title: Emergency Department Processes for the Evaluation and Management of Persons Under Investigation for Ebola Virus Disease.
abstract: BACKGROUND
  Due to the recent Ebola virus outbreak in West Africa, patients with epidemiologic risk for Ebola virus disease and symptoms consistent with Ebola virus disease are presenting to emergency departments (EDs) and clinics in the United States. These individuals, identified as a person under investigation for Ebola virus disease, are initially screened using a molecular assay for Ebola virus. If this initial test is negative and the person under investigation has been symptomatic for < 3 days, a repeat test is required after 3 days of symptoms to verify the negative result. In the time interval before the second test result is available, manifestations of the underlying disease process for the person under investigation, whether due to Ebola virus disease or some other etiology, may require further investigation to direct appropriate therapy.
  
  
  METHODS
  ED administrators, physicians, and nurses proposed processes to provide care that is consistent with other ED patients. Biocontainment unit administrators, industrial hygienists, laboratory directors, physicians, and other medical personnel examined the ED processes and offered biocontainment unit personal protective equipment and process strategies designed to ensure safety for providers and patients.
  
  
  CONCLUSIONS
  ED processes for the safe and timely evaluation and management of the person under investigation for Ebola virus disease are presented with the ultimate goals of protecting providers and ensuring a consistent level of care while confirmatory testing is pending.
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE. Electronic address: mwadman@unmc.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Wadman
authors.affiliation: Emergency Department, Trauma, Emergency Preparedness Services, Nebraska Medicine, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE.
authors.forename: Shelly S
authors.initials: SS
authors.lastname: Schwedhelm
authors.affiliation: Emergency Services, Nebraska Medicine, Omaha, NE.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Watson
authors.affiliation: Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE; Emergency Services, Nebraska Medicine, Omaha, NE.
authors.forename: John
authors.initials: J
authors.lastname: Swanhorst
authors.affiliation: Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE.
authors.forename: Shawn G
authors.initials: SG
authors.lastname: Gibbs
authors.affiliation: Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE.
authors.forename: John J
authors.initials: JJ
authors.lastname: Lowe
authors.affiliation: Department of Pathology and Microbiology, Nebraska Public Health Laboratory, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Iwen
authors.affiliation: Division of Infection Control and Epidemiology, Nebraska Medicine, Omaha, NE.
authors.forename: A Kim
authors.initials: AK
authors.lastname: Hayes
authors.affiliation: Emergency Services, Nebraska Medicine, Omaha, NE.
authors.forename: Susie
authors.initials: S
authors.lastname: Needham
authors.affiliation: Department of Anesthesiology, Division of Critical Care, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Johnson
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Kalin
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE; Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE.
authors.forename: Wesley G
authors.initials: WG
authors.lastname: Zeger
authors.affiliation: Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Muelleman
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D010356:Patient Isolation / Q000379:methods / Q000592:standards; D011481:Protective Clothing / Q000592:standards; D014481:United States