Page 157 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan

Ebola preparedness among the curative and the public health sector 155
Table 1. Specific outcomes focus group sessions per stakeholder
Stakeholder PHS
Regional public health consultant
GPs
Ambulance
Peripheral Hospital
Academic Hospital
Relevant observations (including quotes)
In some regions the academic center took the lead in regional coordi- nation preparedness, instead of the PHS. ‘Clinicians commonly take the initiative for preparedness for emerging infections as EVD; however, they will not coordinate ambulance care and GP preparedness.’ ‘As academic hospitals were responsible for treatment of suspected EVD cases, they im- mediately took the lead in the region.’
There were different views of the role of PHSs, which the regional PH consultants tried to streamline. Geographic distribution regarding referral from peripheral hospitals to academic centers was sometimes unclear; the regional consultant helped to clarify this. ‘Exercises showed missing links in preparedness.’ ‘Handling a suspected EVD patient facilitated coor- dination in the region.’
GPs perceived risk of seeing an actual patient with EVD as being low, therefore GPs had little involvement in preparedness. ‘An EVD patient is mainly a concern for hospitals.’ ‘Information provided on websites was sufficient for us.’ ‘Besides providing information to the receptionist, no specific preparedness activities were undertaken.’ ‘In our village, the risk for an EVD patient was considered negligible.’
Due to limited experience with and exposure of infectious disease, exten- sive investment in developing protocols and training in for example don- ning and doffing of personal protective equipment was necessary. ‘The fear of contamination, we really were afraid that the fear of EVD would cause more casualties than EVD itself.’ ‘It took us months to install the correct personal protective equipment procedures.’
Peripheral hospitals had a small role regarding triage and referral of patients with EVD, but a relative large investment was needed to be pre- pared adequately. Local preparation depended on own initiatives rather than regional or national coordinated planning. ‘There was a small risk for an actual EVD patient, but a larger risk for a patient with fever from an endemic area, being an potential EVD patient...’
The role to advice and support peripheral hospitals, ambulances and GP’s in preparedness was new and not yet standardized. ‘It was a process to find out who was the initiator for the coordination in the region.’ ‘Due to differences of peripheral hospitals and GPs between themselves, it was more difficult to connect with them than with the PHS and ambulance.’
Abbreviations: PHS: public health services, GP: general practitioner, CID: center for in- fectious disease control
Role and engagement
All participants were engaged in the Ebola preparedness, except for 4 out of 7 individual GPs (57%). All curative stakeholders felt the need to implement an EVD protocol, because patients with common import diseases as malaria also fit the Dutch triage criteria. Academic hospitals had a prominent role in Ebola pre-
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