1. Innovations in Medical Education: Teaching Contagious Disease Outbreak Awareness to Medical Students and Residents Larissa May, M.D. Department of Emergency Medicine The George Washington University School of Medicine

2. Teaching Contagious Disease Outbreak Preparedness – Emergency department personnel should be competent at contagious disease outbreak detection and management. – Given the emphasis on emerging infectious diseases and the threat of biowarfare, there is great need to develop instructional methods on these topics.

3. The Educational Methods n The workshop is held in a hospital conference room, with the availability of internet, telephone, and other hospital resources, simulating “real-life”. n A hypothetical case of Ebola presenting to an emergency department is outlined. n Participants are then divided into small groups representing the ED physician, the local health department, the CDC, Hospital Administration, the Hospital Epidemiologist, and the Laboratory Director.

4. Educational Methods n Each group has 30 minutes to define their roles and responsibilities in preparation for the hypothetical outbreak. n A companion manuscript outlining principles of outbreak detection, surveillance, reporting and containment is provided. n After the small group sessions, each group presents and rationalizes their approach to and responsibilities in responding to the outbreak. n The faculty facilitator then gives a 60 minute lecture.

5. Educational Methods n Pre and post workshop surveys have indicated the workshop is considered useful. n We believe the format of this workshop is easy to reproduce and can serve as a foundation for a curriculum in emerging infections and communicable disease management, and can easily be applied to other educational topics.

6. The Contagious Disease Outbreak Workshop: Clinical Case n 28 year old previously healthy female biologist presents with fever and spreading rash n Two days ago she developed a fever, sore throat, and vomiting n She has had several very dark bowel movements n Today her boyfriend noted she was drowsy and disoriented n She returned from Uganda 3 days ago, where she was collecting samples from wild monkeys for DNA analysis

7. Clinical Case n Vitals: 84/52 HR 132 T 104.4 94% RA diaphoretic n Tachypneic with bilateral bibasilar rales n Centripetal maculopapular rash with hemorrhagic erythema on the palms and soles n Subconjunctival hemorrhages, palatal petechiae n Diffuse abdominal tenderness with guarding; black stool

8. You are the only physician working in the Emergency Department… n The nurse notifies you that you have two urgent incoming calls n EMS is transporting a 44 year-old diplomat with massive GI and gingival bleeding, febrile to 102, blood pressure of 60/palp n On the other line a concerned internist is sending two returned travelers with fever and rash

9. Objectives n How do we recognize potential sentinel cases for an outbreak? n How do we report a suspected outbreak? n What measures can we take toward outbreak containment in the emergency department? n What resources are available in the event of an outbreak?

10. Workshop n ED physician n Local health department n National health office (CDC) n Hospital administration (Incident command) n Infection control officer n Laboratory

11. Workshop n Each small group of 2 or 3 students uses the companion manuscript, internet, telephone and hospital resources to define their roles and responsibilities in preparing for an outbreak n The small group research takes 30 minutes n The groups then convene and a representative from each focus group discusses their findings n A faculty member facilitates this discussion

12. Lecture n The faculty facilitator gives a 60 minute lecture on the following topics: – Outbreak Epidemiology and Recognition – Syndromic Surveillance – Outbreak Reporting – Outbreak Containment and Hospital Response Plans – Infection Control Guidelines – Clinical Case Discussion

13. Clinical Case: Conclusion n A tentative diagnosis of viral hemorrhagic fever is made n Patients placed in airborne isolation, cohorted with staff n You call Infectious Disease on Call and Hospital Administration for activation of the Contagious Disease Outbreak Plan n You notify the DC DOH emergency hotline and the CDC for recommendations and assistance in containment of the outbreak and contact tracing n Identification and confirmation of Ebola serotype made by USAMRIID BSL 4 laboratory

14. Outbreak Preparedness: Goals for Clinicians n Be familiar with epidemiologic criteria for sentinel cases n Know your hospital emergency preparedness plans and how to report a suspected sentinel case n Follow basic principles of isolation, infection control, and cohorting in an outbreak

15. Summary: Workshop Materials n Clinical Case n Companion Manuscript “Emerging and Re-Emerging Infections: Public Health Preparedness: Introduction to Infectious Outbreak Reporting and Containment” n Powerpoint Lecture n Pre and Post Workshop Surveys n For more information, contact Larissa May at larissa@gwu.edu n Note: this is not a commercial product