s Suspected Ebola Virus Disease EMS protocol 3

4. Emergency Department Preparedness All ED staff trained in PPE Triage staff asking the screening questions and responding appropriately Rooms identified for isolating patients 4

5. Staffing of the Ebola Patient Care Team After the Texas Health situation, there was extreme concern from the ICU staff over safety. Much discussion in report and during breaks Conversations around the ethics of refusing to care for these patients A call went out for volunteers for the team 24 staff stepped up, most after word went out that the management team of the unit were being trained 5

6. Staffing of the Ebola Patient Care Team On Call list initiated if patient with “some risk” identified by the Health District to be in the community Staff competencies developed for PPE, patient care, lab procedures, Environmental Services and Waste Management Critical Care Intensivists trained on PPE and telehealth/e-stethoscopes 6

7. Telehealth Provided by PH&S 7

8. Patient Placement 2 South ICU was identified as the unit the patients would be admitted to. 4 Negative air flow rooms, along with 2 anterooms. Rooms connected by a hopper room. 1 room for patient care, 1 room for waste and doffing of PPE. Adding toilets to the rooms 8

9. Monitoring Healthcare Personnel and Managing Exposures 9

10. A nurse who is part of the assigned care team will be stationed in the anteroom to monitor entry of personnel into the room Names will be kept on a log and faxed to Employee Health daily Employees to log into EHS Sharepoint website and enter current body temperature and responses to symptom questions 10

11. Monitoring Healthcare Personnel and Managing Exposures This will be done the beginning with the first day of contact with the patient, patient’s lab specimens, or with the waste stream and will continue twice daily through the end of the 21 st day from the last shift worked, including days when not scheduled to work. EHS will provide an Ebola monitoring kit which includes a thermometer, copy of the policy, phone numbers and log in information 11

12. Laboratory Safety Separate lab area set up in the SHMC lab. Volunteers stepped up to man that lab iSTAT training for the ICU staff, procedure written for transport of specimens. Lessons learned: false alarm case came into the ED, blood tubed to Lab, YIKES!! 12

13. Management of Waste Mike Charles, Director of Environmental Services, worked with Steri-Cycle for agreement of transport of waste Procedure developed for waste disposal in the toilets including rinsing with bleach Secure area built at street level for waste storage 13

14. Lessons Learned from CDC visit Shrouds for PAPRs did not allow for removal of CO2, RN would slowly pass out and die, not what we wanted!! 14

15. Carpeting at entrance of Emergency Department should be removed and replaced with non-porous floor covering Need for a specific area for EMS to doff PPE and decontaminate the truck High praise for the incorporation of Ethics into the plan, had not seen that before to the extent addressed at PSHMC 15

16. We Are Ready, Willing and Able This was an amazing team effort From start in October to CDC visit in December all responses to any requests were “what do you need and when do you need it?” All involved Department Managers fully engaged and supportive of their staff 16

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