With a Little Help from My Friends: How EmCare and Its Sister Companies Tackled Ebola

Posted on Thu, Dec 11, 2014
With a Little Help from My Friends: How EmCare and Its Sister Companies Tackled Ebola


Three months ago, Ebola was another exotic disease in some far away land. Then on Sept. 30, the Centers for Disease Control and Prevention (CDC) announced that the first Ebola patient had been identified in the United States. That distant shore became our front door.

Watching the news, you would have thought Ebola was about to run rampant through the streets of every city, county and state. The challenge for public health officials became two-fold: get ready to deal with the possibility of Ebola and calm public fears.

Envision Healthcare’s clinical leadership team understood those challenges and began to address concerns unique to each company. EmCare has two sister companies under the Envision Healthcare parent: Evolution Health, a physician-led company specializing in the management of complex patients in the home and alternate settings; and AMR, the country’s largest emergency medical services provider.

As the nation’s largest physician services company, EmCare was in the spotlight. Dighton Packard, M.D., Envision Healthcare’s Chief Medical Officer, communicated regularly with clinicians as well as partner hospitals and developed web-based informational resources.

“The key to stopping this disease is to quickly identify and isolate potential carriers,” said Dr. Packard.

“Our goal was to provide the latest CDC recommendations as well as helpful clinical resources that addressed concerns unique to our various practice environments.”

Al Sacchetti, M.D., a Medical Director for EmCare, created instructional videos for EmCare clinicians. The videos were sent to EmCare-managed locations across the country.

“The highest probability is that an Ebola patient who enters the U.S. will find his way to an emergency department,” said Dr. Sacchetti. “As a leader in the field of emergency medicine, EmCare is making sure all our affiliated clinicians have the best tools to deal with the situation. We want them to be able to recognize Ebola patients, and respond appropriately and quickly.”

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The videos Dr. Sacchetti created focus on the correct ways to don and doff personal protection equipment (PPE). They were quickly reshot several times as the CDC changed its recommendations.

“Things change,” said Dr. Sacchetti. “When we made the first videos, we had the associates putting on goggles. A few days later, the CDC recommended against goggles because people kept adjusting them and touching their faces. Now we have hoods.”

EmCare also developed a special website for updates, educational resources and messages from Dr. Packard. The site, is still active and will be updated as needed.

Not too long before the first patient was identified in Dallas, AMR had worked with the CDC to transport a known Ebola patient. The transport wasn’t publicized, but AMR leaders realized there was a very good chance more Ebola transports were imminent.

They were right.

“From the very beginning, our primary consideration was the health and safety of our caregivers, our patients and the communities we serve,” said Ed Racht, M.D., AMR’s Chief Medical Officer. “Ebola is a concern for emergency medical services (EMS) because the out-of-hospital setting is unpredictable and identifying potential cases is challenging.”

Dr. Racht’s clinical team began by developing EMS Ebola screening criteria. The document was sent to every operation and the 44 AMR communications centers that answer 911 calls and dispatch ambulances. It was also added to MEDS, AMR’s electronic patient care record, and within six weeks more than 117,000 AMR patients had been screened for Ebola. Eighty-six met the criteria to be considered a potential Ebola patient and were transported accordingly.

AMR also launched an Ebola resource website at that has generated more than 63,000 hits and become a valuable resource for hospitals, fire departments and other EMS providers around the country.

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AMR’s clinical team then worked with the logistics and supply departments to identify and order upgraded personal protective equipment for paramedics and EMTs.

“We looked at the CDC recommendations and felt we needed equipment that in some instances exceeded those standards,” said Ron Thackery, AMR’s Senior Vice President of Professional Services. “The CDC was focused on managing hospitalized Ebola patients. We knew transporting patients would be more challenging, so we developed guidelines that took every possible scenario into consideration.”
The team also set up a hotline at Evolution Health’s Williams Medical Command Center in Dallas (MCC) where nurse practitioners and members of the AMR medical leadership team provided clinical and operational support. Most of the questions regarded the transport of suspected Ebola patients. That changed when the CDC requested AMR’s assistance in transporting two known Ebola patients.

On Oct. 15 and 16, AMR’s preparations were put to the test when Ebola-stricken nurses Nina Pham and Amber Vinson were transported from Texas Health Presbyterian Hospital to Dallas Love Field Airport.

Both transports were broadcast live nationally.

“From wrapping the interior of the ambulance to donning and doffing the PPE, the entire process worked just as we had planned,” said Dr. Racht. “I couldn’t have been prouder of the crew members who participated in these transports. It was a shining moment for the entire organization.”

Starting the next day, the MCC provided monitoring services for the AMR paramedics who were in the ambulances that transported the nurses.

“This is another example of how we came together as an organization to support each other,” said Dr. Racht.

The emphasis on Ebola has slowed for now, but its effect on the healthcare system and emergency medical services has been profound.

“Our experience with Ebola has shown that we must remain vigilant and always prepared for new and evolving infectious diseases,” said Dr. Racht. “The new role for EMS moving forward will be to identify, respond and contain new outbreaks as they occur.”

While the role of emergency medical services may have changed, emergency medicine was once again front and center at this critical time.

“Emergency physicians have been, and will continue to be, on the front lines of America’s healthcare system,” said Dr. Packard. “Whether it’s Ebola, H1N1 or any other infectious disease, we will continue to keep our communities safe.”

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