In this article, we are going to discuss what Ebola is, how it is spread, how we prevent its spread, and how we treat it in the field. A few years ago there was an Ebola outbreak that caused widespread panic and in order to combat this panic, we want to educate ourselves on how this happens and what we can do about it. There is still a lot of research that is being done on Ebola to determine how to best combat it, cure it, prevent it, and reduce its effects on us.
Ebola is the name for a combination of 4 viruses that infect humans, one virus strain that affects primates and pigs, and one virus strain that isn’t fully understood yet. Of these Zaire ebolavirus, Sudan ebolavirus, Tai Forest ebolavirus, and Bundibugyo ebolavirus affect humans. Reston ebolavirus affects primates and pigs, and Bombali ebolavirus was found in bats but it is unclear what its effects are on other species. Ebola is rare and it is typically found in sub-Saharan Africa. It was originally discovered near the Ebola River in the Democratic Republic of Congo. Every once in a while there is an outbreak that occurs in several African countries that is thought to originate with bats. When a bat carrying the virus comes in contact with humans either through touching the bat's bodily fluids or eating it they can spread the virus.
Now that we know what it is, let’s discuss how it gets spread? Ebola can spread through contact with bodily fluids or touching an object that has bodily fluids on it. It starts with a bat or non-human primate and then moves into humans from there. Bodily fluids that can transmit Ebola include tears, sweat, saliva, vomit, urine, blood, feces, vaginal fluids, breast milk, and semen. If these come in contact with broken skin or mucous membranes in the eyes, nose, or mouth the person can become infected. This can include contact with a syringe that was used on an Ebola patient, linens that have bodily fluids on them, or handling infected fruit bats or non-human primates. Ebola cannot be spread if the person isn’t showing signs or symptoms, and it cannot be transmitted through food. There has not been any research that shows that Ebola can be spread by mosquitoes. It has been found, however, that Ebola can still be spread after a person recovers from Ebola if someone has contact with their semen, breast milk, cerebrospinal fluid, or ocular fluid. This is because the virus can still be present in these fluids after it is cleared from the body. However, it is unknown how long the virus can stay in the body. It has been noted that Ebola can survive outside the body on surfaces such as counters and door handles for several hours, and it can survive in blood and other body fluids at room temperature for several days. In areas with an outbreak, cats and dogs have been noted to carry the virus but not develop symptoms or infect others.
What are the signs and symptoms of Ebola? These symptoms can include fever, headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal pain, and unexplained hemorrhage such as bleeding and bruising. Symptoms of Ebola can surface anywhere from 2-21 days after contact with an infected person, however, the most common incubation period is 8-10 days. With the exception of bleeding and bruising these symptoms are common in many viral illnesses. That is why it is important to get a good history from the patient to determine if they have recently been to an area where an Ebola outbreak has occurred.
Now that we know what we are looking for, how do we treat it in the field? This will be determined by your local protocols. The most important thing you can do is get them to a hospital where they can receive supportive care such as IV fluids, treatment of infections, and control of nausea/vomiting and blood pressure. In the field, you can place an IV to administer IV fluids, you can administer nausea medications, and you can support blood pressure with fluids and/or Dopamine, Epinephrine, or Norepinephrine drips. As of yet, there are not any antivirals that are effective on Ebola and there are no vaccines. However, research is being conducted to determine if a vaccine, antiviral, or blood transfusion from an Ebola survivor would be effective.
If we have an Ebola patient, how do we prevent the spread to us or to our other patients? The most effective way to prevent the spread of Ebola is to have good hand washing hygiene and use proper PPE. Ensure you have a mask, gown, gloves, and any other department provided equipment to help isolate yourself as much as possible. Wash your hands frequently with soap and water or use an alcohol-based hand sanitizer. We frequently touch our faces without even realizing it. It is important to make sure that we do not touch any mucous membranes with hands that may have Ebola virus on them. We should also avoid contact with any bodily fluids or items that may have come in contact with bodily fluids. If you place an IV make sure that you place the needle in the sharps, and if you administered medications place the syringe in a biohazard bag and make sure to wash your hands well with soap and water before touching or eating anything. If you travel to a country that is having an Ebola outbreak monitor yourself for symptoms and seek medical treatment if you develop symptoms.
What do we do when we are treating an Ebola patient or a suspected Ebola patient? If we suspect Ebola we should try to have only one person interact with or touch the patient if at all possible. This way we limit the possible amount of contacts with bodily fluids. You should wear gloves and a gown, some places recommend two pairs of gloves, and if the patient is vomiting or bleeding you should also wear a mask and face shield to prevent droplets from getting into your eyes and mouth. If you have contact with an Ebola patient you should not get into the cab of the ambulance and drive, if possible, as these are harder to disinfect. Once in the back of the ambulance try to limit the number of sharps that are used on a patient. If the patient is stable without an IV, do not place one as this increases your risk of coming into contact with bodily fluids. You can administer oral antiemetics, and if the patient is vomiting have them vomit into a biohazard bag so that it can be contained and disposed of properly. If they are having diarrhea wrap them in an impermeable sheet to prevent diarrhea from coming in contact with anything in the ambulance. Be sure to inform the hospital that you are transporting a suspected Ebola patient so that they have a room ready for the patient and can lessen the chances of exposure of other individuals. You can expect an Haz-Mat type of response should you ever transport a patient like this. You will most likely encounter a Hazardous Materials team that will help isolate you, your ambulance, and the patient upon arrival. The more time you can give the hospital to prepare the better.
In summary, Ebola is a series of viruses that are spread through contact with bodily fluids or objects with bodily fluids on them. If you suspect a patient has Ebola, then limit provider exposure, wear appropriate PPE, and inform the hospital. Wear appropriate PPE when disinfecting the ambulance, and use a disinfectant that is effective against nonenveloped viruses.