Summary: A 2021 drill evaluating a patient under investigation for Ebola Virus Disease (EVD) revealed a significant vulnerability in the Emergency Department (ED) workflow, resulting in a loss of access to critical elevators, ED radiology, and ED treatment areas. This report describes the development and implementation of a new treatment area and process to care for patients with concerns for Viral Hemorrhagic Fevers (VHF). ED Administration and the Division of Disaster Preparedness performed a Gemba walk to evaluate ED Viral Hemorrhagic Fever workflows and assess treatment areas that minimally impact the ER flow. For Walk-ins: The Gemba walk identified an underutilized triage room outside the main ED. This room was converted to a “Hot Triage” room, where high-risk patients are cared for outside the ED. This allows other patients to navigate the entire ED without crossing the VHF patient’s path. For EMS: The Gemba walk identified that EMS patients should not proceed past ambulance triage, otherwise significant closures would occur. Therefore, EMS should transport patients into the decontamination showers directly from outside the building. If patients make it into ambulance triage, the door to that area can be secured, and a team will manage the patient there. A just-in-time training document was created that describes the novel workflows above and delineates the preparation that must be taken before entering the patient’s room. A PPE cart was developed that included pre made kits for VHF patient evaluation. Medical equipment listed in the document and found in the cart included telemonitor, resuscitation supplies, POC blood gas and malaria PCR cards, baby monitor, and critical contact numbers. Identifying appropriate care areas is crucial to a comprehensive VHF response plan. By isolating and evaluating potential VHF patients early and outside the department, EDs can minimize the risk of transmission and maintain hospital operations.
Doukas et al. (2026) studied this question.