Tappita Fashion

     Heart to Heart's Website recently featured our ambulance section practicing operations in their Personal Protective Equipment (PPE).  PPE is a subject near and dear to everyone that works in the hot zone of an Ebola Treatment Unit (ETU).  There are very specific sequences and methods which are used to put on (or don) and take off (or doff) PPE.  These methods are taught initially in 'cold training' and reinforced in 'hot training' and shift work in ETUs.  This training is conducted by different organizations in different locations and there are often slight differences in the way it is taught.  Some organizations may teach 3 pairs of gloves, some will teach 2 pairs.  Some will place the straps of the goggles inside the first hood (of the Tyvek suit) and some will place the straps over the first hood and under the outer hood.  Some will seal the cuffs of the outer gloves to the suit with tape, others won't.  These may sound like trivial differences, but they aren't, or maybe they are.  The problem is that nobody knows for sure.  You can always add a little more 'just to be safe', but sometimes that addition may make doffing of the PPE more cumbersome increasing the chance for error.  The majority of identified healthcare worker Ebola exposures have occurred during doffing.  

     You are also much more comfortable with the method in which you were trained.  Standardization of methods helps reduce errors, but how do you accommodate differences in training when the feelings about the styles are passionate.  It isn't surprising that people are passionate when potential problems could mean yours or others survival.  Or maybe not, and you can't know for sure.

     We faced that dilemma in our ETU with two groups that trained under different systems.  Each side felt passionately about their method and there wasn't much inclination to compromise, which was a problem if we were to maintain some degree of standardization for doffing.  We eventually decided, by majority vote, for the less stringent methods, but that left many of our members, including the Liberian staff, very unhappy.  

     The next morning, a team from the CDC arrived at the ETU unannounced.  They had come to investigate reports about the village with multiple unexplained deaths.  That village was in our area so they stopped by our ETU before going to the village.  Providentially, their team included an expert in PPE!  We had a wonderful question and answer period and were able to resolve our disputes.  It felt like a pretty contrived happy ending, but that is what happened.  It was good to resolve this question before we had our next patient, who arrived the next day from the village that the CDC was investigating.