First time in the Hot Zone

     When we walked through the gate, our CDC status changed immediately from 'no identified risk of Ebola' to 'minimal risk of Ebola'.  Today we entered the 'hot zone' for the first time.  No patient care, it was primarily a drill in donning and doffing our personal protective (PPE) with an extensive tour through the 'hot zone' in the MoD One Ebola Treatment Unit (ETU).  Crossing into the hot zone entails potential exposure to Ebola with intact PPE.  That degree of potential contact raised my risk status to minimal.  It will be raised further once I begin patient care to 'some risk of Ebola'.  

     There are exacting procedures for the placement and removal of these protective suits.  Everyone checks each other and there are safety personnel who monitor you while you don the multiple layers of Tyvek, goggles, mask, gloves and boots.  Removal is even more intense as that is the operation which has resulted in the majority of identified Ebola healthcare provider exposures.  You remove the suit as a team with chlorine sprayers a/hygienists directing your actions.  You can't perform healthcare in an ETU until you have completed training.  We will all be paying close attention in class.

     These suits can be quite warm.  With the temperature in the low nineties and quite muggy, these essentially air tight suits can generate temperatures of over 120 degrees Fahrenheit.   Due to this, we are limited to 45 minutes at a stretch in the suits.  While you know you are hot, you don't have a good feel for how much you are sweating.  When in the hot zone, you don't want your hands to go above your nipple line.  Gloves are the most contaminated part of your suit and you don't want your hands near your face.  You also don't want to let your hands drop onto your apron which is the next most likely contaminated part of your suit.  That leaves you hands held with your forearms level much of the time.  That allows the sweat to accumulate in the arms of your suit and to slosh around when you use your arms.  Altogether, I needed to chug two bottles of water when I had completed disrobing.

     We also toured the U.S. Public Health Service ETU which is located near the airport.  It is a more sophisticated ETU which is staffed entirely by Public Health Service physicians and nurses.  It is there solely to evaluate and take care of health care personnel (of any nationality) who becomes symptomatic.  Usually, it is something other than Ebola, but of course there have been positive cases as well.

     Tomorrow is a light day while we wait for our official cold training to start on Monday.  Please keep everyone here in your prayers.