Spain: it was the nurse’s fault
It doesn’t look good for the Spanish nurse in Madrid who contracted ebola while caring for an infected priest who’d been brought back from Africa. And, in today’s current climate of passing the buck, the Spanish authorities are passing it to her:
The health of a Spanish nurse with Ebola worsened on Thursday and four other people were put into isolation in Madrid, while the government rejected claims that its methods for dealing with the disease weren’t working, and blamed human error.
Not their human error. Hers:
Ruben Moreno, health spokesman for the ruling People’s Party, said Romero had told another doctor at the hospital that she had touched her face with her protective gloves.
“It’s obvious that the patient herself has recognized that she did not strictly follow the protocol,” he said in a television interview.
I don’t know exactly how these suits are supposed to work, but I would think it’s a poor design whose protective value can be thwarted by such a simple—and almost reflexive—move. Why do I see goggles and face masks in most of the photos of ebola hazmat suits? Did Spain not provide them? How was the nurse’s face left so exposed? If the face touching happened as she was taking the face mask off, I could understand it a little better, but surely there must be some protocol to avoid the almost inevitable problem a person would face during that required maneuver?
And what’s up with this with touching her “face” business? I thought the official word was that a person had to touch his/her eyes or mucus membranes to contract the disease; simple unbroken skin just wouldn’t do. But, as with much of the official word we’ve heard so far, perhaps that’s wrong.
Then there’s this:
Health workers — whose unions have called for Health Minister Ana Mato to resign — said the training and protective suits provided to hospital staff had been inadequate…
Another doctor, who cared for Romero and was among those now in isolation, said the sleeves on the protective suit he wore while handling her had been too short.
In a letter to healthcare authorities, published by national newspaper El Pais, the doctor detailed treating Romero while on a grueling 16-hour shift during which he was not told she had the Ebola virus. He said he only learned of this via the press
Talk about informed consent!
It’s not as though this happened in an understaffed, overburdened hospital in some poor area of Africa, where they lack the money for proper protective gear, and the number of ebola patients is overwhelming the already-inadequate system. This is a major hospital in Madrid—and, what’s more, the ebola-stricken priest was one of only two ebola victims in the country (at the time, anyway), who were brought back for special treatment in a unit one would think had received state-of-the-art training and equipment.
One would think.
If a situation had been specifically designed to undermine faith in our ability to deal with a disease such as ebola, it would be hard to imagine a better one than this.
[NOTE: By the way, it may or may not be relevant to this particular incident (although I think it probably is relevant), but Spain has socialized medicine.]
This grammar bugs me:
Another doctor, who cared for Romero and was among those now in isolation, …
How about “is” among those now in isolation? Present tense and “now” make a pretty good team.
As to your point about dealing with these patients, you would think they would cross every I and dot every T. Instead, it seems more like the Keystone Cops. Especially, with the way they treated the nurse. Anybody working with these patients should have been actively followed for signs of infection since, as you say, Spain has no experience with this disease. What moron would allow her to go to a neighborhood clinic when she was showing signs of fever after working with an Ebola patient – even with a suit on?
I am looking at Ebola as a kind of a test case for health care systems worldwide. For what will eventually happen when a deadly disease that is easy to spread comes along, as most assuredly will happen some day. So far, this has been one gigantic FAIL.
Most of the reports are saying you can only get it through mucus membranes or broken skin, but I have seen other reports that say you can get it through any skin exposure. This seems perfectly plausible–there are drugs that are delivered with skin patches. I wish there were more serious science reporting about this.
Another thing we keep reading is that you have to be exposed to bodily fluids like blood, etc., but quite a few reports say that sweat from a symptomatic person will also do it. Obviously it’s much harder to see sweat…
Regarding the protocols, it doesn’t surprise me in the least that they are not being followed perfectly. That takes a tremendous amount of discipline and training. One of the experts at a so-called Level 4 facility in the US (I forget where) explained that their protocol includes a person whose role is to help the medical professionals into and out of the protective suits. So apparently there’s a non-trivial risk there.
On the other hand, a dedicated person can follow the protocol perfectly and even create her own methods, as is shown by the uplifting story of the nursing student in Liberia who has saved three out of four Ebola-stricken family members and not gotten it herself. She uses trash bags:
http://www.cnn.com/2014/09/25/health/ebola-fatu-family/
Also in Liberia, the Firestone rubber company stopped the spread of Ebola:
http://www.usatoday.com/story/news/world/2014/10/08/ebola-firestone-liberia/16908853/
Nigeria has reportedly brought Ebola under control. I would like to see more stories about that.
http://i.dailymail.co.uk/i/pix/2014/10/07/1412693181706_wps_5_A_medical_exercise_takes_.jpg
image from
Spanish nurse contracts Ebola Virus! Despite wearing a safety suit
http://ozaragossip.wordpress.com/2014/10/07/spanish-nurse-contracts-ebola-virus-despite-wearing-a-safety-suit/
if you look in the picture, the person on the left has moved their goggles off their face so that they could see what they are writing…
the tent door is wide open…
etc
What this all means is the forces for good are crumbling in all sectors of human activity and our will to resist has evaporated over the past few decades. We are all being gang-raped whether we know it or not, and we are paralytically passive. Whether it’s Hong Kong or Obama or Erdogan or ISIS or Ebola or the economy, it doesn’t make any difference. The outcome is the same.
Neo: but surely there must be some protocol to avoid the almost inevitable problem a person would face during that required maneuver?
sorry… common sense is not common
you keep trying to think through this logically, when human logic outside of a math course is not vulcan logic.
duh..
you would think a person who was an EMT Would not use cardiac paddles for “fun”.. but they did and went to jail
how about my watching a guy use a lighter to see if he had gas in his tank?
you think most fingers get cut off by the application of logical sane methods?
i had to once collect body parts of a man and woman who slammed into the trees in a $200k car at over 180 miles an hour late at night
anthony weiner sends photos?
actresses put nudie photos on the cloud
people die every year taking a swim off their boat and not putting the ladder down so they cant get back on it.
why not take some time and peruse the Darwin Awards for examples of how logical it is for you to use logic in analysis?
Chance Werner was playing the shopping cart came, where you tie the cart to a tree, and people push someone in the cart off a dock and into the lake. chance werner tied the cart to himself, and so, when the cart was run off the dock, he was pulled into the lake, and taken deep
here is a very common one (Sadly). person climbs into a cesspool to clean or get something, gets over come by the gas, and one at a time others climb down to rescue them, get over come and die as well.
seven people in Karczé³wka poland died that way, one at a time…
it frustrates me no end that people use logic when in their daily lives they DONT use logic and dont even understand the things that would go into a logical something!!!! so its a wrong way to analyse anything!!!! unless your analysing vulcans or robots, and even then, robots will trick you
in a simulation of naval battles in a potentially nuclear confrontation, the generals and others stood in horror as the computer started shooting their own ships. turned out that the ship that was firing was newer, and it was faster to sink your own vessel to get a clear shot than it was to wait. they had to reprogram the system to NOT shoot their own vessels
then there was the lady across the street from my friends. she lived in a ny apartment, and decided to sit on the rail of her balcony. the rail collapsed, she fell enough floors to smash herself into a blintz…
but then again, there was the kid that jumped off a building from way way up (over 30 floors) and cause he slammed into a car top, it broke his fall and he survived.
this years darwin awards number one goes to a man who used a titanium ring around his penis. needless to say, the fire department coulld not cut it off and he waited so long to call them, he had to be castrated.
now thats logical
then there was the guy in nj… just ask any paramedic you know in the city, most know the story. turned out that he stuck a light bulb up his ass, his muscles cramped up, and he could not get the light bulb out of his arse.
then there was the man and his mate we had to transport, as the same happened to him, but instead of a lightbulb he had half of the other mans foot in his arse (it was hard to get them on gurneys and not laugh and be sued).
one guy in spain died with a friend.. why? he laid down on the tracks to show how much space there was underneath the passing train, and his friend held his head near where he thought the train would be close. they were both wrong when the 130 mile per hour train passed through
Maqsood was a man warned not to go into the tiger pit again.. but he did, and swam the moat to the white tiger, and it went nutty on him.
then there was the lady that tried to hug the polar bear
the man who lived with bears, took his leftist girl friend with him, and you can go online and listen to the tape of them being mauled and eaten
some of the worst offenses of this kind are from simlar people who have risen to places of some power and authority and used said power and authority to force others into idiot acts… cause following orders is safer with authority than speaking up….
[note as a programmer for 30 years. a professional logician, i have watched management spend millions on systems that would never work because they decided the meetings went smoother if they didnt have a programmer in the meeting to tell them it wouldnt work. smooth meeting, 20 million healthcare money lost… nothing to show for it]
often times in such cases you will find a perfectly logical series of things that would work except that the basis of the logical start was wrong…
ie. put balloons in car… dont know physics… step on accelerator, have balloons rush to front of car and cause accident!!! perfetly logical, except that helium balloons are lighter than air, and when you accelerate the heavy air goes to the back of your car, and the lighter balloons rush to the front of the car
a man was arrested on 4th of july… why? well, he was setting off legal firecrackers, and thought that throwing a few over the fence of the white house was a good logical idea
the whole of marxism inthe world is thought to be a logical thing, and the wacky ideas, like mass murder, perfectly logical and pragmatic outcomes and requirements.
it is much better to analyse things in terms of the goals of the person that makes the rules… then you will see them change logic in terms of the goal when REAL logic would cause them to fail, miss their goal, etc…
ie. move the goal posts and call touch down…
redbull commercial calls such behavior brilliant..
here is a good one… i tried to explain why darwinian evolution seems so good at things… but the phd doc didnt understand that its a lot easier to put holes in the side of a building and paint bullseyes around the holes than it is to paint bullseyes, and shoot them from a dsitance
in the case of spain, your going to find that someone in charge of things decided to save money for their raises (like where i work), and explain logically why the kinds of suits and things they decided to use should have been good enough. charging the nurse with human error is their way of avoiding the blame for doing such…
see? perfectly logical… but you have to put in the right terms to understand it, and those wont be your terms as your not going to consider that if they put the best practice in place, the budget is used up, and so if they do that, they cant get raises for managemetn.
my dad worked for a company… they had to open cardboard boxes every day… so did they use a utility knife made for the job? nope!!! they bought expensive disposable scalples and were ordered to only make one cut with each and throw them out. why? well, if they came in under budget, the other management would cut the budget for next year… so they had to come up with ways to waste the money so that they would come in just over budget and would get more money next year.
of course, classical logic of the average person just dont get such things. its a kind of logic that is completely foreign to them…
then there are things in which average normal logic fails.. if one takes the time to study the subject, as i have. you get amazed
oh… another part of this is that we as people percieve, and perception is processed information, not pure unadulterated information.
which is why there are lots of visual illusions and logical illusions that are well known, and screw people up, and yet, they are unware of them
take the tall thin cup vs the short fat cup. they hold the same amount, but guess which one we logically beelieve has more?
ie. we are not logical creatures outside a math class – and then, we have to think hard to insure that the logic is correct as we have no internal sense of such correctness!!! [trust me, as i get to argue logical things and if they are outside the scope of the people i am working with, i cant bring them along to the breaking point… so they assume it doesnt exist, or i am causing trouble, being self serving, being negative, etc… later on sometimes they admit that they could not see that far and so could not work out what i was trying to point out!!!!!!!]
one of my fav areas to indulge is “non classical logic”
Non-classical logics (and sometimes alternative logics) is the name given to formal systems that differ in a significant way from standard logical systems such as propositional and predicate logic. There are several ways in which this is done, including by way of extensions, deviations, and variations. The aim of these departures is to make it possible to construct different models of logical consequence and logical truth
and that is what applies in the real world…
where the idea that something someone does is not common sense or logical to another (Who seems to be thinking clearer), is actually mostly erroneous and leaves people confused.
mostly cause they dont think in terms of the inputs, or take for granted the inputs. and logical things are always GIVEN X… then proceed onwards.
so, given infinite money, the logic of the wrong bio suits makes no sense… given X in which budget is constrained by self serving beuracrats, the wrong bio suit that is barely good enough, and risks someone other than the self serving beuracrat, is perfectly good logic.
the point is we refuse to think in terms of given X
given a logical rational person, this is the outcome
but people are not logical rational, so the given is wrong, and GIGO rules… garbage in, garbage out
often we do this when we refuse to clip what we know, in favor of what the subject knows or comes from, or how they live in surroundings we have never lived in or cared to learn about.
so given germ theory, the suits were not adequate
given mysticism, they were too much
given our idea of humanity, murdering a race makes no sense. given reality where the exterminated are never a threat again in eternity, it perfectly sensical
Paraconsistent logic
The Nature of Logic, Classical Logic and araconsistent Logic
Paraconsistent Logic Doesn’t Make Sense!!
in a way… what you think to yourself if consistent is a normal world, and what another things based on eroneous information is actually a not normal world, and so, any application of logic from the normal does not work or make sense in the not normal world.
this is where so much of the issues i see here with the way things are analysed as its taken for granted that the more well informed live inthe same world that the person under analysis does not live in
in a way its reflected in Mishnah, Sanhedrin 4:5 – Whosoever saves a single life, saves an entire universe
ie. each world is logically consistent but only to itself
🙂
Socialized medicine will redeem Western civilization’s World Wars and blood guilt, so the Left thinks. But redemption for the Leftist death cult is bought in extermination, rape, and torture. Remember that.
In Authoritarian systems and tyrannies, the peons and slaves don’t get informed of much of anything. So even a medical person in their society, is little above trash. It’s not a meritocracy, but an oligarchy at least.
Neo says:
“By the way, it may or may not be relevant to this particular incident (although I think it probably is relevant), but Spain has socialized medicine.]”
Ludwig Mises has pointed the theoretical flaw in the pricing system in socialism which makes it fail every time even if the leaders are all angels and are also geniuses. There is a similar theoretical flaw in government run health care which makes it very unlikely it will ever be equal to private health care.
Government is very good at finding flaws in private industry. When government Bureaucrats are hired to oversee private industry they will go out of their way to prove they are worth their salary and will spend their entire working time trying to find flaws in the industry they are supervising. The higher the scalp they harvest the better. The only way private industry has to avoid this close scrutiny is to find a way to bribe the government bureaucrats.
On the other hand, when those same government bureaucrats are hired to run the industry themselves the motivation changes entirely. Now when they wish to prove they deserve their salaries they will try to make things look better than they really are. Now their self interest leads them to cover up problems and to shift blame for the problems to the lowest level possible.
The proprietor of Lean Blog, who consults in healthcare and has an extensive background in manufacturing, has written extensively about the importance of Error Proofing: paying attention to the *design* of systems so that they don’t encourage errors, rather than simply blaming the front-line employee who made the error.
http://www.leanblog.org/
Design of systems and procedures to minimize errors is very important both in medical devices and in manufacturing. Here’s an interesting case I wrote about in a post last year:
A surgery patient was under anesthesia; as is standard practice, his blood pressure was being monitored by an electronic device. The patent’s blood pressure showed a high reading, and the surgeon noted profuse bleeding. The anesthesiologists set the blood-pressure monitor to measure more frequently. Periodically, they glanced back at the monitor’s display, noting that it still showed an elevated blood pressure, actively treating the hypertension—as they believed it was—with drugs that dilated blood vessels.
But actually, the patient’s blood pressure was very low. The alarmingly-high blood pressure values shown in the display were actually constant…the machine was displaying the exact same value every time they looked at it, because after the measurement-interval reset, it had never made another measurement.
What happened here? The blood-pressure monitor has three modes: MANUAL (in which the pressure is measured immediately when the “start” button is pressed), AUTOMATIC (in which pressure is measured repeatedly at the selected interval), and IDLE. When the interval is changed by the anesthesiologist, the mode is set at IDLE, even if the monitor were already running in AUTOMATIC. To actually cause the automatic monitoring to occur, it is necessary to push START. In this case, the pushing of the START button was omitted, and the machine’s display did not provide adequate cues for the anesthesiologists to notice their mistake.
An analyst notes that “The kind of change they sought is not very different from changing the temperature setting in your toaster over…On almost every oven, you simply grab the temperature knob and rotate it from 300 Farenheit to 450, and that’s it. You are not expected to tell the system that you want it to stay in OVEN mode—you know that it will.”
Discussion of similar debacles at my post here:
http://chicagoboyz.net/archives/39039.html
Art–“so, given infinite money, the logic of the wrong bio suits makes no sense… given X in which budget is constrained by self serving beuracrats, the wrong bio suit that is barely good enough, and risks someone other than the self serving beuracrat, is perfectly good logic.”
This is where we are living (especially in Los Angeles, a “sanctuary city”. And it reminds me of this:
Milton Friedman noted the following about humans and money:
Spend your own money on yourself and you are concerned about both cost AND quality.
Spend your own money on someone else and you’re only concerned about cost (not quality).
Spend someone else’s money on yourself and you’re concerned about quality (not cost).
Spend someone else’s money on someone else and you’re concerned about NEITHER cost nor quality
Loved the comments left by the Artful Dodger.
Except for the Darwinian (macro) evolution part. Which is false, thereby also making it bad.
Also love the stuff by Sharon W about Milton Friedman.
As far as the post, it shouldn’t be any surprise that the nurse got thrown under the bus.
the doctor detailed treating Romero while on a grueling 16-hour shift during which he was not told she had the Ebola virus. He said he only learned of this via the press
Oh my god!!! What a mess.
As for ‘human error’, it’s going to happen. That’s why they have to put in multiple safeguards against it. Which it sounds like they didn’t, if she could touch her face with her glove.
I am thinking, from the cases reported, that a dead patient (or possibly last stages) is the most dangerous vector for the disease and the precautions should be increased as much as possible for those involved.
“Ruben Moreno, health spokesman for the ruling People’s Party,”
Just letting the lovely phrase “the ruling People’s Party” roll around in my head.
My initial reaction is to inject with Ebola Moreno, health spokesman for the ruling People’s Party and anyone else responsible.
But that’s a form of scapegoating as well.
Commenter Yann, who evidently is familiar with Spanish society, maintains that denial and avoidance of personal responsibility is a cultural characteristic of Spanish society. I think that likely, as I know it to be a characteristic of Mexican culture as well and the ancestral influence of Spain upon Mexico is similar to England and the US.
Spain has the officials that it deserves because they are a reflection of the larger society, just as ours are as well.
So the Spanish people are simply harvesting the fruit of the seeds they have sown, just as we will.
Fools may kill as many innocent as criminals, they just do it indirectly.
Spend someone else’s money on someone else and you’re concerned about NEITHER cost nor quality
And if Spain is anything like the US govt, they have all sorts of rules involved in purchasing. Lowest cost (because that’s always what you want, the cheapest contractor or product!), minority or small business owner, etc… None of these things that are forced on the purchaser involves picking the best product for the job. I think many lower level employees would like to pick the best thing, but are not allowed to because of other rules.
I heard it announced the other day that the ‘lowest bid’ was accepted for rebuilding a local bridge! That did not fill me with confidence.
vanderleun – despite how it sounds the People’s Party in Spain is the “conservative” party. I put conservative in quotations because I know that you won’t consider any European conservative party as conservative.
So if she told a doctor she had touched her face, why wasn’t she being monitored and/or isolated from that point on?
It wasn’t that long ago when dentists didn’t use gloves. And when they started using gloves, I would note that their blood-stained gloves would reach up to adjust the articulated lamp. Or his nurse would come in, and reach up and grab it while wearing gloves she had on in a previous room. And I would wonder. It’s not hard to follow the touch-path. Now they put disposable wraps on the handles.
Not too many years ago, my son was in a much-touted hospital and even I could follow the broken path of protocol when the foot-lever for the sharps bucket stopped working and every.single.nurse just used their hand to lift it up. And the night-nurse (Philipina) could not make herself understood, so poor was her English. She just followed whatever she thought she understood on the orders sheet. Hope she’s learned “Ebola” now.
I watched where lung sputum from a patient with staph pneumonia (placed in same room with my son with a collapsed lung!) was left to fester in the vacuum container by the bed for two full days before I complained loudly to any doctor who would listen. They sent in an orderly –all of 14 yrs old– to “disinfect” the room and the kid didn’t have a clue what to do. I went and found cleaners and disinfected every surface.
I experienced a failed laproscope in the OR, woke up during the now-emergency, unplanned surgery, only to later experience the delightful interaction with nurses and pharmacists who were given no new orders for my recovery, or my new level of pain, considering we went from laproscopy to major surgery. I had to fight for pain meds. Nobody could make anything happen.
And these were all private hospitals and I had good insurance. Beware, people.
Reading the Spanish newspapers the Orderly, she was not a nurse, changed the diaper, cleaned the vomit and put new sheets on bed of the diseased priest the first time and then cleaned the room after he died on her second visit to the room.
The supervising nurse that was supposed to observed the orderly as she removed her suit missed her touching her face. Interesting thing is that they were 2 pairs of gloves and she could not touch her face until she had removed the outer pair which would have been the ones that would have been in direct contact with any fluids while attending to the priest or cleaning the room.
Regardless, the Spanish authorities now have revised the temperatures for screening for Ebola to 99.9F not the 101.5 F that CDC recommends here. The orderly as did Duncan the Liberian that died here, both went to the hospital days before being admitted but their temperatures were not seen as dangerous.
Ha Ha Ha, from WaPo:
“As the number of infections increases, so does the possibility that a person with Ebola will carry it to another country. This is known as an export.
“So we had two exports in the first 2,000 patients,” Frieden said in a recent interview. “Now we’re going to have 20,000 cases, how many exports are we going to have?”
But keep the planes flying from W Africa!
Maybe Hussein al-Hawaii is not showing up for his daily CDC briefings. Lotta maybes. Maybe we’re being ruled by the malign.
Bori:
Well, I guess the Spanish authorities listended to my recommendation about lowering the temp guidelines 🙂 .
Do you have a link for that, by the way? I looked, but couldn’t find one. Thanks.
Artfldgr:
You misunderstand my point.
I’m well aware of the tendency of people to be illogical, and/or to not follow logical rules, and/or of rules to sometimes be illogical.
However, I wrote “surely there must be some protocol to avoid the almost inevitable problem a person would face during that required maneuver? ”
What the phrase means is not that the Spanish authorities surely had some such rule in place, or that it surely would have been communicated to staff, or that the nurse’s assistant surely would have followed it. What is means is simply this: surely somewhere on earth, from someone who has used hazmat suits with ebola or other diseases, or thought about their optimal use in such diseases, there exists some such protocol for optimal removal of the suits and gloves, minimizing harm to the personnel involved. That such a protocol exists somewhere on earth does not mean it is studied, communicated, or followed, in any particular place or time (or even in most places or times—or even in any place or time).
““surely there must be some protocol to avoid the almost inevitable problem a person would face during that required maneuver? ”
Of course there is and it is well understood and widely practiced.
Bio-weapons research labs and infectious disease research labs couldn’t exist without those procedures.
The US Army is sending mobile labs to Liberia, which will be handling Ebola victims blood samples. Such procedures are vital, without them the labs cannot operate.
Its virtually certain that the CDC has published procedures, which makes the Spanish ‘incompetence’, criminal negligence.
It seems obvious that a hazmat suit has to be decontaminated before any part of it is removed. Which means that much more is involved than just the suits.
neo-neocon:
The link is in Spanish from the El Mundo newspaper and it is quoting the Health Minister about what are the steps being taken to deal with Ebola. Lowering the temperatures for those suspected is one of them.
http://www.elmundo.es/espana/2014/10/10/54380e7b22601df1668b4595.html
I have lead decon crews at nuclear reactors. People in my former position are not there to actually assist in the decon, they are there to observe everyone else to make sure procedures are followed 100% of the time by 100% of the personnel. After the job was finished everyone is reminded of the procedure for safely removing protective gear.
I would like to see the CDC procedures for treating ebola patients, and if it is sop to have an observer monitoring caregivers adherence to those procedures. If the nurse absentmindedly touched her face with a contaminated glove an observer might have been able to stop her mistake by shouting out a warning.
Lurch’s comment is right on the mark. Governments in the developed world, especially our own, are demonstrating they are not up to the task of protecting their societies.
Bori:
Thanks.
Did you see this, though?
parker:
These seem to be the CDC’s latest guidelines for treating Ebola patients. I don’t see any mention of observers monitoring the procedure for removing protective gear.
Well, Neo wants to minimize harm (or risk of harm). Minimize is not “eliminate.” Perhaps we can agree elimination of risk is impossible. It strikes me as odd that a bunch of people who in the aggregate have never been in a sterile or “hazmat” environment should feel such indignation about what is being done or not done in the ebola environment, what should be done or not done. Absolute safety cannot be achieved, period.
Disinfecting the outside of a “hazmat” medical suit means a risk of exposing the disinfecting person to the bug while reducing that risk to the person inside the suit. Which is simply to say that risk can be distributed or shared but not eliminated. Risk is a constant, “X”; the product of (X/n) x n remains X regardless of the number n among whom that risk is distributed. So my risk is reduced by increasing yours? Yep. Just think about it a bit.
Once again, there is no free lunch.
Cleaned up (via my high school Spanish, apology for any errors) version of Google Translate of relevant paragraph.
On the other hand, it was announced after a meeting of the Interregional Health Council (?), that the protocol would be changed to lower the fever threshold to 37.7 degrees (Celsius) for those suspected of having been exposed to the Ebola virus. The minister explained that this threshold is already being implemented in the city of Madrid, but will now be incorporated into the general protocol for all regions.
Don Carlos:
There are protocols that reduce risk, but of course can never eliminate it.
Some of the glove protocols, as I understand them, involve multiple layers of gloves.
I assume that at a certain point the suits become too cumbersome to work with, and protection must be sacrificed to the ability to work.
However, this nurse was one of just a few people in Spain who’d tended to ebola victims. And her “mistake” (if in fact it was a mistake) occurred in one of those very few. So I hope this doesn’t indicate how high the rate of failure would be.
>> [NOTE: By the way, it may or may not be relevant to this particular incident (although I think it probably is relevant), but Spain has socialized medicine.]
I’m afraid it´s just the opposite.
Even though its obvious flaws, Spain has had traditionally amazingly good socialized public services. Healthcare was far more cheaper than US one, and was considered one of the best ones in the whole Europe. Foreign people (specially english ones) used to travel to Spain to be treated in spanish hospitals.
That was about one-two decades ago.
Then public services started to be slowly dismantled, healthcare included. And they started to go worse (many people say that on purpose, to justify going private).
Where´s the issue? as much as politicians in Spain are basically scoundrel, many technical (and health) cadres had (still have) a very high level of professional ethics. That time, public services were managed exclusively by technicians and they were as efficient and cheap as any german one could be.
Then somebody saw the money and politics arrived. Right now everything is going private, what basically means an inefficient private monopoly (no competitors allowed) where some people are getting their pockets full.
If spanish politics would have stayed out of it, and this problem would have been handled by medical services, we wouldn´t have Ebola right now in Spain.
One of the things I have seen comparing US and Spain is that it doesn´t matter that much whether services are socialized or not. As long as they´re handle by engineers (or doctors), they work well. What really matters is that politics stay the hell away from them.
They blamed the nurse in Dallas too. It’s a recurring theme among doctors, always blame the nearest available nurse.
The Dallas problem is the hospital ADMINISTRATORS and SPOKESMEN, and perhaps its general counsel. They run their mouths in grossly irresponsible fashion. First, and never denied, is the ER nurse did her/his job, but it was the doc’s fault. Then, oops, it was the EHR software’s fault. Now, oops oops, he had a pretty high fever (103F).
Finding someone to blame in this case is akin to blaming the Ferguson cop the first night and going on a tear. No one here admits the obvious: We do not know 99% of the evidence. How many of you know an abdominal CT scan was done? What did it show? What were his blood counts? His serum chemistries? Even if we knew, the results would have to be explained to you. Etc, etc, etc.
Perhaps we should all temper our righteous indignation. Our government and authorities worry me a great deal more than finding blame re Duncan. Or are we trial lawyers in front of a jury?
Ann,
Guidelines are not procedures. Guidelines are a foundation. Procedures are the minutiae of each tiny step to maximize safety. Guidelines will protect no one, rigorously following procedures will; not 100% but perhaps 98 %. Treating ebola patients under guidelines is not good enough. For example, the procedures I followed for removing gloves contaminated with radioactive material involved 4 steps and the use of 2 other pairs of sterile gloves. With a few exceptions monitoring for radioactivity is a quick and simple process. This is not true when a virus or bacteria are involved. Which means the sop for enbola requires extremely detailed procedures.
neo,
While it is true that protocols/procedures can not be 100% effective due to human fallibility, the idea that safety must be sacrificed because of “cumbersome” protective gear is the wrong way to go. If anything, sacrificing ‘the work’ to protect the worker is paramount. Who decons the reactor if the decon team is contaminated? Who treats the patients if the caregivers die from the disease? Its not as if there is an endless supply of trained people to decon the reactor or treat the diseased patients.
parker:
I just meant that if the gear is too cumbersome, the worker can’t work at all. At some point, that would happen. The trick is to get just to that point, but stop short of it.
Don Carlos:
I think most people here are well aware that our information on these incidents is quite incomplete. It almost goes without saying—but I am careful to add in many posts and comments of mine disclaimers such as “if this information is correct.” It think it’s obvious the information we have may not just be incorrect, but is very incomplete.
After all, if Duncan’s medical history at the Dallas hospital ran to over 1000 pages, we know very little of it. But what we know is not the least bit reassuring.
I wonder why you keep acting as though you’re the only person who can think of things that are actually rather obvious. I missed where people here were saying “Our information on this is now complete.”
I agree with you, however, that we should be very concerned about the administrators and the government re ebola and its treatment. They have hardly covered themselves with glory—au contraire.
Hazmat gear is uncomfortable in the best of circumstances and in equitorial Africa it is beyond my imagination to appreciate how miserable it is to work under the conditions faced by aid workers. They must feel a bit of sympathy with lobsters tossed into the boiling pot. However, there should be not even the slightest deviation from procedures, assuming there are actual procedures beyond nebulous guidelines. As Lurch stated, and I agreed, this is not a test. It is the real deal and so far even societies with advanced medical systems are falling short of their mandate to protect their citizens. PC is the 5th horseman.
It doesn’t matter whether you are at the care delivery point or in the upper echelons of a critical care organization, physicians –medical doctors– run the show. The physician group lead the administrators and spokespersons, not the other way around.
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I am from Spain. Yes, we have a socialized health system here, and although there are some aspects to it that I do not like, the fact is that it is a very good health system. We do have problems to finance it, as everywhere I guess. We have one of the highest life expentancies in the world and one of the lowest child mortality rates. There have been some failings in the way ebola has been managed but as this was a new challenge it was to be expected to some extent I guess. But the problems have been smoothed out quickly and we now have a scientific comitee that is in charge of things and it seems to be working out very well. The party in government is the Peoples’ Party, a centre-conservative party, and it is doing a decent job managing the countries’ finances etc., which has some merit taken into account the country was in a desperate situation when they won the elections in 2012, after 8 years of Socialist Party in government!