Respiratory therapists work on a great many teams, but few can compare to the team in place at the Nebraska Bio-containment Unit (NBU) on the campus of the University of Nebraska Medical Center in Omaha. One of only a handful of similar units around the country, the NBU stands ready to care for people who have been diagnosed with the deadliest infectious diseases on the face of the earth.
Frank Freihaut, BS, RRT, is one of five RTs assigned to the NBU, and he describes for us here what it’s like to work on a team of this caliber —
How are RTs chosen for the NBU and what are their main roles in the unit?
Every clinician who volunteers for the NBU is interviewed by the NBU management to outline our duties and the risks involved in working with patients who have highly infectious disease or special pathogens. This allows both parties to get a feel if they would be a good fit for the team. In addition, NBU leaders contact the RT department manager to review teamwork, communication, and dependability behaviors.
The RT role within the unit, like the RNs and Patient Care Technicians, consists of all patient care processes within their scope of practice, plus shared duties of cleaning the unit, autoclaving waste, and supporting the team through donning and doffing Personal Protective Equipment (PPE). They also review and assist in devolvement of our unit-specific policies and procedures.
How are these RTs trained for this unique role and how often do team members get together to practice the skills they have learned?
Since each health professional that joins the team maintains their discipline-specific competencies in their regular job, they train with everyone together for the donning and doffing and shared roles (i.e., the waste management, unit preparation, cleaning, knowing what EPA-approved cleaning solutions will be used for what procedures, etc.) Our team has monthly staff meetings to review policies and procedures, quarterly drills to assess readiness, and occasionally combined city, state, or national drills with other facilities and state and national health departments to coordinate mobilization of possible patient scenarios and unit activation.
How often do RTs serve in the unit?
Because the unit, once activated, is self-contained, the unit management schedules staff based on the patient needs. If the need is respiratory-related, then the RTs will be utilized for their clinical expertise.
We train for all highly infectious disease scenarios, not just Ebola — even airborne possibilities like Middle Eastern Respiratory Syndrome (MERS) and many others. As you could imagine an airborne disease with pulmonary complications manifesting in ARDS-like symptoms would necessitate quite a bit of our respiratory skills. Realizing that many health care workers contracted the airborne disease SARS through use of NIV/BiPAP makes an RT question what treatment modalities would be safe, and which should be avoided for an airborne special pathogen.
When the respiratory clinical need is accomplished the RTs help with the shared duties. Thus, all staff help keep the unit running smoothly. Our unit does not bring in Environmental Services personnel; the clinicians perform these duties to reduce risk and the number of staff we would need to train. For example, our unit’s waste management process for a viral hemorrhagic fever scenario is to autoclave all waste and laundry prior to it leaving the unit. Thus, the clinical staff train for and perform that function.
What can you tell us about the new Global Center for Health Security scheduled to open on your campus and how RTs might be involved in it?
The leadership of the Global Center for Health Security (GCHS) includes many of the NBU leaders. For many of the programs in the GCHS, the clinical expertise of the NBU staff will be used to develop the standard operating procedures for the quarantine unit and creation of the curriculum for the training programs.
One of our duties back during the 2014-15 Western Africa Ebola outbreak was observing health care workers who had possible exposure to Ebola. Bringing individuals back close to a unit that can care for them if they convert can save valuable time for the start of treatment should signs and symptoms develop. RTs are utilized in staffing and helping review the policies and procedures for this separate unit. This requires a different way of looking at our tasks since individuals needing monitoring are not considered patients. But they need to be observed for a period of time by trained staff who can recognize if signs or symptoms develop. Should an individual show signs and symptoms they would be transferred to the bio-containment unit for optimum care and safety.
This isn’t a job for the faint of heart — how do you screen RTs who express an interest in serving in the unit and what kinds of mental and emotional characteristics do you look for in potential candidates?
As you say, this job is not for the faint of heart. But most of us are more familiar with the phrase “fear of the unknown.” This fear of the unknown is what all of us who work in the emergency department or frontline clinic, and to some extent any acute care facility, deal with. We often do not immediately know what our patients are suffering from. But when the NBU is activated, we have a good idea of the pathogen our patient has contracted. This knowledge and extensive preparation allow for a rational reduction in the fear of treating a person with a highly infectious pathogen.
The skills for infection prevention and use of PPE we learn in the bio-containment unit allow us to be seen as prevention experts on our regular duties throughout the facility.
Screening for clinicians to work in the NBU really has to do with the understanding that you will be wearing cumbersome, hot PPE for several hours — that it is difficult to work in the PPE, and it may restrict your vision, hearing, and tactile sensations. Also, recruits need to consider how family and significant others will feel about one working close with special pathogens.
You recently went to Africa with some fellow team members. Tell us more about how the trip came about and what you accomplished there.
This past August another outbreak of Ebola started in eastern Democratic Republic of Congo (DRC). The University of Nebraska Medical Center (UNMC) and Nebraska Medicine had hoped to send a small group of clinical staff to help care for patients in an Ebola Treatment Unit in eastern DRC. I was preparing for that trip. Because of serious security issues with unrest in the affected area of the DRC the mission was canceled for safety reasons.
There were some funds available, so an infection prevention education trip to western Uganda was planned. James Lawler, MD, an infectious disease specialist with UNMC, helped set up the trip, and our leadership chose a few of us who had worked with our Ebola patients in 2014. I was honored to be the RT asked to go.
Our team was Dr. Lawler, three nurses, and myself as the RT. We taught about 135 health care workers at five locations, transit centers, and refugee settlements along the border of Uganda and the DRC. Our efforts were in conjunction with Medical Teams International, a non-governmental organization helping with health care needs at the refugee settlements.
Both Uganda and DRC citizens routinely travel to and from the eastern region of the DRC where the Ebola outbreak is happening. Our efforts were mostly doing hands-on PPE donning and doffing, along with hand hygiene and review of other essential infection prevention processes. We learned that great care can be delivered in an austere environment and we increased the skill set of the health care workers we taught.
We hope to send another team back to continue the education missions as well as the possibility of helping care for patients. All our RTs have expressed interest in helping with this outreach and will be considered for future trips.