JOINT BASE SAN ANTONIO-FORT SAM HOUSTON – The Defense Department’s unprecedented mission of establishing a 30-member team to rapidly and effectively respond to any potential Ebola virus outbreak in the U.S. has brought some of the U.S. military health system’s best medical professionals together.
One member of the joint team brings real-world experience treating Ebola patients to the DoD training course that will assist in advancing the group’s proficiency. Navy Cmdr. (Dr.) James Lawler, chief of the clinical research department of the bio-defense research directorate, Naval Medical Research Center, Fort Detrick, Maryland, discussed his role on the DoD team serving as a subject-matter expert on Ebola treatment.
“I’ve had the opportunity to work in a couple of isolation treatment units in sub-Saharan Africa,” he said, “and recently, in May, I was at the Ebola treatment unit in Conakry, Guinea, as a consultant for the World Health Organization. He also worked with the local health ministry and with Doctors Without Borders, which runs the Ebola treatment unit in Conakry.
Advances in Ebola treatment
Lawler, an 18-year Navy veteran, said he thinks the treatment of Ebola has “evolved significantly” due to the outbreak in West Africa.
“We’re really rewriting the textbook on Ebola virus disease, because we’ve seen so many more cases in this outbreak,” he said. “I think we’ve tried to capture a lot of the lessons that have been learned from West Africa, and also from the repatriated patients who have been treated here in the United States. We’ve learned a lot about effective treatment and how important aggressive supportive care can be, and we’ve tried to impart those lessons to the team here.”
One characteristic of Ebola, he said, has been recognized more widely now for contributing to the mortality and morbidity of the disease: diarrhea and the incredible amount of fluid loss and associated electrolyte abnormalities that come with the disease.
“I think being more aggressive in treating those features of the disease has been an advance that this outbreak has precipitated,” Lawler said. “And I think that there’s a better appreciation that aggressive supportive care can make a significant difference in outcome.”
Training focused on infection prevention
During the DoD training the 30-member team has undergone, Lawler said, the focus has centered on appropriate infection prevention and control in isolation units -- how to set up an isolation unit appropriately, how to use the personal protective equipment, and how to integrate the appropriate infection control procedures into daily clinical practice.
The team’s make-up — 10 critical care nurses; 10 noncritical care in-patient nurses; five physicians with infectious disease, internal medicine and critical care experience; and five members trained in infection control specialties — is essential to its success, Lawler said. “Their complex patients require a significant amount of care,” he added, “and as part of the team we have a core of critical care nurses who are really the most important part of the team.”
That intensive nursing, Lawler said, makes the biggest difference in patient outcome, and all of those disciplines are important to managing patients.
“We also have some other folks who specialize in things like industrial hygiene and environmental health [who] can help with some of the other aspects of setting up a patient care unit that are important,” he said.
The infection prevention control practices the team is training on will work if they’re done effectively, Lawler said.
“It’s important to really rely on your training and to remain focused and deliberate when you’re working in a unit,” he said. “Errors usually come when people get sloppy; when they get tired [and] careless. We really focus on preventing that.”
Additionally, Lawler said, there is “absolutely” a benefit to having a team available for any infectious disease contingency, because Ebola is not the only worry.
“There’s [Middle East respiratory syndrome] Coronavirus that’s out there in the Middle East right now,” Lawler explained. “We’ve already had experience with [severe acute respiratory syndrome] [and] with pandemic influenza, so the threat of emerging disease and pandemic disease is always out there.”
Confidence in DoD team
Lawler expressed confidence in the team’s training and said he believes it’s ready to “deliver good care, and to do it safely.”
“I feel very comfortable that our training has prepared the team to deliver care effectively and safely,” he said. “If the event ever happens [where] the team gets called up, hopefully, other people [outside DoD] have the same confidence that I do that the team is ready to go.”
Lawler said the nation always turns to the military in difficult times, and it is up to the DoD team to ensure it lives up to that trust.
“I think, in general, doing good patient care in difficult situations is what the military medical system always does,” he said. “That mission is not unfamiliar to us, and we’re ready to go if the call comes around for this particular instance.”