Perspective Piece Being Ready to Treat Ebola Virus Disease Patients

As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontieres, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD. An unprecedented number of health care professionals from a variety of clinical settings, in a wide range of countries are thinking about, preparing for and caring for Ebola virus disease (EVD) patients. Guidance documents on infection prevention and control (IPC) practice and clinical care have been pro- duced by organizations with EVD experience. 1-3 The World Health Organization (WHO) produces guidance for implemen- tation across a wide range of resource settings. Medecin Sans Frontieres produces guidance for medical team activities across the outbreak. The Centers for Disease Control and Prevention (CDC) focus on measures which can be taken by the United States health system and extrapolated by others involved in preparedness and response. There are no short cuts to clinical preparedness for EVD. These documents and their revisions should be reviewed carefully. As important as guidance documents are, many lessons must be learned from specific hands-on experience. The WHO has mobilized clinical consultants in support of EVD response in each of the affected countries in West Africa. This short list of key points attempts to consolidate practical lessons learned that do not always percolate into technical documents. Having landed in unconstrained, resource-limited settings at the start of local EVD clinical operations in an outbreak, and more established EVD care centers, we hope that others might adopt some of these lessons and avoid some of the risks inherent to the steep learning curve associated with delivering EVD care. The points are geared toward the daily care of patients as opposed to the critical mechanics of establishing a care center and develop- ing its procedures. They are focused on the outbreak setting and also have relevance to the referral hospital setting.