(dramatic instrumental music) NARRATOR: Plague,
influenza, Ebola, the most contagious and
deadly diseases in the world could be on our
doorstep overnight. Would we recognize the symptoms? Can we treat the disease or
even keep it from spreading? The margin of error, zero. At stake for the medical
team, their own lives, the safety of their families and the community
where they live. An elite group at a Nebraska
hospital, faced the real thing. This was not a drill. The lessons learned treating three different
patients with Ebola reshaped high-risk emergency
medicine nationwide. The crisis passed, but
a question remains. Are we ready for what
comes After Ebola? (dramatic instrumental music) (easygoing instrumental music) DR. ALI KHAN: Nature is
experimenting 24 hours a day, seven days a week,
365 days a year, so it's a little bit of a
Frankenstein-type picture that nature runs continuously, and we're never sure what
the new bug is going to be. We have to be prepared for that. NARRATOR: Do an Internet
search for recent new coverage of pandemic or
infectious disease and you will find recent stories about a high-risk outbreak
somewhere in the world. Science can identify
a virus quickly, but the world
remains vulnerable. Avian flu, smallpox, cholera, new strains of tuberculosis. DR. KHAN: I don't need to point
to some hypothetical disease in the future. I'll point to Zika and
say "We're not ready." Clearly, we're not ready. NURSE: So, before
that patient gets here, we need to have-- DR. KHAN: There's a
lot of work that needs to happen in hospitals and
in public health departments to make sure we are ready
for the next pandemic. (sirens blaring) (camera clicking) NARRATOR: Then came Ebola. A unique set of
circumstances gave the University of
Nebraska Medical Center the extraordinary opportunity
to encounter face-to-face patients infected with one of the world's most frightening and highly infectious diseases. This became, in a
sense, a dress rehearsal for the worst-case scenario. DR. PHIL SMITH: What
do you think we'll get? It wouldn't be the
first one we'll get. If we get one, which one
would you rather get. Somebody piped up and
said, "I really hope "we don't get Ebola 'cause
that's the worst of the worst." NURSE: When you're docking,
the only things you take off yourself
are your gloves and your respiratory protection. NARRATOR: A special
unit on the campus of the University of
Nebraska Medical Center spent 10 years
preparing for patients with dangerous,
highly-contagious diseases. REPORTER: This is
the deadliest outbreak of Ebola on record. FEMALE REPORTER:
Ebola infections will
double every three weeks. MALE REPORTER: In a city of a
million, almost 50 new cases are reported every day. NARRATOR: In 2014,
the Ebola virus swept through West Africa. More than 11,000
people died in Guinea, Sierra Leone,
Liberia and Nigeria. REPORTER: Has this
meeting to discuss the Ebola outbreak. MALE REPORTER: This Ebola
thing is not under control. We're not being told the truth. MAN: Most of those
who get it will die through uncontrolled-- DR. KHAN: Without a doubt
people are afraid. If you look at Ebola,
there's no treatment, and there's no vaccine
for the most part. That's a scary situation. NARRATOR: By late summer,
the United States government felt Americans infected
with the hemorrhagic fever, should be brought to this
country for medical care. Emory University
in Atlanta received the first Ebola patients
ever treated in the US. At the time, only three
hospitals in America had facilities able to safely
contain and treat the disease. Emory, the National Institute of
Health in Washington DC and the Nebraska
Biocontainment Unit. ROB McCARTNEY: Hey, good
afternoon everybody. We are following breaking
news of national import in Omaha at this hour. BRANDI PETERSEN: We are live
at the Nebraska Medical Center. Doctors are holding
a news conference to discuss an American
doctor with the Ebola virus coming to the Nebraska
Medical Center. DR. SMITH: I'll never forget I
was walking down the hallway with Angela Hewlett, the
Associate Medical Director, and my phone goes off. It said State Department. I thought, "Well, here we go." And they said, "We
like your unit. "In fact, we like it so
much that we're going "to send an Ebola
patient to you." DR. ANGELA HEWLETT:
We started saying, "Well,
what do we need to do now?" And it involved a very
quick array of phone calls and talking with the
Health Department and the rest of the
Biocontainment Unit
leadership team. NARRATOR: The
Nebraska isolation unit was a creation of the
University of Nebraska. The privately managed
hospital, Nebraska Medicine, and the state's Department
of Health and Human Services. DR. SMITH: We say that for
activation, it's kind of like a safely deposit box. You need two keys. The State Health Department
and the hospital. NARRATOR: State
health officials agreed. It was time to open the unit
to accept its first patient. JENNIFER ROBERTS-JOHNSON:
It was a little bit surreal, more than a little
intimidating, I think. And it was definitely
invigorating in the sense that I think our team said,
"Okay, we're activating. "We're going to do this work. "We're going to work
through this problem." And that's exactly
what happened. DR. THOMAS SAFRANEK: And
we needed to do so in a way where the healthcare
providers themselves weren't jeopardized and
that was the real advantage that the University of Nebraska
Medical Center provided. NARRATOR: Patient
one, Dr. Richard Sacra, a medical missionary
based in Liberia. He apparently contracted
Ebola delivering a baby. With the Ebola virus
engulfing his body, the US government arranged the
airlift to Omaha, Nebraska. DR. SMITH: We didn't know
exactly when they would come, but I remember
getting another call late in the evening from
the State Department saying "Wheels up in Monrovia." (jet taking off) (dramatic instrumental music) DR. SMITH: That meant the
patient's in the air and there's no turning back. DR. HEWLETT: There was
definitely a physical reaction. Yeah, there was a little
bit of fast heartbeat, a little bit of
all that going on. DR. SMITH:
I tingled from head to foot. It's almost something
that's hard to believe. We were ready for it, but
when it actually happened, you say, "Wow, this is an
amazing event, historic event." NARRATOR: The
biocontainment team included two dozen doctors,
10 lab workers, six respiratory therapists,
five patient care technicians, and 22 nurses. ANGELA VASA: I got the text,
and we actually have a system that sends you a text
message that says "NBU activation,
this is not a drill." And so, I read it
and it read it again. BETSY FLOOD:
I was almost relieved the
first time I was going in because, you know,
you think about it. You think about it. You practice it
and you know what, and so, I was almost
like "Okay, thank God. "We're just going to
do this now," you know? SHELLY SCHWEDHELM: We just
were like, "Let's go." So, we brought our team in
again, and said, "He's coming. "Probably be here in 48 hours." I wanted today to maybe
have 20 minutes or so and answer any questions. I wanted to make sure we had
every detail taken care of and they felt
confident and safe. I remember saying that
"we'd trained for 10 years "for this moment and these
were our fellow Americans. "And if we aren't
going to seize this, "than really everything
we've done has been for naught." (jet plane flying past) DR. HEWLETT: When the plane
actually touched down, I was in the biocontainment
unit already with my team. DR. SMITH:
We were all in the unit, and we were watching
it on television. At that time, the
nurses were ready. We knew which people were
going to be in the first shift. The physicians were all there, and then we knew we
had about 30 minutes to get things ready. FEMALE REPORTER:
And breaking news now at 6:19 on First News. An American doctor
with Ebola is in Omaha. MALE REPORTER:
This is a live look at the Nebraska Medical
Center where Dr. Richard Sacra will be treated. He landed at Bellevue's
Offutt Air Force Base in the past half hour. NARRATOR: Plans for
getting the patient across town and safely
inside the hospital fell to John Lowe, the unit's
infection control specialist. JOHN-MARTIN LOWE: It was an
incredibly unique experience, so it happened very
early in the morning. It was still dark out, and it had been
raining all night. NARRATOR: There were
no cameras on the ground to record the transfer
from jet to ambulance. LOWE: The plane arrived
shortly after we did at Offutt Air Force Base. It parked out on the tarmac and we had a military
security vehicle escort, the Omaha Fire Ambulance. My role and responsibility
is that if anything is done differently than
how it was anticipated, gonna stop it. So, I was watching
incredibly intently all of the different movements of our personnel and the patient to make sure everything
was going as planned and looking for anything
that I felt like we would need to stop and
address before we went further. KATE BOULTER:
I was standing at the bottom
of the stairs looking up, and the patient came to
the door of the aircraft. And I just remember
thinking, "Why am I here?" You know, I did not have
to be the one doing this. As the patient came
down the stairs and we got him onto the
gurney, that's what be became. He became my patient. I'm a nurse. I'm going to take care of him, and that's what it was. (ambulance beeping) NARRATOR: The City of Omaha
emergency medical technicians knew the danger. The slightest contact
with body fluids could be a fatal proposition. For months, they drilled
anticipating the transport of high-risk patients from
one hospital to another. (gurney legs going up) Dr. Sacra's arrival from
West Africa provided an unexpected twist,
delivery by jet. In a matter of days,
the fire department drew up plans to get the
patient safely off the plane. (dramatic instrumental music) (air traffic conversation) LOWE:
Having a patient flown into the air force base was a little bit different
than what we had anticipated from a hospital-to-hospital
transfer within the Omaha Metro. The motorcade was overseen
by Nebraska State Patrol. This was essentially
the same motorcade and same protocol that they used when the President came to Omaha to help move the President
through the community quickly. MALE REPORTER: And we take
a live look right now at the transportation
looks like from Bellevue. LOWE: If you're familiar
with the highway that runs from Bellevue to Omaha at about 8:00 in the morning, it can get pretty congested. The quickest trip from
Offutt Air Force Base to the medical
center I've ever had. NARRATOR: Inside
the ambulance, Dr. Sacra remained in his
protective suit on the gurney, delirious from the drugs used to calm him from the flight. BOULTER: I did see his eyes. I could see that, you know, he was very thankful to be here. We had a conversation where
I welcomed him to Nebraska and told him that we
were going to take the best care that
we could of him. FEMALE REPORTER: We can
see line of vehicles coming down the street now. ROBERTS-JOHNSON:
There were a number of us
sort of on a conference call that morning watching
it unwind on TV, and I think we were
basically saying to ourselves "Please let this go how
it was planned to go." DR. SAFRANEK: We think
they've done everything right, but it's trust but be
careful and monitor. And that was our
role in public health to make sure that those
healthcare workers who go back home every night aren't at risk to the
broader community. LOWE: We didn't
see a great deal of press from our motorcade
until we got down here to 42nd and Emily where
there was a whole line of cameras and press
recording the transport. So, that's when it really
started to sink in, that all eyes were
on this process. (music and helicopter sounds) DR. HEWLETT: Everyone was kind
of quiet and doing their job. And the patient rolled in and went to the designated
room, and then the work began. NARRATOR: Why here? Why this hospital
in Omaha, Nebraska? It was the largest
biocontainment unit in America. How did it get here? After the September 11
attacks brought fears of bioterrorism, America
needed hospitals able to cope with an
outbreak of smallpox, or who knows what. Dr. Smith believed if UNMC
got federal and state funds for bioterrorism, the
unit's mission could expand to care for patients
with a variety of highly contagious diseases. (fan blowing) DR. PHIL SMITH: there you can
see the fan, this is the kind of air that blows inside the... Well they're all diseases with a very high mortality
rate, 50% to 90%. They're diseases
generally like Ebola, for which there's no vaccine
and there's no treatment, so they're incurable. And thirdly, they're contagious. Those three factors
are the things that in general put the diseases
on the most wanted list. DR. ANGELA HEWLETT: The
biocontainment units has things that are a little bit different than a regular hospital room, things like
engineering controls, special airflow and
things like that to try to keep infectious
diseases inside of the care facility as opposed to letting them into
the outside world. (door closing) (beeping) DR. SMITH: We want the air to
be sucked in, pull the germs in and not let them get out
into the community. It senses that there's a leak-- NARRATOR: No one could
predict what disease might present itself. Some spread by way
of bodily fluids. Others transmit by air. There's no telling what
equipment might be needed in any of the five rooms. It's bare bones by design. BOULTER: What makes it
different when we have a patient and we go in, is that
everybody knows their roles. NURSE: So, all of that
happens in one fell swoop. NARRATOR: The high-risk
nature of the work demanded special
skills and a staff with a particular frame of mind. DR. HEWLETT:
Biocontainment units
also have specialized staff so that have trained teams
of nurses and physicians who do a lot of
drills and training in order to take
care of the patients with highly infectious diseases. We're all volunteer
staff which is different than regular hospital. You obviously
volunteer for your job if you're applying for a job. But, in our situation,
just because you work here at UNMC doesn't necessarily
mean that you'll be part of our biocontainment unit team. You have to actually want
to be part of the team. DR. SMITH: By the end of that
nine years, we had the hardcore
biocontainment geeks, if you want to say it that way, (music) and that's what
helped us be ready. NARRATOR: The rooms,
the staff, the planning, that was all in place. Year after year, the only thing
lacking were the patients. DR. SMITH: 'Cause I
know there were times when the hospital was
full, we had to divert people to other hospitals. They were saying, "Why
are we just letting "this 10-bed unit sit there?" DR. DAN JOHNSON: Dr. Smith put
his foot down about 100 times saying "We need
to keep this unit. "We are going to
need it, trust me." DR. SMITH: To their credit,
they had the long vision and they could see the
global trends and the fact that
this is something that could be very
useful if there were an outbreak down the line. NARRATOR: Down
the line was now. The federal government requested
the Nebraska Medical Center activate the unit. (gentle piano music) DR. JOHNSON: I remember
watching our first patient wheel into the unit, and I
thought, "I am now engaging "in the treatment of
someone who has a disease "that is almost
sure to kill him." NARRATOR: Dr. Daniel
Johnson spent most of his time in the UNMC
intensive care unit. He didn't have the
years of training in biocontainment procedures. In fact, he'd been
recruited only days earlier when it was clear his
skillset would benefit the treatment of Rick Sacra. DR. JOHNSON: I was getting
put into a suit that I had only ever seen
either on the news or in movies. In the moments leading up
to going into the room, I did have a little wave
of fear and anxiety. DR. HEWLETT: I helped
him get his gear on and we had a little talk
right before he walked into the biocontainment unit. I just said, "Go in there
and do what you do every day. "Just be extra careful." NARRATOR: For this patient,
inserting a standard IV was impossible. Sacra arrived so
dehydrated, the medical team feared his veins would collapse. DR. HEWLETT: This
is actually a large catheter that goes into the neck, into
one of the veins in the neck, and the reason we have to do is because we wanted to be able to deliver those medications
quickly and efficiently. NARRATOR: This would
be Dr. Sacra's lifeline. For Dr. Johnson, a routine
procedure became perilous. Damaging the jugular vein
had deadly consequences for everyone. (heavy breathing) DR. JOHNSON: It was the walk
down the hallway , (chuckles) it was actually more
nerve racking than anything
else. The fight or flight
response is off the charts. As soon as I walked in the room and saw a human being there
who needed my help, I was fine. DR. SMITH: When
someone was drawing blood, we were all looking in
on our video system. Everybody would just stop and
keep their fingers crossed. DR. HEWLETT: Holding my breath,
wringing my hands and my gloves, doing everything like that. But I'll tell you, it
went off very well. DR. JOHNSON: One of the nurses
and I both had inches of sweat. It was up above our
ankle within our suit when we walked out of the
room for the first procedure. There's actually
a photograph of me right after I've
taken my suit off, and I am drenched and I've
just got two thumbs up with a huge smile on my face. DR. HEWLETT: It
was a nice moment. BETSY FLOOD: Dr. Smith and
Shelly told us that everything
was going to good. We had prepared for this. We knew what we were doing, and they said this kind of calm that it's kind of like,
"Well, okay, they say "it's all going to be okay. "I'll be good. "We know what we're doing. "We're smart. "We've practiced. "Let's go."
MORGAN SHRADER:
We bought into it. FLOOD: Right, we bought into it. (laughing) NARRATOR: Staying safe
begins with the layout of the unit itself. With five specialized
rooms, up to 10 patients can be treated at once. Caring for this single
case of Ebola meant rooms were available to keep
medical supplies close at hand and provide space
for biohazard waste waiting to be sterilized. An onsite lab was added later. BOULTER: The unit's
kind of an L-shape. You've got your nurses station and then it goes
up a long corridor. We have a line, and
that line marked the difference between
clean and warm. The hot zones, of course,
were the patient rooms. ANGELA VASA: When we say the hot
zone is the patient room, that's where the highest
burden of viral load is most likely to be present. The warm zone is
where you're going to take off your equipment,
and then the cold zone is where you would say there's
the least likely chance that you're going to be
exposed to the virus. There are behaviors that are
restricted to every zone, and that's to help
decrease the risk of cross-contamination. NARRATOR: The safe operation
of the biocontainment unit relies on a set of protocols. Standard operating procedures
guiding every doctor, nurse, and technician. NURSE: Tuck inner
cape into suit. NARRATOR: Nurses rotate
on four-hour shifts, always with a backup. SHELLY SCHWEDHELM: When our
people went into the room and we always wanted
a second person in personal protective equipment that if the caregivers in
the room needed something, that person could quickly
step in and be ready to go. (Putting on hazmat
suite and gloves) (machine whirring and beeping) KATE BOULTER: So, PPE stands for
personal protective equipment, (putting on protective gear) and that's everything
from gloves, masks, respirators, gowns, hoods,
visors, all of those things. And what that's going
to do is put a barrier between you and the infection. When we opened and
we were looking at what policies were
there for one thing, putting on and taking off
PPE, there wasn't any. And we had to develop that
right from the beginning. NARRATOR: In Africa,
healthcare workers responding to the Ebola crisis
died at alarming rates, in part because
doctors and nurses removed gloves and gowns in ways that put them in contact
with the very virus killing their patients. BOULTER: We decided we needed
to develop strict policies, protocols on how to
put on the PPE safely, meaning you were going
to be completely covered. And then, more
importantly, you were going to get it off in a way that you
didn't contaminate yourself. VASA: You want to make sure that you have everything covered that could transmit any
kind of Ebola virus to you, any mucous membranes,
eyes, nose, mouth, lungs 'cause we breathe in. NARRATOR: Donning is the
word for putting on the gear. Taking off the gear
is known as doffing. NURSE: So, you're going
to kind of turn to make is easier for
you, like do one shoulder turn back, do another
shoulder, turn back. SCHWEDHELM: There's a very
significant sequence to taking it off so
that you make sure that you go from
most contaminated to
least contaminated. DR. HEWLETT: You come out of a
room and you've just been seeing a patient with Ebola,
the last thing you want to think about is did I remember to put that step
in the right order. And so, we take that element out and we have a person who's
been outside the room who actually directs
every move you make. VASA: That's the most
vulnerable point in the entire care continuum. NARRATOR: In simulations,
newcomers to the team learn the sequences
designed to keep them safe. Disposable boots come off
first to avoid tracking. Feet shift to different
zones on a mat to avoid recontamination. Helpers carefully peel away
hoods to avoid spatter. The three pairs
of gloves come off in a specific sequence. (removing tape and gloves) NURSE: That will happen. That will happen
in real life too, so what you want to
do is take a minute, pause, reset,
troubleshoot through it. DR. SMITH: We taught people
stop, assess the risk, get help, take your time. Nothing is worth
putting yourself in
increased jeopardy for. NARRATOR: Comfort with
the safety rituals allowed the medical team to focus
on Dr. Sacra's recovery. DR. SMITH: Well, he was
ill and we knew he was very ill between the fact that he
was somewhat delirious, although his vital
signs were stable. And after the physical
exam, it was obvious he was not at death's door,
but he was quite sick. And then, we drew
laboratory work, and his laboratory work
was way out of whack. NARRATOR: Out of
whack, in this case, meant Dr. Sacra's inadequate
electrolyte levels caused the convulsions,
nausea and diarrhea racking his body. Dr. Smith explained
to reporters, even if a cure was elusive,
routine medicine could cope with the symptoms. DR. SMITH: There is a feeling
amongst the clinicians that treat these
patients that if you can get fluids into them early and balance their electrolytes, you can prevent some
of the complications. But, even that's
just a supposition, but that makes a lot of sense. NARRATOR: Smith consulted
with doctors around the world and found reason
to be encouraged. Reducing the fever and
dehydration allowed a body to heal and
fight the virus. Ebola need not be
a death sentence. MORGAN SHRADER: This is just
manageable, flu-like symptoms. We can do this. And so, within the
first 12-hour shift or 14-hour shift, we had
overcome a lot of challenges that I think addressed
right away and moved on. KATE BOULTER: It was new
territory everywhere really because you know, we
had learned lessons so were looking at what could
we learn from past events. NARRATOR: Two American
medical missionaries, stricken with Ebola, had
been airlifted out of Africa to Emory University. The hospital had its
own isolation ward where highly infectious diseases
could be safely treated. Both were cured. (people applauding) DR. KENT BRANTLY:
Today is a miraculous day. I'm thrilled to be
alive, to be well. NARRATOR: One survivor,
Dr. Kent Brantly, was a friend of Sacra's. He donated 800 CC's
of his own plasma because research
showed antibodies in the blood of people
recovering from some diseases can help fight off viruses. DR. SMITH: The convalescent
plasma, it was taking blood from patients recovered
and has antibodies is a very safe
treatment modality, so we felt very confident
giving it to Dr. Sacra. NARRATOR: Approval for
testing experimental drugs on humans can take years. For Ebola, the medical
team in Nebraska got fast-track emergency
clearance from the government. Ultimately, it
wasn't clear if any of the drugs helped
contain the virus inside Dr. Sacra. DR. ALI KHAN: We now know that
without sophisticated drugs, we can take down the
number of people who die from eight in 10 to
maybe four in 10, or something like that
just with good management of the fluids you give them, the minerals you put
back into their body. So, that's been a great message. (gentle instrumental music) NARRATOR: In biocontainment,
the patient's room becomes a tiny
self-enclosed world. Visitors, including Rick
Sacra's wife Debbie, could only visit by
way of a video feed at the nurses station. The staff found ways
to make small talk through plastic shields. ANGELA VASA: You know,
initially I think it's hard because I attribute a
lot of my interaction with patients with touch. And you don't have that
human touch in this case. But, I don't know
if it was because of the situation
that we were in, you got very close
to these patients. BETSY FLOOD: We are their
human interaction, and so we spend a
lot of time doing, you know, therapeutic
communication. DR. JOHNSON: I think when he
was eating normally, and when he started
to be bored (chuckles) of being in the
biocontainment unit, there was a sense of relief. DR. HEWLETT: Because so much was
unknown about this disease, when we started to see even those little
increments of improvement, we got very excited. NARRATOR: The Centers
for Disease Control required two separate blood tests
verifying virus loads low enough to ensure no one else would contract the fever. DR. HEWLETT: We were waiting
on the lab work, and when we got word that the
viral loads were negative, when that happened,
there was a lot of joy, a lot of excitement. I'm smiling just
thinking about it. I was thinking about
back to that day because he was waiting. You know, Dr. Sacra,
he's a physician. He knew what was
going on with him. He was feeling better. He was ready. He was ready to
get out of there. He was ready to see his family. (gentle instrumental music) NARRATOR: 25 days
after tests confirmed he had the disease, Rick and
Debbie Sacra were reunited. (gentle instrumental music) (people cheering and applauding) DR. RICK SACRA: God has used
you to restore my life to me. I am so grateful. I would like to request
a continued outpouring of prayer and practical
help for the people of West Africa. Though my crisis has reached
a successful end here, unfortunately the
Ebola crisis continues to spin out of control. NARRATOR: The
lessons learned inside the Nebraska Biocontainment
Unit would be tested again. A disease anywhere can
be a disease everywhere. As international air
travel becomes common, emergency room crews
anywhere in America could encounter exotic,
highly-infectious diseases. DR. HEWLETT: Before 2014, a
lot of facilities just didn't have
these things in place. They just weren't
ready to take care of these kind of patients. SCHWEDHELM: I was getting a
lot of emails from people out in the world and the
community across the nation asking, "What's your
protocol for this? "How do we do this?" BILL KELLY: How many times
were you asked "Is it safe "for the rest of us?" SCHWEDHELM: Too many to count. REPORTER:
How confident do you feel? SHELLY SCHWEDHELM: I feel very
confident in our unit, and in our team and our staff. I think there was
tremendous fear that somebody was going
to show up in their place and they really didn't
have the understanding or knowledge to know what to do. NARRATOR: Well-founded
fears, as it turned out. REPORTER: The first person to
have been diagnosed with Ebola in the
United States has died in a Texas hospital. NARRATOR: Thomas Eric Duncan,
a Liberian visiting Dallas was sent home from a
hospital emergency room after complaining
of a high fever. His travel history should
have been a red flag. REPORTER: Duncan
carried the deadly virus from his home in
Liberia, but did not show any symptoms when he arrived
in the US on September 20th. NARRATOR: He returned
to the same hospital presenting all the
symptoms of Ebola and died within days. REPORTER: There was already
a high level of anxiety among many Americans,
and the death in Texas only fans the Ebola fears. NARRATOR: Two nurses
on his treatment team contracted the virus. Both survived. KATE BOULTER:
A lot changed as well
after what happened in Texas when the nurses got sick. Then there was a
lot more interest. REPORTER: But, US health
workers aren't satisfied. They say the government
needs to do more. HEALTH CARE WORKER: We've
been told a lot of things that have been wrong. We've been lied to. BETSY FLOOD: And I remember
when that poor Dallas nurse came down with Ebola, you know, that brought up a lot
of interesting feelings. This poor woman didn't have
the resources that we did. (sirens blaring) NARRATOR: Just as the
unsettling news broke in Dallas, the US State
Department requested the Nebraska Medical
Center prepare for a second American
infected with Ebola. Barely two weeks had passed
since Dr. Sacra's release. SPOKESMAN: Our patient arrived
in his room a few hours ago directly from West
Africa and is now-- NARRATOR: Photographer
Ashoka Mukpo fell ill in Liberia while on assignment covering the Ebola
outbreak for NBC News. DIANE MUKPO: He's enormously
relieved to be here. Of course, it's still
quite frightening. NARRATOR: The biocontainment
unit assumed all along there would be more Ebola cases. In the days before
admitting this new patient, they continued to
review procedures and refine the protocols from
changes in protective gear to how to unclog a toilet
that becomes a biohazard. SCHWEDHELM: This is really
typical of this team. I can't tell you how
many times we've really made small adjustments
in our how to get a specimen safely out of
the room and to the lab. NARRATOR: A small
change was a big deal when it came to getting
lab results faster. When drawn from
an Ebola patient, blood instantly becomes
a high-level biohazard. The State of Nebraska maintains a high security
testing laboratory on the campus of
the medical center. (beeping and door opening) BOULTER: Took at least 40
minutes between drawing the lab and getting it there
to begin the analysis. We changed that
process very quickly. NARRATOR: By the time
the second patient arrived, the med center had arranged
for the biocontainment unit to set up a temporary lab
in an unused patient room. DR. PETER IWEN:
Look at the news that came out with the nurses in Dallas. I mean, we really had
no room for error, and that was a caution
that we were taking. NARRATOR: Lab Director Pete
Iwen found little precedence or guidance from the
Centers for Disease Control for safe-handling
of the samples. DR. IWEN:
They, quite frankly, didn't
have it all in writing either. So, it was kind of like, okay, I would call an emergency
operation center and say, "I need guidance on how "to do this particular sample
or how to run this sample." Process it, you know, in
the laboratory safely. And quite frankly,
what I got response was "We'll get back to you." They didn't have
the information. So, we were involved
in the process of writing protocols
on how to do this. BILL KELLY: On the fly?
DR. IWEN: On the fly. NARRATOR: In the movies,
heroes treating a pandemic wear sturdy high-tech
biohazard suits, sterilized in chemical showers. The truth, in this unit,
most personal protective gear gets thrown away. The garbage infected with
Ebola accumulated quickly. Day after day, 1,000
pounds per patient. FRANK FREIHAUT: In general, it
was probably four or five times the normal daily waste
coming out of an ICU room. (opening autoclave door) NARRATOR: Hospitals
routinely use an autoclave, a method of high-pressure
steam cleaning to sterilize equipment. Here, it also decontaminates the dangerous
garbage left behind. (closing autoclave door) Efficiencies learned after
treating the first patient allowed the team to
reduce the amount of waste by hundreds of pounds. Safe-handling
remained a constant. FREIHAUT: It was clean
stored in the hot zone, several steps there, and then it would be wiped again and brought up to the warm zone where somebody in the full PPE that's running the
autoclave could then get it and cleanly get it
to the autoclave, and then run through the
steps of the autoclave. NARRATOR: Mundane routines
become life and death matters in the unit. The medical team stayed healthy as a second Ebola
patient left their care to celebrate his recovery. ASHOKA MUKPO: When I first came
in, you know Dr. Smith, I looked up at him and I said "Am I going to make it?" He goes, "We don't know a
whole lot about this disease." (laughing) NARRATOR: Once again,
the treatment cycle worked, hydration and
appropriate medication. Blood tests from
Ashoka Mukpo confirmed he was Ebola-free
in just 20 days, five days sooner
than Rick Sacra. DR. PHIL SMITH: We feel
we learned some things about the natural
course of the disease and how to intervene,
and we're applying what we've learned
to the new patient. NARRATOR: Even as
a cure seemed elusive, the lessons learned
from the treatment of patients in Nebraska
and at Emory University seemed to improve the overall
health of the patients making it possible
to survive Ebola. DR. KHAN: The care
in Africa was influenced by the care here because
we learned very quickly how much fluids
we should be giving, what type of fluids
we should be giving. What sort of electrolytes
we should be monitoring. So, that was easily
transferable. NARRATOR:
Successful models used to care for the
American patients proved to be of little value
in the treatment of Dr. Martin Salia. NARRATOR: Dr. Salia served
in missionary hospitals throughout his
career as a surgeon. In 2014, he was
Chief Medical Officer at the Kissy United
Methodist Hospital in his native Sierra Leone. (beep) As the Ebola epidemic worsened, the lifesaving surgeries
he routinely performed became dangerous, even heroic. NARRATOR: A few weeks
after that interview, Dr. Salia contracted Ebola. A delayed diagnosis gave the
virus a 13-day headstart. (jet landing) REPORTER: We were told
transporting him took longer because of how critically
ill Dr. Martin Salia is. He was physically unable
to walk off the plane and we don't even know--
JOHN-MARTIN LOWE:
As soon as you hear that someone's not going
to walk off a plane, when the other patients
you have received have walked off a
plane, you understand that the situation is different. NARRATOR: Every aspect
of the patient's care would be more challenging. Every procedure
would be more risky for the medical team. DR. DAN JOHNSON:
I was his main ICU physician, so I admitted him with
Dr. Hewlett and Dr. Smith. And I spent, at one point,
30-some hours in a row in the unit with
the nursing staff and the other team
members trying to turn him for the better. DR. ANGELA HEWLETT: He was very
sick, not only in person, but also on paper,
in his lab work. And we knew that it
was going to be a real, a real uphill battle. DR. JOHNSON: We applied
every possible therapy to every problem that he had, just the way we do in the
regular intensive care unit. Nothing was held
back because he was in the biocontainment unit. DR. HEWLETT: It was too late,
and we battled. And by battle, I mean,
it was a real battle and I've seen a lot of
patients in the ICU. I do that routinely
as part of my job, but he was incredibly sick. And at those last few hours, we knew that we weren't winning. DR. JOHNSON: And it was clear
that after some period of time, his body was just,
it had shut down. His body couldn't go on anymore. The disease had overwhelmed him, and it was an
absolutely awful feeling when I realized that
we needed to stop. That he had died. And anything more
that we did to him was not ethical or humane. And I remember looking at him and just taking
his hand. (crying) It was particularly
difficult because he was an amazing person. (solemn instrumental music) DR. JOHNSON: The next step
though was to tell my team, everybody in the room. "Everybody listen,
don't do anything "that's going to compromise
your own health and safety." We were going to follow
those protocols perfectly so that no one in this room
ends up with this disease. DR. HEWLETT: We watched how
terrible this disease is. We saw it in person. And I think that Dr.
Johnson did an excellent job of just taking a
step back and saying "All this is happening and
we all want to grieve." "We all wanted to. "But, we need to also remember "that we need to be careful." BETSY FLOOD: That's
one of everybody's goal as a healthcare worker
when someone dies, to give them that
grace and dignity. DR. HEWLETT:
And patients that die from
Ebola are very infectious. That's part of the
reason that this disease was rapidly
transmitted in Africa was during that burial process. And after patients had died, people contaminating themselves and getting sick
from that process. NARRATOR: The process,
disposing of human remains, put a crucial safety
procedure to the test for the first time at
the medical center. It became a unique mixture
of ritual and caution. ANGELA VASA: Yes, we did
have to follow CDC guidelines and our own protocol
to package the remains, but we had the support
of our institution to go above and beyond that. To take the time. BOULTER: We wrap our patient
in their bedding first. And then, when we go to put
them into the mortuary bags, we even put the pillow
behind their head. NARRATOR: At every
stage, the medical team swabs surfaces with bleach. The deceased is
placed between sheets of special watertight material
to contain any biohazard. Every edge is heat-sealed twice. A separate crew in
protective gear helps transfer the body
through the doorway into the warm zone and
a third containment bag before being prepared
for cremation. VASA: And then, to be able
to provide those ashes back to the family, I
think that that was really a relief for the family. And I think that,
for us, that's where it was such an
intense experience because we knew
the type of person that we were treating. And I think that we really
felt it very intensely because we were not able to help this particular person
survive the disease. (dramatic instrumental music) SUE HUNTER: We didn't
think Ebola was going to be in the State of Nebraska. It brought it home real hard. You always think someone
else will handle that. (zipper closing) NARRATOR: The big
lessons for emergency crews and hospitals across Nebraska
and across the country, planning and practice
can improve the odds of keeping safe
the medical teams and the people out
in the community. (music and siren) EMT: Midwest Medical
to Saint Elizabeth, we are transporting
an Ebola patient. DISPATCHER: What's
your ETA Midwest Medical? EMT: 10 minutes. NURSE: Midwest encoded that
they were 10 minutes away with an Ebola patient,
but no other details. EMT 1: He's got diarrhea. EMT 2: And fluid in his lungs. EMT 1: Could have
fluid in his lungs. NURSE: Okay. (ambulance driving in) NURSE: Okay, so let's get our
areas marked appropriately so we have our cold
zone marked off. (beeping) WOMAN ON LOUDSPEAKER:
Attention all house staff, this is an infectious
disease exercise. Command center has
been activated. DR. THOMAS SAFRANEK: It's
taking the worst-case scenario and learning off of that,
and it's almost like if you can deal with
that, you're going to be fine with many
of these other ones. NARRATOR: For
years, medical centers used realistic drills
to test their ability to cope with a mass
casualty tornado, or a school bus crash. (coughing) NARRATOR: Since Ebola, many
hospitals stage test runs for staff who might encounter
a highly-infectious disease. Surprise complications
expose flaws in training or equipment. Honest input from staff
helps improve the system. SUE HUNTER: We know Ebola may
not hit, but there may be another infectious
disease of something that the practice
and the information that we learn from that,
we'll be able to apply. DR. HEWLETT:
The things that we had done, it doesn't make any sense for us to do this in a silo and to
just work it out on our own and not tell anybody else,
because other centers may encounter these
types of patients. DR. PHIL SMITH:
The care and coordination of highly-infectious
disease patients and related procedural training. My name is Phil Smith. I'm Medical Director of
the Biocontainment Unit and welcome you to
our program today. NARRATOR: In the months
following the treatment of the Ebola patients in the US, there was a tremendous
demand for information. Healthcare professionals
hoped to benefit from the lessons learned during
these rare high-risk cases. DR. HEWLETT: Other
facilities have to be ready to take care of these patients, and we were very willing
to share our learnings, our learnings clinically,
our learnings operationally with everyone who was
willing to listen. SCHWEDHELM:
Truly, one of the barriers
identified was, you know, "I've been doing
this for 20 years. "It's never happened to me." NARRATOR: Sometimes
the most basic lessons became the most essential. SCHWEDHELM: It doesn't have to
be all the bells and whistles that we had, but
you need to know how to wear proper personal
protective equipment. I think I would just say
basic PPE and solid screening. Two things that could
help us the most. WOMAN: I'm not
feeling very well. NARRATOR: That
second piece, screening, being alert for
what might be coming through the emergency room door. WOMAN: My chest really hurts
and I have a bad cough. NARRATOR: In most cases,
the Biocontainment Unit would get some warning
before a case arrives. Any other hospital
never knows for sure. The consequences of
misdiagnosing that one case of Ebola at the
hospital in Dallas became a cautionary tale
heard around the world. SUE HUNTER: Prior to all
this, if someone had presented with some of those
symptoms who we check into our emergency
room, they've gone back to the emergency room. And then, if we truly
had something like this, we could have shut down
the emergency room. And that would create
quite a problem, so we've learned a lot. NARRATOR: Before the
Ebola crisis subsided, the Federal Centers for
Disease Control, the CDC, updated guidelines for
checking in patients at hospitals and clinics. NURSE: Have you been outside
of the United States in the last 21 days.
WOMAN: No, I have not. NURSE: No. DR. BRADY BEECHAM: The
CDC gives us some guidance
about questions to ask and often it has to do
with have you traveled outside of the United States? Have you received
routine immunizations? Because it is hard to tell
just by looking at somebody. NARRATOR: That woman with
a fever might have returned from Sierra Leone where
Ebola remains a threat, or contracted Zika
from a mosquito bite during a church
mission trip to Haiti. Or picked up tuberculosis
from a visiting relative. DR. BEECHAM: In a community like
Lexington where we have lots of people that
are moving around, the temptation is to say,
"Alright, we have a lot "of immigrants." Naturally, we consider
ourselves to be at higher risk. And while that may
be true, it's also a more specific
conversation with somebody about where have you traveled? Those are the kind of
things that help us as much as looking at
somebody's nationality. NARRATOR: Just
how bad could it get if it all goes wrong? MODERATOR: And today,
we have you all in one room and we're finally to the
point where we are going to exercise that pandemic
really impacting your community. NARRATOR: In Dawson County,
a fictional epidemic drill organized by a regional
public health cooperative revealed how quickly
an influenza outbreak could undermine
community institutions. LADY: Oh,
this is our school nurse. NARRATOR: They
started the exercise by randomly picking names of
crucial real-world characters lost to the flu. Those too ill or already dead. DR. SAFRANEK:
The problem is this,
when the healthcare workers start coming down with
this, and you take a disease like influenza
where we're all co-mingling out there
in the community, your healthcare
worker may have a risk of picking the disease up
in the course of their job. PARTICIPANT 1: The clinic is
flooded because we've lost at least two of the
people at the front desk and one of our providers. PARTICIPANT 2:
So, they're saying I don't
want to wait in line. It's like listen, you will wait if you're healthier than
the person in front of you. DR. SAFRANEK: When you
workforce at the facilities is decimated, then
you're really straining your care provision resources, so it's a major problem. DR. BEECHAM: We would
implement our protocols to try to keep people
as safe as possible and separated from each other. NARRATOR: What is happening
outside the hospital starts to strain the very
fabric of the community. MALE PARTICIPANT 1: Law
enforcement being down. They've called in all
available off-duty, retired, possible using security
guards for local facilities. ALLISON FIKE: So, it brings out
questions that you need to be answered by your staff, your administration,
you yourself. What if I was sick? Who's going to fill my position and know as much
as I need to know to fulfill that
requirement and to have the information that they need
to continue down the road. PARTICIPANT 2:
So, this baby is dying if we
don't take immediate action. Will you call Lifeflight and
see if they can still take her? MALE PARTICIPANT 2: I do think
this is influenza-related, so we need to proceed with
caution with the family. FIKE: By us going
exercises like this, making people aware that we are
planning for the unexpected. Will it ever happen? We don't know, but at
least when it does happen, we have something to go
off of rather than nothing. MALE PARTICIPANT 1: The
funeral homes are already
getting inundated. Refrigerated vehicles
are being ordered to come in to house the dead. NARRATOR: The fictional
outbreak in Dawson County mirrored a historic
calamity from 100 years ago. Spanish influenza killed
on a massive scale in Nebraska, across America,
and across the world. DR. BEECHAM:
From what we know from 1918, they talk about
huge death rates, death among old people,
death among pregnant people. I mean, imagine young,
health pregnant women suddenly dying of the flu. I think it would be a
really frightening event because it's not just
people getting sick, it's people dying and
young people dying, young healthy people. NARRATOR: Visit a
cemetery of a certain age anywhere in America
and graves of the dead from the winter of 1918
can easily be found. The death toll worldwide
may have exceeded 50 million people. DR. THOMAS SAFRANEK:
That was a respiratory spread. Anybody within three feet
of somebody who had it was at risk. That was probably, I would
say, worse than Ebola in terms of its virulence. The combination of its virulence and its ease of communicability. NARRATOR: Public
health experts consider a lethal strain of the flu
the most likely scenario for a modern killer pandemic. A rogue strain of the
flu could present itself anywhere in the world. DR. KHAN: 750,000 Americans died
a century ago from influenza. Influenza could be really bad. I mean, it is our
biggest concern about what a pandemic
could look like. BILL KELLY: Modern medicine,
couldn't happen again? DR. KHAN: (laughing) Sorry. It makes me laugh. (solemn instrumental music) DR. KHAN: It's a big fallacy to
think that modern medicine would protect us completely from the next
influenza pandemic. (solemn instrumental music) (dispatcher instructions
over loudspeaker) NARRATOR: Two years after
Ebola came to Nebraska, the Omaha Fire
Department received word from the Biocontainment
Unit, a new round of patients would be
delivered by jet from Liberia. JOHN-MARTIN LOWE:
So, what I want to do is I want to pull together the
drivers and the medics. NARRATOR: Patients arrived
one at a time in 2014, delivered weeks apart. This time, three Americans
contracted the disease within days of each
other and needed to be airlifted out
of Africa, immediately. DR. PAUL SCHENARTS: Patient
number one's a 34-year-old
male, 125 kilos. Fever, weakness, renal
failure, liver failure, respiratory distress. NARRATOR: Three
separate ambulance crews will be dispatched
to the airport. DR. SCHENARTS: We don't do IV's
and we don't do crazy stuff. Alright, they're
rarely doing CPR. With this disease,
that person's dead, so no sense making
things worse for us in an unsuccessful attempt. NARRATOR: This is,
however, a drill organized by the US Department of
State and the medical center. DR. SAFRANEK: One size doesn't
fit all, but if you're doing a really good job on
rehearsing and planning and dealing with one
event, it gives you the comfort level
and the confidence that you can deal
with different events that have different kinds of
disease transmission scenario. (cutting plastic) EMT: Perfect. NARRATOR:
Ambulances delivering highly infectious
patients are wrapped in industrial-weight
plastic sheeting. (cutting plastic) LOWE: We're trying to mitigate
the risk of contamination of that ambulance and
we're trying to make sure that any cleaning of
that ambulance is good, so that if we put that
ambulance back into service, we know beyond a shadow of
a doubt that it's clean. NARRATOR: Before
2014, only a handful of first responders
prepared plans for these unusual cases. The guidelines, tested
in the real world by UNMC and Emory
University became the bible for emergency
medical responders. (sirens blaring) DR. ALI KHAN: It's now
fair to say, a year later, that we didn't infect any
of our healthcare workers and we definitely did
not infect our community. And not only did we
not infect anybody, but we actually sort
of blazed the trail on how can you take
care of patients safely but also take care of them. And this is brand new. NARRATOR: Many of
the lessons learned will soon be shared inside
a new training center on the med center's campus. UNMC SPOKESMAN: So, we have
two separate quarantine units. NARRATOR: With $24
million in federal funds, the National Center for
Health Security plans to use high-tech
training methods to the benefit of American
government researchers and medical teams struggling
to contain a pandemic. UNMC SPOKESMAN:
In addition to the quarantine, we'll have an entire
biocontainment unit that's simulated here
with state-of-the-art training opportunities. (people talking) NARRATOR: Word came
that the jet carrying the simulated Ebola
patients would be arriving within minutes. (putting on protective gear) For some of the
paramedics, this marked their first experience donning
personal protective gear under pressure. EMT: We have about 10
minutes before we need to leave. NARRATOR: For EMT's,
testing the procedures and learning the risks of
highly-infectious diseases can determine how
comfortable they'd be volunteering for these
hazardous assignments. LOWE: I think that that
helps us when we go out and ask someone to presumably put their own wellness at risk
by entering this environment. (closing ambulance doors) That they're able to
make that decision in an informed manner
based on science. NARRATOR: The three
patients arrive from Liberia in a specially
outfitted Boeing 747 chartered from a private
medical transport service. The weather provided a
real-life slap in the face that computer models and
conference room discussions can never duplicate. Bitterly cold,
40-mile-an-hour winds ripped protective masks from
the faces of the EMT's. The elevator platform
shook and rattled as it delivered
patients from the plane to ambulances below. Even in extreme circumstances, crews stuck to their protocols. LOWE: That would allow us to
test the full spectrum of protocols down to
the minute detail. Recognize things that
we felt could be changed and done better. And we'd make those changes
and in the next year, for that big
full-scale exercise, we would test those. So we had a number of
years of doing that. NARRATOR: When the University
of Nebraska Medical Center Biocontainment Unit opened,
the team had no clue which killer virus would emerge. They can't possible
predict the next disease. DR. PHIL SMITH:
And we didn't know. We didn't back off
on our preparations and I'm really glad we didn't. But, I think that
there's a good chance that during the next 10 years that they'll be a disease
that will transferred up to the biocontainment unit. NARRATOR: As the
last patient was loaded into an ambulance, a team
member in a biohazard suit walked down the
airplane's stairway carefully wiping down the
railing with disinfectant. Details mattered here. The details need to matter
in hospitals, big and small. Every city and county
in America has a chance to prepare for whatever
arrives after Ebola. The question is, are they ready? DR. KHAN: We have tons of work
to do in our communities to try to make sure that not
just community hospitals, but public health
systems are prepared for the next pandemic. (lively instrumental music) Captioning by FINKE/NET
Television Copyright 2017,
NET Foundation for Television (lively instrumental music)
Very interesting!
Paaandemic. Got that Pandemic.
Shit. I have a class at UNMC. I'm a little bit terrified now.