Monday, October 20, 2014

When Life Imitates Art

There is a television show called “The Strain” a television series that premiered on FX on July 13, 2014.  It was created by Guillermo del Toro and Chuck Hogan, based on their novel trilogy of the same name. The show depicts a vampire-type apocalypse that when superimposed on the “Ebola Crisis” have very similar characteristics.
In the show the “infection” which leads to a form of vampirism has the following characteristics:
  1. The illness arrived by plane.
  2. The illness is spread by direct contact.
  3. The illness is contained in a “wormlike parasite” which looks very similar the electron microscope pictures of the Ebola virus.
  4. The victim proceeds to transmit the illness directly to their immediate contacts (the people they love).
  5. The Centers for Disease Control are both the heroes and villains.
  6. Decisions about protecting the community are a complex interaction between fact, fiction, political issues, financial issues, and last medical issues.

It is interesting the parallels and if one get rid of the vampire stuff, pretty close to reality. These are complex problems which hopefully will get sorted over time.
The recent admission of an Ebola victim to a Texas hospital has created a furor in the media but how could the Emergency Department send someone home with “fever and feeling bad.”  The blame game started with triage nurse, the Emergency Department, the hospital system, TSA and Homeland security, and now the Electronic Health Record for not identifying this problem the first time.
Before everybody gets upset, the reality of Emergency Medicine is that it is traditionally a reactive specialty that once it identifies the specific threat it is nimble and organized to create policies to avoid missing the next case.

The Texas hospital had the misfortune of being the first place known to have had an Ebola exposed patient leave the department without initially identifying that individual and setting the “government” machinery on them.
The individuals involved unless prescient are victims of a system error where the safeguards were not already in place. The institution having no experience of what to look for probably were not geared up. The Electronic Health Record and clinical decision support (artificial intelligence) is probably not geared up to give the providers adequate warnings.
Blaming individuals will not solve the problem, but a plan to be ready for the next case is the proper pathway. These are “system issues” that require an organized response. Vampire shows are not for everyone, but sometimes they are well-made and interesting.

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