Review of the staff member's rights and duties as a patient regarding medical evacuation in the context of Ebola outbreak in West Africa, 2014-15

1. The staff member/EVD patient in
the context of medical
evacuation by air ambulance:
rights and duties of the patient
and chain of survival.
Dr. Jean-Jacques BERNATAS
Regional Staff Physician
WHO/EURO
Workshop of private air ambulance providers on medical evacuation of patients with Ebola virus Disease,
Luxembourg, 01 October 2014
European Commision, Health and Consumers Directorate-General
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does not guarantee the accuracy of the data included in this
paper and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with WHO official terms."

2. The context
• Global humanitarian crisis, not just the problem of the African continent,
• Local population affected by thousands in a context of urban setting in
developing countries
• Local healthcare facilities devastated, international transport disrupted,
• Individual commitment to assist the affected population:
• requires an individual strong commitment, and may meet the
foundations of the humanitarian action that usually inspire most of our
staff,
• the context may also be appealing for "wild" individuals, who are prone
to take unacceptable risks for them and for the others around,
• It never happened before, so no one knows what the daily life will be,
and no one is really fully prepared
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3. The bill of rights of the patient
(1)
• Definition of a patient: a potential, possible,
probable or confirmed case.
• Rights, before being a case:
• Access to prevention: training (practice with
minimal theory), equipment (medical kit,
water&soap, hands sanitizer, condoms, ...),
• Access to up-to-date information
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4. The bill of rights of the patient (2)
When becoming sick or highly exposed to the risk: access to
appropriate care:
• Based on clear, available, evidence-based algorithms,
• Under the lead of an experienced medical team, using the
appropriate equipment and following the recommended
procedures in appropriate healthcare facilities
• Access to accurate, updated, evidence-based medical
information, 24/7
• Psychological support/counseling available 24/7
• All care to be free of charge, under the coverage of the employer,
• This is where medevac takes place
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5. The bill of rights of the patient
(3):
After recovery: to benefit from a constant support
from the employer and its medical services:
• Long-term basis monitoring (medico-psycho-
social),
• Counseling, PTSD management on a long-term
basis,
• Classification as work-related accident,
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6. The duties of the staff member
before being a case:
• Never overestimate her/his capacity and skills. Self assessment is not
enough. Requires an external support. Coaching is an approach.
• Tell the truth about any kind of possible limitation (personal, family,
health, pregnancy, ...).
• Understand the importance of the rules and policy, and commit to
adhere to them (administrative sanction must strictly apply, just at the
level of the threat).
• Commited to be a team player, under the lead of an experienced, firm
but supportive team leader,
• Ever report any potential accidental exposure, on work place and also
in personal life (including sexual exposure). Not reporting may be
considered as a criminal offence, putting others' life at stake.
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7. The duties of the patient exposed to high
risk of contamination or becoming a case:
• No delay in reporting the exposure and any
symptoms belonging to the approved case
definition; comply with the procedure of notification
• Actively prevent secondary infection in following
the procedure in place, especially in refraining any
contact with anyone else,
• Adhere to the treatment and follow any piece of
advice given by the medical team officially in
charge of the care,
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8. The place of medevac in the EVD
patient's management:
• As of now:
• very limited options for a sick patient,
• the soonest the best, up to right away after a confirmed high-risk
exposure
• Nationality-dependent process for admission to the receiving hospital
• In the future:
• Implementation of high-standard ICU by developed countries in the
heart of the affected areas,
• Simplification of medevac of asymptomatic patients exposed to high-risk
• Extension of the capacity of private operators to medevac symptomatic
patients
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9. Conclusion
• Education to risk management at the very individual level to non
specialist of risk management,
• Decision of fitness to work to be carefully taken, whatever the
pressure might be,
• Importance of the very simple rules to never ever forget and apply:
work-life balance, hands hygiene, prevention of diseases, prevention
of road accidents,
• To debrief with the medical services, and try to draw lessons from this
experience is instrumental to improve the procedures in place (CQA),
• Team work, on staff member/patient's side, as well as on employer
and medical services providers ("chain of survival"),
• The medical assistance provider must be a very strong link of this
chain and a full member of the team.
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