Ebola Virus Disease (EVD) Screening
Emergency Department screening criteria for patient isolation/testing are likely to be:
1. Fever, headache, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite, and in some cases bleeding.
2. Travel to West Africa (Guinea, Liberia, Nigeria, Senegal, Sierra Leone or other countries where EVD transmission has been reported by WHO) within 21 days (3 weeks) of symptom onset.
If both criteria are met, then the patient should be moved to a private room with a bathroom, and STANDARD, CONTACT, and DROPLET precautions followed during further assessment.
IMMEDIATELY Report Person Under Investigation (PUI) for Ebola to:
1. Hospital Leadership
2. Local and State Public Health Authorities
3. U.S. Centers for Disease Control and Prevention (CDC) by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 or via email at .
Case Definition for Ebola Virus Disease (EVD)
Early recognition is critical for infection control. Health care providers should be alert for and evaluate any patients suspected of having Ebola Virus Disease (EVD).
Person Under Investigation (PUI)
A person who has both consistent symptoms and risk factors as follows:
1. Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
2. Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.
A. PUI whose epidemiologic risk factors include high or low risk exposure(s) (see below)
A. case with laboratory-confirmed diagnostic evidence of Ebola virus infection
Exposure Risk Levels
-Levels of exposure risk are defined as follows:
-High risk exposures
-A high risk exposure includes any of the following:
•Percutaneous (e.g., needle stick) or mucous membrane exposure to blood or body fluids of EVD patient
•Direct skin contact with, or exposure to blood or body fluids of, an EVD patient without appropriate personal protective equipment (PPE)
•Processing blood or body fluids of a confirmed EVD patient without appropriate PPE or standard biosafety precautions
•Direct contact with a dead body without appropriate PPE in a country where an EVD outbreak is occurring*
Low risk exposures
A low risk exposure includes any of the following
•Household contact with an EVD patient
•Other close contact with EVD patients in health care facilities or community settings. Close
contact is defined as
1. being within approximately 3 feet (1 meter) of an EVD patient or within the patient’s room or
care area for a prolonged period of time (e.g., health care personnel, household members) while not wearing recommended personal protective equipment (i.e., standard, droplet, and contact precautions; see Infection Prevention and Control Recommendations
2. having direct brief contact (e.g., shaking hands) with an EVD patient while not wearing recommended personal protective equipment.
•Brief interactions, such as walking by a person or moving through a hospital, do not constitute close contact
No known exposure
Having been in a country in which an EVD outbreak occurred within the past 21 days and having had no high or low risk exposures
* As of 30 August 2014, EVD outbreaks are affecting multiple countries in West Africa (see Affected Areas)
1 For purposes of monitoring and movement restrictions of persons with Ebola virus exposure, low risk is interpreted as some risk.
ACOEP is speaking out for you! Recently, ACOEP co-signed a letter in response to a survey conducted by Doximity and US News & World Report ranking residency programs. ACOEP and other top emergency medicine organizations oppose this survey and on Monday, September 22, ACOEP President Mark Mitchell, DO, FACOEP will meet with the editors of US News & World Report to discuss the findings as well as the flawed methodology of the survey.
Click here to read the letter to US News & World Report.
The American College of Osteopathic Emergency Physicians (ACOEP), a national association representing the interests of osteopathic emergency physicians, stands in support of the Memorandum of Understanding for a single pathway for graduate medical education in the United States and uniting the educational systems of the Accreditation Council of Graduate Medical Education (ACGME) and the American Osteopathic Association (AOA).
ACOEP holds the strong belief that without the training opportunities made available through this single pathway the osteopathic profession will be unable to train its graduates and ultimately all specialties will fail. While it cannot comment on other specialty areas, it feels strongly that emergency medicine residency programs will be able to transition over the five-year period and continue to train emergency physicians to care for the American public.
“After long and meaningful discussions with leaders and members of ACOEP we are confident in this endorsement,” says ACOEP Board President Mark Mitchell, DO, FACOEP. “Although we have some areas of concern, we are confident that these steps will ultimately benefit physicians and patients alike.”
One such concern is comments made regarding the credentialing and recognition of program directors in current osteopathic programs. ACOEP strongly states that this core group of physicians has more than proven their capabilities to effectively train highly qualified emergency physicians and should not be made to apply for positions that they have held for years. The College’s credentialing processes, from scholarly activity to board and continuing certification has kept pace with ACGME standards and their credentialing processes. The AOA, American Osteopathic Board of Emergency Medicine (AOBEM) certification should be recognized as equal to American Board of Medical Specialties (ABMS)/American Board of Emergency Medicine (ABEM) certification.
Prior meetings between ACOEP and the ACGME Resident Review Committee (RRC) for Emergency Medicine produced few discrepancies within each set of standards. Major areas of concern were identified as protected time for program directors/ associate program directors, and core faculty, as well as faculty research requirements. At the meeting in April 2014, ACGME officials did not find AOA certification or the program length to be issues. Currently 11% of AOA emergency medicine programs are dually accredited with AOA/AOBEM certified physicians holding program director positions.
Please take a moment to read this important letter from ACOEP, EDPMA and ACEP regarding standard health plan covereage and emergency services; cost-sharing requirements for use of emergency department services; transparency, and more.
Click Here to download the important memo from ACOEP EDPMA and ACEP.