Some hospital, somewhere in the United States, was going to be the first. Texas Presbyterian in Dallas was the one. In spite of the mistakes made there, it was fortunate that Thomas Duncan decided to go to the emergency department of a large, sophisticated, well-resourced hospital. If he hadn’t, the outcome and potential ripple effect could have been much worse. I will speak for many doctors, nurses and healthcare executives I know and say what we all think, “There but for the grace of God go us all.”
The Ebola scare has raised many questions. One of them: Is the healthcare system in Miami ready to receive an Ebola patient? Yes, and more than most. We are well-versed in emergency preparation as a community prone to natural disasters, and we have survived a few man-made ones as well. The institutional memory of Hurricane Andrew is strong at Baptist Health South Florida, with many people here having not only survived it, but shown up for work the next day to take care of the patients who were their friends and neighbors. I trust them implicitly in any crisis, including one as unfamiliar as the Ebola virus. That Andrew memory also includes a vivid one of Kate Hale, then the Director of Emergency Services for Dade County, standing up before the national media saying, “Where the hell is the Cavalry?” What she meant was that we had a circumstance that was beyond our ability to handle completely on our own. Eventually, the Cavalry did come. I see parallels with the current situation.
Baptist Health staff train year-round for disasters of every kind. We have a dedicated Department of Emergency Preparedness that coordinates our readiness among our six hospitals and 30-plus outpatient centers. We send surgical and primary care teams to Haiti, because they need the help, but also because those missions put our clinical staff through arduous, real-time training under adverse conditions. With this latest turn of events, training has been accelerated and personal protective gear has been modified to comply with CDC guidelines. Even with this level of commitment, we must consider the appropriate role of our local health system in a crisis that has not only a national scope, but also national security implications. The current plan, in practice but not guaranteed by anyone in authority, is that we will locally receive potential Ebola patients, diagnose them, isolate them, begin treatment, and prepare them for transport to a CDC-designated bio-containment facility. We will then go through a rigorous decontamination process and return the hospital to full community service. That plan works, unless there is an escalation in the numbers; if there is, this solution falters.
Texas Presbyterian, a very good hospital and a major community asset, has been brought to the brink of collapse. Fortunately, Dallas has many other good hospitals, but what if a city or town had only one trauma hospital or one safety net hospital? I suggest, strongly, that a bio-containment unit be established for each major population center in the United States, on federal or military property. It is the safest, most practical thing to do and in our community we have a resource available. Homestead Air Reserve Base is a well-situated, secure environment that is easily accessible by ground or air. A mobile field hospital could be established there on the underutilized grounds. Staffing could be provided locally through the resources of a large health system like Baptist Health South Florida, our two medical schools at Florida International University and University of Miami, as well as the Jackson Hospitals.
It is not the time for false bravado. The healthcare professionals in South Florida are courageous on a daily basis, but the right thing to do, both for the safety of the patients and the staff is to thoughtfully deploy our resources in the most effective manner.With a dedicated facility, a secure environment, and motivated volunteer staff, the right thing is done for both these patients and the community. Let’s learn from the brave nurses and doctors at Texas Presbyterian, and let’s also remember Kate Hale calling for the Cavalry and not wait until the storm hits to put a solution in place. Mr. Brackin may be contacted at wayneb@baptisthealth.net.
