Page 158 - Timeliness of Infectious Disease Notification & Response Systems - Corien Swaan
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156 Chapter 7
paredness, especially regarding supporting and advising curative partners, and in their position as knowledge center for infectious diseases. Although the like- lihood of a patient with suspected EVD was considered low, peripheral hospitals and ambulances invested heavily in EVD preparedness. General practitioners did not conduct specific preparedness activities at an individual level.
Preparedness chain possible EVD patient at regional level
The starting point of preparedness activities differed between stakeholders, va- rying from February 2014 to April 2014 (academic hospitals) and July 2014 to August 2014 (ambulance sector, peripheral hospitals), or none (individual GPs). This was due to a difference in sense of urgency between stakeholders. Prepa- redness took place first within organizations, then between involved organizati- ons: “There was no crisis .... That was an important delaying factor” (peripheral hospital representative).
Information exchange started within sectors and among professionals and in a second phase between organizations on regional levels. Communication systems did not fulfill the need for information among all stakeholders, for example, for peripheral hospitals. Another barrier for peripheral hospitals was the lack of standardized response protocols, including a medical care protocol for possible EVD patients for emergency departments. The peripheral hospitals needed more support and advice from the regional academic hospital in the preparation phase compared to previous infectious diseases threats. For acade- mic hospitals, this advisory role was new. Exercises involving regional partners responding to a patient with EVD were considered very valuable. Exercises led to increased knowledge of each other’s roles, responsibilities and expertise.
Academic hospitals and PHSs mostly performed the regional coordination of EVD preparedness, this varied between regions. However, in several regions it was not clear who coordinated, and some PHSs looked at the CID for guidan- ce and instructions: “It is necessary that regional networks function in a better way, to be prepared for infectious diseases that may constitute a real threat for the public health” (PHS representative).
Academic hospitals proposed to develop national contingency guidelines including standardized criteria for enhanced preparedness and regional coordi- nation. Nonetheless, they felt informed and were satisfied with the information provided by the CID regarding outbreak development in West Africa, and Dutch triage, diagnostic, and personal protective equipment guidelines.
During the Ebola outbreak, medical care for patients with confirmed Ebola was centralized in the national preparedness plans. Four out of 8 academic hos-



























































































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