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Committee Releases Dallas Ebola Timelines
October 17, 2014
Timelines of Events Surrounding Ebola Preparedness Efforts and First Emergency Room Visit of Thomas Duncan in Dallas Raise Concerns About Implementation and Quality of Treatment Plans
WASHINGTON, DC – The House Energy and Commerce Committee today released documents obtained in its investigation of the ongoing Ebola outbreak. The documents were submitted to the committee by Texas Health Resources. One outlines the preparedness timeline from August 1, 2014, through September 24, 2014, and the other document details the sequence of events at Thomas Duncan’s first visit to the Emergency Department on September 25, 2014.
The preparedness timeline indicates that on August 1, 2014, one of the components of the response plan includes, “Electronic Health Record includes a travel history question that should be completed on every patient.” The preparedness timeline goes through September 24, 2014, just one day before Duncan first arrived at the Texas Presbyterian Hospital Emergency Department.
DUNCAN EMERGENCY ROOM TIMELINE
The second document indicates that Duncan first arrived at the Emergency Department at 10:37 p.m. Triage began for Duncan at 11:36 p.m., at which point, “Obtaining the patient’s travel history was not part of the triage nurses’ process on September 25, 2014.” The timeline later showed that there was an RN assessment from 12:33 to 12:44 a.m. At that point, “The nurse documents that Mr. Duncan ‘came from Africa 9/20/2014’” and “RN states she recalls the discussion because of how long the plane flight was. (She had personal experience with very long plane flights). Attached no further significance to this travel history.”
The detailed timeline of events continues, “This information was not verbally communicated to the physician, as prompted by the EHR.” The Emergency Department physician performed his evaluation of Duncan from 12:52 to 1:10 a.m. The timeline recalls that the physician did access the EHR, but, “The record does not show which information the physician read, only which information was available.”
These data, as reflected in the EHR, reveal that Mr. Duncan and his companion advised
that he was a “local resident”, that he had not been in contact with sick people, and that
he had not experienced nausea, vomiting or diarrhea.
The timeline later showed that there was an RN assessment from 12:33 to 12:44 a.m. At that point, “The nurse documents that Mr. Duncan ‘came from Africa 9/20/2014’” and “RN states she recalls the discussion because of how long the plane flight was.
Person Under Investigation (PUI) A person who has both consistent symptoms and risk factors as follows:
Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats or non-human primates from disease-endemic areas.