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Mortuary Response to VHF - 2

During the actual response of the 2014 Ebola Outbreak, there were many operational issues and problems that needed to be solved as they presented themselves. Now, these issues can be completely reviewed and adapted for future responses. Evaluating these issues and making corrections, will provide for a more competent response in future generations. Not evaluating and inserting corrections into your operational plan will deteriorate the response and possibly cause needless deaths.

One operational infrastructure adaptation that shall be needed in future responses is that of STAGING. In the 2014 incident medical facilities were initially created to handle low patient/victims. This caused a quick overflow of victims to the point where patients were literally dying in the streets outside the initial hospital facility activated for treatment. Ask yourself; “How many patients can my current plan accommodate”? Is this the probable or possible amount/flow of patients I can expect? Or, is this number/flow inadequate? If it is likely to be inadequate, you have two (2) choices.

1] Expand equipment, personnel, and resources for a response or,

2] Partner with other same resources.

Both of these are obviously a full time position for many months for the emergency manager. In the first choice, your budget needs to be drastically increased as well as permanent employees. Equipment expansion will require additional storage space and or facilities on-site in a secure manner. Additionally, equipment maintenance will increase and require additional support personnel. Response personnel increases stress your total hiring and training infrastructure so there may be increases needed in these departments as well. When deployed to a response, support and supply personnel and resources will also need increasing to accommodate a smooth operation once activated.

Partnering with like organizations for a smooth organized response requires inter-departmental training on a regular basis. As changes occur, multiple groups must be all included as being, on-the-same-page. If geographical distance is an issue, how will you coordinate multi-group training? Is employee transportation possible? Can regular group training be done at simultaneous locations? Can training information be accomplished across an internet medium?  These are some of the considerations that must be taken into account, just for staging but true for all areas of operations!

Another problem was the breakdown (in the initial stages) of ICS between the government and medical staff. This was somewhat political and can be expected when dealing with foreign Nations, but more so in this situation due to the fact that the governments in question did not rely on their SME (Specialists Material Expertise). This is a common failure of the ICS staff and one in which when corrected, can quickly increase the effectiveness of any operational team.

Contract tracing was absent before the WHO/CDC was in a mode of full mobilization. This is a problem directly related to the UN and its medical guidelines but can also be instigated by localized Team directive. Your response group can identify this issue at the initial stages and continue to emphasize to the bigger picture until you receive confirmation that contact tracing protocol has been activated and is functioning. This is a good objective to insure by your Team Leaders and after all, your team members ARE affected by this practice. So this is really a safety issue for your Team. Study has proved that not activating a solid “Contact Tracing” protocol shall increase victim mortality.

Local custom conspiracy theories hampered many objectives from being successful (see film for details).  A cultural attaché is needed for all response groups operating outside of their local geographical operating area. In many cases, an interpreter must be included. If Team members cannot communicate properly with victims or local responders, this will increase cultural conspiracy theories thus making your response more difficult and success questionable.

During the 2014 incident DWB (Doctors Without Borders) staff experienced a high degree of PTSD (Post Traumatic Stress Disorder). Response Teams and the Military have to realize that physicians in general are not used to emergency situations. Their world is usually a controlled environment with disassociation from patients as human beings and looked at as “conditions”. This too, is a coping mechanism for Doctors having to deal with the emotional aspect of invasive patient treatment. Making sure that part of your “personnel” upgrades includes trained counselors in this type of trauma counseling. The goal of your operation is to have all parts flowing functional at the same time. Any one of these mentioned elements have the capability to derail your operational effectiveness.

Finally; an excellent time-line of this operation can be found through the PBS Frontline News group at

Haz Mat Mike



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