Part 1: This preparedness plan documents the United States role if the Ebola Virus Disease breaks out in the West African countries such as Sierra Leone, Liberia, and Guinea. These countries have had occurrences of Ebola in the past and are liable to have another. This is of importance to the United States because if the virus is not properly taken care of in these countries it could spread to other parts of the world, including the U.S.. This plan focuses on the response of hospitals and clinics in these West African Countries.

 

Part 2: Hospitals, clinics and other groups that deal with the health of individuals are an important area to focus on when trying to contain the spread of the Ebola Virus. Due to its modes of transmission, people that deal directly with the infected patients are at most risk. Included below are guidelines for the individuals that work in the healthcare systems of West Africa, as well as the intervention and help planned by the United States if the scale is large enough. Preparedness involves two main entities, the healthcare system of West Africa as well as the United States, without one or the other containment would not be efficient.

1. Preparedness plan for healthcare professionals of West Africa:

   • Knowledge of symptoms is an important way to prepare for an Ebola outbreak. Knowing the possible symptoms, ensures that patients are not overlooked or mishandled when they receive medical attention. Below are the symptoms according to the CDC:

     • Fever

     • Severe headache

     • Muscle pain

     • Weakness

     • Fatigue

     • Diarrhea

     • Vomiting

     • Abdominal (stomach) pain

     • Unexplained hemorrhage (bleeding or bruising)

   • Awareness of transmission is also crucial for the preparedness of health professionals. Once it is suspected that a patient may have Ebola based on their symptoms it becomes important to take proper measures to contain transmission from the patient to other patients as well as the health provider. Transmission can occur in several ways according to the CDC, including through:

     • blood or body fluids, including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen, of a person who is sick with or has died from Ebola

     • objects, like needles and syringes, that have been contaminated with body fluids from a person who is sick with Ebola or the body of a person who has died from Ebola

     • infected fruit bats or primates

     • possibly from contact with semen from a man who has recovered from Ebola

   • Alert the officials that there is a possible case of Ebola. People to notify are the facilities infection control program, and health authorities so that proper care can take place.  

   • Isolation is the next best step to take based on the modes of transmissions. It is optimal to place the patient in a private room with a private bathroom or covered bedside commode. This is important because the symptoms include diarrhea and the virus can be spread through feces, making this a probable mode of transmission. The people that enter the room should be as few as possible and only necessary tests and procedures should be done.

   • Personal protective equipment should be worn by all personnel entering the patient’s room. The clothing should completely cover the skin and mucous membranes.

   • Disinfection and sterilization of all things in contact with patient. Proper disinfecting procedures, cleaning, and managing waste are important to contain Ebola. Studies have indicated that Ebola can stay viable on solid surfaces. It is vital to have proper disinfectant products before an outbreak occurs, so that it can be managed when the time comes.

   • Assess level of threat of outbreak. It is important to determine how many people the patient has come into contact with since the expected infection date, and locate and isolate them as well since they might also be infected. This is a crucial step, if the virus has reached too many people to contain on a small scale it is time to bring in more resources, this is where the help of the United States may occur.

2. Preparedness plan for the United States when an Ebola threat is found in West Africa:

   • Determine level of action needed to contain threat. When an outbreak has become difficult to control with local resources in West Africa it is time to bring in outside resources and personnel from the United States. When it is time for the U.S. to intervene, the first step is to decide what level of action needs to be mobilized to determine who and what should be introduced to the infected area.

   • Send in experienced infectious control specialists. The U.S. has teams prepared in the case of a pandemic with expertise in a biological outbreak. These people know the precautions necessary to help the patients as well as keep themselves and the community from even more exposure. These health professionals can either set up camp in hospitals or in isolated camps to keep the containment. This is the most important step, without proper care of the patients the spread can happen very quickly. Providing this medical support is very important.

   • Keep division of healthy and infected individuals. It is vital to keep the healthy uninfected people away from the infected, therefore, large scale isolation must occur.

   • Proper disposal and handling of infected remains and materials. The Ebola virus can also be spread through deceased individuals that were infected, with that in mind, safe and respectable actions must be coordinated to remove the people so that further contamination does not occur.

   • Shipments of vital medical materials to keep up with growing demand. Medical materials used in the care and treatment of individuals infected will be supplied. This includes personal protective equipment for the healthcare providers as well.

   • Help communicate to the public the level of seriousness. Without proper knowledge and announcements concerning an outbreak, individuals may be unknowingly promoting spread of the virus.

 

Part 3: Based on communication with a Civil Support Planner from CONR-1AF(AFNORTH) the Air Force component of U.S. Northern Command or otherwise known as USNORTHCOM, Mr. Jon Graydon, there is a plan in place for the U.S. Military to assist civil authorities such as the CDC if there is a national pandemic emergency.   In short, upon notification by civil authorities such as the Department of Health or the Center for Disease Control, the military is asked to assist these Civil Agencies in addressing issues above and beyond these agencies capabilities such as medical, logistics, engineering, transportation (air, water, ground), and security assistance, and if necessary aerial eradication assistance if needed.  Specifically, the Air Force plan is an “Air Force Capabilities based – Centric” part of the over-arching Department of Defense Plan/USNORTHCOM preparedness plan to address such pandemic emergencies in the continental U.S. that can also be extended to other countries to address their specific health related emergencies if necessary.  The primary agency (CDC) has to specifically ask for assistance from the Department of Defense, which then tasks whichever USNORTHCOM DOD component (Air Force, Army, Navy, or Marines Corps) that has specific expertise that the civil authorities requires. The military has been utilized in the past in such emergencies.  If an Ebola out-break occurs in West Africa and escalates to the point that the African Government can ask for U.S. CDC assistance.  Camps for the health care workers and sick can be constructed by the U.S. Military to help better contain those infected, and military transport aircraft can be utilized to ship vital materials needed for treatment and protection of personnel.  Although the military assistance plan is a peripheral plan to direct medical assistance, it can be the difference between containment in a specific area or a worldwide pandemic.