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In the Hot Zone: Nebraska RTs on Frontlines of Ebola Fight

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October 13, 2014

August 2006 AARC Times

Back in 2006, AARC Times featured a cover story on the Nebraska Medical Center’s Biocontainment Unit. Just a couple of years old at the time, the facility was being staffed by physicians, nurses, and respiratory therapists who were training on a regular basis to handle whatever deadly infectious diseases might land on our shores.

AARC member Frank Freihaut, BS, RRT, was our go to person for information on the unit then, and we got back in touch with him late last week to find out what’s been happening with the facility since our first story, and how he and his colleagues have been coping with the two Ebola patients they’ve seen over the past couple of months.

AARC: What has changed in the unit since we first did the story in 2006?

Frank Freihaut: The purpose of the Nebraska Biocontainment Unit has not changed, but while a few of the original staff have left and a few new members joined, we have grown as a team. The respiratory therapists involved are from multiple shifts and the nurses and technicians are from many areas of our medical center. We drill a few times a year and these drills not only keep us sharp on our processes and policies, but they have also helped us get to know each other and have a great working relationship. There is a confidence we have together that I believe would not be there otherwise. 

AARC: What do the drills consist of?

Frank Freihaut: Our drills most often focus on specific aspects of our infection control and personal protective equipment, since our clinical skills are tested through our regular jobs. We then review and determine what we can do better and what will work better to reduce any exposure risk. This has even helped as we activated. Our team members have been flexible to adjust to process and policy changes that we find can keep us and our patients safe. Then knowing each other through our drills, we watch out for each other, making sure our PPE is on correctly and that of others is also correct. If any one of us “corrects” another, our working relationship helps us to appreciate that it is not a “correction” or a “you did something wrong”—it is a good feeling of “thanks for having my back.” With the multiple times each shift that we don and doff sometimes multiple layers of PPE, we must stay vigilant to keep each of us and our patients safe.

AARC: How many RTs are on the team today?

Frank Freihaut: There are currently six respiratory therapists on the team.

AARC: What kinds of patients have been treated in the unit in the eight years since we did the first story?

Frank Freihaut: Though we had a couple “almost” activations in the years since we opened—those patients ended up not needing isolation—Dr. Rick Sacra was our first patient admitted to the unit this September. And currently we have our second patient with Ebola. 

AARC: What are the biggest challenges you have faced from a respiratory standpoint in treating these patients and what have you found were the best solutions to the issues that arose?

Frank Freihaut: To date our patients have had few respiratory needs. Our protocols utilize metered dose inhalers should a patient require bronchodilators. This should help reduce aerosol. Our leadership staffs at least one respiratory therapist per shift in case respiratory needs develop. Otherwise we perform duties as our other licensed professionals do in donning and doffing, maintaining the unit’s constant cleaning to reduce/eliminate the risk of spreading the infective agent. We maintain the unit with just a few staff in the “hot zone” so everyone pitches in to do any task needed within their scope of practice.

AARC: What are some of the other challenges you have faced and how have you been addressing them?

Frank Freihaut: To me the general communication while in the unit has been the biggest challenge, and I think our team has done a good job working through the challenge. Our leadership coordinates our input to a shift “huddle,” so along with the communication on our patient’s needs, we also update any improvements we may have implemented, or risks we know to avoid. Our hospital leadership has acquired a secure video conferencing system so we can communicate with the patient and caregiver in the room from the unit desk. And this system has also allowed for consulting physicians to communicate, as well as family to communicate with the patient. For patient care we have utilized an electronic stethoscope. This allows for small “ear buds” to be placed in the clinician’s ears while clean, prior to going into the patient’s room, then hear the heart and lung sounds over the sound of the air handlers and the noise from the clinician’s own PPE. 

AARC: You and your colleagues have been training for years for situations like the one you are in now. How does it feel to put all your training into operation and why do you believe it is important for RTs, in particular, to step up and volunteer to fill these types of roles in the battle against these deadly infectious diseases?

Frank Freihaut: Our whole team, from our physicians, nurses, RCPs, technicians, laboratory staff, even administrators, pulled together and supported each other. I actually had a recent time away from the unit due to working with our electronic health record. I returned to a clinical specialist role this past June. So as soon as I heard the unit was to be activated, I called our leadership and asked if I could come back to help. After drilling for years, this was the moment we all worked for and I wanted to be there with the ones with whom I had trained. When Dr. Sacra’s test came back negative for the Ebola our hard work swelled our pride of a job well done. We have had other therapists and nurses subsequently step forward, volunteering to join our team. Your original article had a picture of myself and Deborah Ray. We are both RCPs that have been on the team since opening in 2005. The current RCPs are Deborah Ray, Jean Bellinghausen, Lauren Mainelli, Susan Denny, Dee Pinkney, and myself.

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