Officials will establish safety procedures for hospitals across state

Hawaii health care officials plan to meet every day for the next two weeks developing procedures for island hospitals and health care workers aimed at exceeding current standards for dealing with an Ebola patient.

"If the recommendations say to put one glove on, we’re going to put two on," said Toby Clairmont, director of emergency services for the Healthcare Association of Hawaii. "We’re going to bring it to a level of protection that’s going to be unmatched."

A new committee jointly led by the state Health Department and Healthcare Association of Hawaii begins its work as concerns about an Ebola outbreak spread across the mainland and in the islands.

"Everybody’s pretty worried about somebody developing Ebola in the community," said Dr. Linda Rosen, state director of health.

Locally, U.S. Rep. Tulsi Gabbard met on Friday with Rosen, Clairmont and other health care officials and said "they’re serious about getting it right."

On Wednesday morning, state Sen. Josh Green (D, Naalehu-Kailua-Kona), chairman of the Senate Committee on Health, wants a briefing on Hawaii’s Ebola plans from the Health Department, Healthcare Association of Hawaii, state Department of Transportation and the Centers for Disease Control and Prevention.

Green, a physician, is in the middle of a 48-hour emergency room shift this weekend at Kohala Hospital on Hawaii island and said the chances of an Ebola case are unlikely in the islands.

Nevertheless, Green said, "We have to prepare an absolute fail-safe plan. Right now, our state of readiness is a work in progress. But the right people are asking the right questions. And we’re going to stay focused on this with each of these departments working together until we have a safe and effective plan to protect Hawaii."

Currently, hospitals and clinics are working on their own individualized protocols for dealing with an Ebola patient, Rosen said.

But she plans to issue uniform procedures within two weeks that will include an emphasis on protecting health care workers using "personal protection equipment" (PPE) currently available at island hospitals, such as gloves, masks and gowns.

"The recommendations are continuing to evolve," Rosen said. "What is the best PPE to be used? What is the minimum PPE to be used? We can take the best of what’s out there and what works for our hospitals."

Other recommendations will touch on everything from the questions a 911 operator should ask in suspected Ebola cases to techniques that specially trained ambulance crews should employ while treating a patient.

A few hospitals — not just the Queen’s Medical Center — would be designated "upper tier" intensive care facilities that would treat any Ebola patient from around the islands, Rosen said.

"Every hospital that is licensed must have personal protective equipment," Rosen said. "But we do not believe any of the neighbor island hospitals have that higher level of intensive care that’s needed."

But health care workers at all facilities will be trained to deal with an Ebola patient, Clairmont said.

A patient would be isolated in a private room with a bathroom while the Department of Health and Healthcare Association of Hawaii are contacted, Clairmont said.

A special "bio-containment" team would then arrive to transport the patient "under containment" to one of Oahu’s upper tier hospitals. A patient on a neighbor island would be flown to Oahu via specially equipped military transport or commercial air ambulance.

"We need to move them interisland before they become too sick — and to take that burden off of that smaller hospital," Clairmont said. "We want to make sure all of our hospitals have access to training and don’t have to figure it out themselves. We want health care workers to have more confidence. And that’s only going to come from practicing and training."

Green treated a patient last weekend who showed up at Kohala Hospital with a high fever, one of the symptoms that triggered more questions about the patient’s recent travel and potential contacts with people from West Africa, which has been hit hard by Ebola.

The patient turned out to have strep throat.

But Green learned to ask "questions that four months ago people were not asking routinely," adding, "Now every physician and every health care provider is asking these questions all of the time. We’re more attuned to the international crisis."

On Friday, Gabbard had plenty of questions of her own.

"My concern is for what we’ve seen on the mainland and the lack of preparedness by the CDC and mainland hospitals, and wanting to make sure our health care professionals here are taking this seriously, so we’re not facing these kinds of incidents here," Gabbard said.

Officials with the CDC on Friday did not respond to requests for comment.

Gabbard on Friday also called for the immediate temporary suspension of visas for citizens from West African nations, as well as flights out of West Africa into the United States.

"If infections rise domestically, our health care workers will be focused here at home and will not be able to go to these West African countries and provide the assistance they need," Gabbard said.

Meanwhile locally, Gabbard said, "the need is recognized at every level that we need standardized training and equipment and rehearsals."