U.S. Nurse Leads Ebola Ambulance Team

c_Molly-Feltner_Handicap-International__Mike_Denny_standing_in_front_of_a_Handicap_International_Ambulance.jpgMike Denny is a nurse and Infection Prevention & Control specialist from Gallup, New Mexico, U.S. He served as the Infection Prevention & Control Manager for the Ambulance project in Sierra Leone from June to November, 2015. This was his first mission for Handicap International.

VIDEO: See Mike in action with the ambulance team in Sierra Leone.

What are the services provided by Handicap International’s ambulance project?
It has several aspects. First, we transport patients from their dwellings to Ebola testing centers. Second, we decontaminate their dwellings.  At the same time we inform the family and surrounding community about what we are doing and how they can protect themselves. Finally we bring the vehicles, both the ambulances and the decontamination vehicles, back to our base in Hastings for a final decontamination.

What is unique about the services Handicap International provides?
Before this project started an centralized ambulance service for Ebola patients did not exist in Freetown. The local ambulance services do not transport Ebola patients. Transporting Ebola patients requires highly skilled and highly trained professional ambulance drivers and attendants. The dwelling decontaminations must also be done under the strictest of standard operating procedures. The decontamination of the vehicles back at Hastings also requires special skills. We have detailed standard operating procedures for every task and each staff member must master the tasks they are assigned to perform through training and practice.

Because of the staff’s skill level we’ve transported almost 3,800 patients, did nearly 5,000 vehicles decontamination and 1800 dwellings decontamination without a single person being contaminated by the virus.

How are staff members protected from Ebola?                                                      
The primary safety factor that we use to ensure that workers remain safe is a team concept. Nobody enters a contaminated area alone and people are always supervised by observers not actively participating in the decontamination operations. By using this team approach we make sure that everybody remains safe and follows the protocols that we established for their safety.

The primary personal protective equipment (PPE) that we use is the coverall. It goes from the ankles to the wrist and then the neck, providing complete coverage of the limbs and torso. We then also use rubber boots, a facemask, goggles, and a hood. We cover it with an apron and three pairs of gloves, two pairs of soft nitrile gloves and a pair of heavy gloves over the top.

What happens on a typical intervention?
People report suspected Ebola cases by dialing 117, which goes to the Command Center in Freetown. The Command Center is where the Ebola response is coordinated. We take calls from the Command Center at our dispatch. When a call comes in, our dispatch manager will get the address and all necessary details to locate referred cases. The dispatch manager then chooses a team to respond, which includes an ambulance to transport the patient, a decontamination vehicle with our equipment, a “dirty car,” which will remove the contaminated belongings of the patient and a “clean car” that will distribute a replacement kit to the family.

Once we arrive on scene our health promoter and team leader will engage with the community, the family, and the patient to inform, explain and determine what type of intervention will be needed. Sometimes people will refuse to let us work, but our health promoter’s job is to convince them to allow us to proceed with the intervention.

In the meantime, the team leader does an assessment of the situation. He will determine if the patient can walk or if he needs to be carried from the site, and where we can set up our operations. This can be a real concern, especially in slum areas, where sometimes our preparation areas can be as far as 200 meters from the dwelling that we’re decontaminating.  Once these issues are resolved, the team leader will brief his team and supervise them as they put on their personal protection equipment. Then two hygienists, one carrying a sprayer with a solution of 0.5% chlorine will proceed to the dwelling, followed by the ambulance attendant who will then escort the patient to the ambulance.

If the patient needs to be carried, the ambulance attendant and one of the hygienists will carry the patient on a stretcher. Often dwellings are very small and poorly lit, we have to be very cautious when the staff get inside to pick up the patient. Any rough edges or sharp objects can breach the PPE and expose our workers to the Ebola virus.

Once the patient is safely inside our ambulances and being transported to the Ebola Testing centers, the hygienist with the sprayer will proceed to systematically decontaminate the dwelling with the chlorine spray. The final act is to remove the patient’s mattress and other material, which can be soiled from body fluids. We’ll saturate the mattress with chlorine, and then take it to a dumping site. After the intervention, a “clean car” will bring a new mattress and others replacement items like pillows, mosquito net for when the patient returns to the house.

Tell me about the staff you work with.
I arrived here and they taught me how to fight Ebola. I’ve learned from them every day that I’ve been here. They come from a variety of backgrounds and they’ve all come together to fight Ebola. 

I’ve served in the company of heroes. I’m so proud to have fought Ebola with these people. It’s been an honor to lead them. They’ve inspired me to work 10-12 hour days, seven days a week, for five months for this, I do it for them. It’s the best job I ever had. I’m so proud to be part of this effort. I want the world and my fellow Americans to know what these people here in Sierra Leone have done.

Please don’t forget them. They have faced serious consequences as a result of their work due to the stigma of Ebola in Sierra Leone. When they leave our camp after work, some have to hide their IDs, so that people don’t know what their job is. If they didn’t do this, they would not be able to get on a bus, nobody would pick them up. When they get home, they have to hide the fact that they work for Handicap International so their landlords don’t evict them. Many of their families will no longer associate with them. Their wives, parents, and other family members won’t see them anymore since they started working on the Ebola epidemic.

Now that the Ebola outbreak in Sierra Leone seems to be at its end, what is the plan for this project?
Handicap International plans to maintain a staff of Ebola responders. We want to be ready so that if Ebola does come back, we will have trained professionals ready to deal with it.

Support our mission in Sierra Leone.