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To ensure an effective system of quality patient care and coordinated emergency medical response by planning, implementing and evaluating an effective emergency medical services system including fire department and public ambulances, prehospital providers and hospitals, including specialty care hospitals, such as trauma and cardiac care hospitals. Expression of concern regarding paper by Park et al, published on 25 June 2015: “Epidemiological investigation of MERS-CoV spread in a single hospital in South Korea, May to June 2015”, Euro Surveill. It has been brought to our attention that some of the authors may not have been informed about the content of the above paper. Citation style for this article: de Jong MD, Reusken C, Horby P, Koopmans M, Bonten M, Chiche JD, Giaquinto C, Welte T, Leus F, Schotsman J, Goossens H, on behalf of the PREPARE consortium and affiliated clinical networks.
In response to the Ebola virus disease (EVD) outbreak in West Africa, the World Health Organization has advised all nations to prepare for the detection, investigation and management of confirmed and suspected EVD cases in order to prevent further spread through international travel.
The unprecedented and devastating epidemic of Ebola virus disease (EVD) in West Africa, with over 15,000 reported cases and nearly 5,500 deaths as of 21 November 2014 [1], has ignited increasing global concerns about the potential introduction and further spread of the disease by international travel and repatriation [2–4]. To gain insights into the preparedness of European hospitals and identify potential gaps in preparedness at hospital level, we conducted a survey of hospitals in 40 European and western Asian countries, focusing on the willingness and capacity to admit patients with suspected EVD and on specific preparedness activities of hospitals in response to the current Ebola crisis. In addition, the questionnaire asked whether hospitals would, in principle, admit patients with suspected EVD, and if not, whether local or national agreements were in place for transfer to another hospital. After pilot testing in three hospitals, an online link to the electronic questionnaire was circulated by email to 984 medical professionals representing 736 hospitals in 38 European and 2 western Asian countries (Turkey and Israel).
Responses were received from 266 out of 984 (27%) medical professionals of whom 12 did not provide permission to use the data for reporting. Of 236 hospitals, 111 (47%) stated that they would admit suspected EVD patients, 99 (42%) indicated that they would not admit such patients, and 26 (11%) did not know whether such patients would be admitted (Table 1).
Respondents from 181 hospitals (77%) were aware of the existence of national guidelines for management of patients with haemorrhagic fever (including EVD) while 30 hospitals (13%) indicated these were not available. Local hospital guidelines were available in 153 of 236 hospitals (65%), not available in 60 hospitals (25%) and the remaining respondents did not know (Table 1). The availability of national, and even more so of hospital guidelines was highest in hospitals that would admit patients with suspected EVD compared with those that would not admit patients or did not know (Table 1). EBOV diagnostics were performed on site in 17 hospitals, which included 14 hospitals that would admit patients, 1 that would not admit patients and 2 that did not know. Preparedness activities in response to the EVD outbreak included revision of hospital protocols or guidelines in 168 hospitals (71%), education and training of healthcare workers (HCWs) in 131 (56%), formation of an outbreak management team (OMT) in 121 (51%) and participation in regional or national preparedness committees in 89 (38%) (Table 1). Northern and western Europe had the highest proportions of hospitals that would admit patients with suspected EVD (57% and 56% respectively) and this proportion was lowest in eastern European states (12%) (Table 3). Suggestions were received from 60 of 266 respondents, of whom 42 (70%) emphasised the need for education, information and harmonised guidelines for infection control, diagnostic procedures and clinical management. Our exploratory survey was initiated less than three weeks after WHO’s Public Health Emergency of International Concern (PHEIC) declaration on 8 August 2014 [4], to provide initial insights into the state of EVD preparedness in European hospitals at that time.
At the time of the survey (August–September 2014), the vast majority of admitting hospitals were engaged in various preparedness activities such as revision of protocols, training of HCWs and implementation of a local OMT. Technical characteristics of admission rooms varied across admitting hospitals, with differences observed between European regions. Availability of national and local hospital guidelines for management of patients with (suspected) haemorrhagic fever was indicated by a majority of respondents with highest availabilities observed in admitting hospitals and in western European countries.
In summary, this survey has provided important initial insights into the preparedness and capacity to admit patients suspected for EVD in European hospitals. We are greatly indebted to all colleagues who have participated in this survey, and to Julia Bielicki and Mike Sharland for helpful comments on the questionnaire.
This work received funding from the European Union Seventh Framework Programme (FP7) under the project PREPARE (grant agreement No 602525). Disclaimer: The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Centre for Disease Prevention and Control (ECDC) or the editorial team or the institutions with which the authors are affiliated. Type of ProgramThe Department of Emergency Medicine at Bellevue Hospital Center and NYU Medical Center has been a recognized leader in academic adult and pediatric emergency medicine, disaster preparedness, toxicology, and public health. Ultrasound Fellowship EducationFellowship education will include training in both basic and advanced ultrasound applications, weekly video review & QA, weekly didactics and journal article review.
Denise Bulling joined the University of Nebraska Public Policy Center in 2003 and is a Licensed Independent Professional Counselor with extensive field experience in behavioral health that she uses in her work to create bridges among practitioners, academicians and policy makers.
A national expert in emergency preparedness and emergency medical systems, with strategic and operational experience, Dr. Jocelyn Montgomery is a Public Health Nurse who has spent most of her career in long term care. Ten year old Madison Leahy, daughter of Jon and Terri Leahy, wanted to do some-thing for sick kids who came to the emergency room. Through Madison’s act of kindness, children who come for care at the Decatur County Hospital’s Emergency Department will be able to choose a brand new stuffed animal to take home with them.
Decatur County Hospital would like to thank Madison for her special act of kindness and for making a difference in the lives of other kids! Frederick Memorial Hospital held an Emergency Preparedness Fair day on Thursday, June 29th. They will also have the ability to think critically and creatively about what is needed to improve patient activation and health improvement. Preparedness for admission of patients with suspected Ebola virus disease in European hospitals: a survey, August-September 2014. To gain insights into the state of preparedness of European hospitals, an electronic survey was circulated in August–September 2014 to 984 medical professionals representing 736 hospitals in 40 countries.
For this reason, the World Health Organization (WHO) has advised all nations, including those not directly neighbouring currently-affected countries, to prepare for the detection, investigation and management of confirmed and suspected EVD cases [4]. It should be emphasised that the survey did not address preparedness for EVD at national levels but was solely intended to explore the preparedness at the hospital level. For hospitals that would admit patients with suspected EVD, additional questions were asked about the characteristics of admission rooms (e.g.
In case of discrepant responses from multiple representatives of the same hospital, affirmative or negative answers took precedence over ‘do not know’ replies.
The remaining 254 respondents represented 236 of 736 hospitals (32%) in 38 European and western Asian countries. In the 99 hospitals indicating they would not admit patients, local or national agreements for transfer of patients were in place in the majority (local 25 (25%), national 67 (68%)).

Guidelines were based on national guidelines in 81% and on international guidelines in the remaining cases (19%). In these laboratories, biosafety level (BSL) 2 and 3 facilities were available in 57% and 24%, respectively and not available in 11% and 40%, respectively. For the majority of remaining hospitals, agreements and procedures were in place for performance of Ebola diagnostics in national (59%) or international (13%) reference laboratories. In 67 hospitals (28%), exercises to test procedures and protocols were completed or planned in the immediate future. Differences were noted between regions with respect to availability of national and local guidelines, laboratory infrastructure and preparedness activities, with highest frequencies mostly observed in western European countries, followed by southern, northern and eastern European states (Table 3, Figure 2B). Most remaining suggestions pertained to the need for support and clinical research in affected West African countries.
It should be emphasised that this survey explored the preparedness to admit patients with suspected EVD at the level of hospitals and no inferences can be made from the results of this survey with regards to preparedness at national levels.
Recent healthcare-associated cases in the US and Spain have demonstrated the importance of training of HCWs in personal protective equipment regimens [7,8], and the finding that 27% of hospitals indicated they had not performed or planned training of HCWs shows room for improvement. Admission rooms in a substantial proportion of hospitals lacked one or more characteristics considered to be important for control of highly infectious pathogens and 5% of hospitals appeared to have none of these characteristics.
Of note, discordant responses from the same country in relation to availability of national guidelines were observed on several occasions (data not shown), indicating that differences in awareness of guidelines exist within countries. First of all, although the geographical distribution of participating hospitals across Europe was excellent, the survey results may not be fully representative of European medical professionals and hospitals for several reasons. These results, including identified gaps or concerns, help to provide direction towards further preparedness activities and prioritisation thereof.
Ebola virus disease in West Africa--the first 9 months of the epidemic and forward projections. Preparedness is crucial for safe care of Ebola patients and to prevent onward transmission in Europe - outbreak control measures are needed at its roots in West Africa. Infection control management of patients with suspected highly infectious diseases in emergency departments: data from a survey in 41 facilities in 14 European countries. Isolation facilities for highly infectious diseases in europe - a cross-sectional analysis in 16 countries. Neither ECDC nor any person acting on behalf of ECDC is responsible for the use that might be made of the information in this journal. We are excited to offer fellowship training in emergency ultrasonography in this inspiring setting. Fellows will be expected to give lectures and workshops to medical students, residents, and faculty. Paul Biddinger is the Vice Chairman for Emergency Preparedness in the Department of Emergency Medicine at Massachusetts General Hospital (MGH) in Boston. Khan's professional career has focused on emerging infectious diseases, bioterrorism and global health security.
Public Health Service and serves as Chief of the Healthcare Preparedness Activity in CDCa€™s Office of Public Health Preparedness and Response. David Marcozzi currently serves as the Senior Advisor for Emergency Preparedness and Acute Care within the Centers of Medicare and Medicaid Services.
She joined the California Association of Health Facilities in 2006, and currently serves as their Director of Clinical Affairs.
Madison said “I wanted to donate stuffed animals to the hospital so kids in the emergency room wouldn’t feel scared or lonely. Contribution to high quality Surgical care given to families by a team of nurses and skilled providers. The survey addressed the willingness and capacity to admit patients with suspected EVD as well as specific preparedness activities in response to the current Ebola crisis.
In view of the non-specific nature of initial symptoms, suspected patients essentially include all travellers with unexplained febrile illness recently arrived from areas with ongoing EVD transmission, particularly when accompanied by gastrointestinal symptoms.
PREPARE is a partnership of established and developing European clinical research networks, covering primary care (GRACE and TRACE) and hospital care (CAPNETZ, COMBACTE, ESICM and PENTA) in more than 40 European countries, including all EU Member States. Comparisons were made between hospitals that would admit patients with suspected EVD and those that would not or did not know. Similar to national guidelines, triage criteria and infection control practices were covered in more than 95% of local guidelines with less frequent coverage of other topics.
In the remaining cases respondents were not aware of the biosafety levels of the laboratory (32% and 36%, respectively). All preparedness activities were performed more frequently in hospitals that would admit patients (Table 1, Figure 3). At the time of the survey, 46% of admitting hospitals had planned or carried out exercises to test protocols. During the course of illness, clinical specimens can contain very high viral loads for extended periods of time [14,15], and a careful assessment of the risks for processing such specimens in the local laboratories is crucial.
This might illustrate the importance and challenges of dissemination of guidelines, also at national levels.
The survey was circulated only to hospitals actively participating in established clinical networks and these may not be representative of European hospitals overall.
Bellevue Hospital Center is an urban, academic, Level I Trauma Center with a combined emergency department census of 130,000 patients yearly.
Fellows will also receive training in the ECHO and Vascular labs, as well as in Critical Care and international settings. Bullinga€™s interests include behavioral health policy, disaster and homeland security issues, and threat assessment. Peggy is the staff liason to the disaster planning committee and customer experience committee. Khana€™s vision is for the College to play an integral role in making Nebraska the healthiest state in the Union. He founded the Public Health Matters blog and has been personally engaged in guinea worm and polio eradication activities. CAPT Levya€™s primary interest is all-hazards healthcare preparedness and emergency response for threats including pandemic influenza and other infectious diseases, bioterrorism agents, and natural disasters such as hurricanes and earthquakes.

She created the CAHF Disaster Preparedness Program, a nationally recognized program in its eight year of HPP funding. Evaluable responses were received from representatives of 254 (32%) hospitals in 38 countries, mostly tertiary care centres, of which 46% indicated that they would admit patients with suspected EVD. The current assessment is that travel-associated cases will remain rare across Europe, but that the occurrence of EVD in returning healthcare workers is a realistic scenario [5,6]. An open question was added to capture specific suggestions or needs in relation to EVD preparedness that could be addressed by the PREPARE project. In addition, comparisons were made between hospitals in the four regions of Europe (eastern, northern, southern, western) and western Asia, as defined by the United Nations Statistics Division’s Geoscheme [9]. Among the remaining respondents were infection control specialist (19, 8%) and paediatricians (9, 4%). Availability of BSL 2 and 3 facilities was higher in hospitals that would admit patients (70% and 36%, respectively) compared with those that did not (51% and 14%, respectively).
Given the complexity of issues surrounding admission of patients with suspected EVD, such exercises are essential. Laboratories without BSL2 containment should therefore be encouraged to upgrade their facilities and refer samples to laboratories with BSL2 or preferably BSL3 facilities in the meantime.
At the same time, the need and desire for guidance was illustrated by responses to our open request for suggestions, the vast majority of which emphasised a need for education, information and harmonised guidelines, especially for diagnostic issues and clinical management of patients. Furthermore, the response rate was fairly low: responses were received from 27% of colleagues representing 32% of hospitals, which means that the survey results may also not be fully representative of hospitals to which the survey was circulated. While directing global infectious disease activities, he designed the laboratory component of the CDC's field epidemiology and training program.
She focuses on working with communities to assist them with integrated planning of their public health, healthcare, emergency medical services, and emergency management sectors to safely deliver the right care at the right time and in the right place. Patient transfer agreements were in place for the majority of hospitals that would not admit patients. The recent experiences with both types of EVD cases in the United States and Europe, with local transmission to healthcare workers, illustrate the importance of being prepared [7,8]. Respondents could indicate whether or not permission was granted to use the anonymised results in reports or publications. Hospitals represented in the survey were mostly tertiary care centres (78%) and were widely distributed across Europe and western Asia (Table 1, Figure 1). Preparedness activities were significantly less frequent in hospitals that would not admit patients or were not sure whether they would. Therefore, while standard contact precautions would generally suffice for management of EVD patients, this may differ for such high-care settings.
The majority of responses (78%) were from tertiary care hospitals, which might suggest overrepresentation of tertiary care settings. Except where otherwise stated, all manuscripts published after 1 January 2016 will be published under the Creative Commons Attribution (CC BY) licence.
Biddinger additionally serves as the Director of the Emergency Preparedness and Response Exercise Program (EPREP) at the Harvard School of Public Health and holds appointments at Harvard Medical School and Harvard School of Public Health. He also helped design and implement the CDC component of the $1.2 billion, 5-year Presidenta€™s Malaria Initiative.
I collected the stuffed animals by friends and family bringing them to my birthday party instead of a present. Compared with non-admitting hospitals, admitting hospitals were more frequently engaged in various preparedness activities and more often contained basic infrastructural characteristics such as admission rooms and laboratories considered important for infection control, but some gaps and concerns were also identified.
Although unlikely, suspected EVD patients may present at any healthcare setting, and so awareness of initial management of suspected cases is important for all settings, including non-admitting centres. However, the extent of this possible overrepresentation could not be determined since no information was available about the settings (i.e. You are free to share and adapt the material, but you must give appropriate credit, provide a link to the licence, and indicate if changes were made. He co-founded a novel center at the CDC to champion a one health strategy and ensure health security from a myriad of zoonotic, vector-borne, and food-borne infectious diseases. The results of this survey help to provide direction towards further preparedness activities and prioritisation thereof. Almost all respondents indicated the availability of initial triage protocols, suggesting that undetected hospitalisations are unlikely. Of note, the proportions of hospital admission rooms with characteristics such as the presence of an anteroom and availability of negative pressure were higher than observed in a previous survey of emergency departments in 14 European countries (87% and 69% vs 46% and 42%, respectively) but, not unexpectedly, lower than those observed in a survey of 48 isolation facilities for highly infectious diseases in 16 European countries (100% and 90% respectively) [12,13].
However, some training of HCWs for this scenario also in non-admitting hospitals seems prudent.
Nevertheless, as tertiary care centres generally have a central and leading role in preparedness efforts for emerging health crises, our survey results do serve as important indicators of the state of preparedness in Europe.
Secondly, several of the questions in our survey remained unanswered (‘do not know’) a substantial proportion of respondents, likely due in large part to differences in medical background of respondents (ranging from intensive care specialists to clinical microbiologists) and the variety of topics addressed. However, close collaboration between these specialists is clearly needed to provide optimal and safe care for EVD patients. Thirdly, as the number of participating hospitals differed substantially between regions, with relatively low numbers from eastern Europe and western Asia, geographical differences in the results of this survey should be interpreted with caution. Finally, this survey represents a snapshot of the state of affairs six months after the EVD outbreak in West Africa became apparent to the world and three weeks after it had been declared a PHEIC. Since then, preparedness activities of hospitals, including training and exercises, will undoubtedly have intensified globally given the continuing and expanding crisis in West Africa and emergence of travel-associated cases elsewhere.
It will be interesting to assess whether this is indeed the case in a future follow-up survey.

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