title: Cross-sectional study of Ebola virus disease preparedness among National Health Service hospital trusts in England.
abstract: BACKGROUND
  The largest outbreak of Ebola virus disease (EVD) is ongoing in West Africa. Air-travel data indicate that outside Africa, the UK is among the countries at greatest risk of importing a case of EVD. Hospitals in England were therefore instructed to prepare for the assessment and early management of suspected cases. However, the response of hospitals across England is undetermined.
  
  
  OBJECTIVE
  To evaluate the readiness of acute hospitals in England, and to describe the challenges experienced in preparing for suspected cases of EVD.
  
  
  METHODS
  A cross-sectional study using semi-structured telephone interviews and online surveys of all acute National Health Service (NHS) hospital trusts in England (hospital trusts are the vehicle by which one or more NHS hospitals in a geographical area are managed).
  
  
  RESULTS
  In total, 112 hospital trusts completed the survey. All interviewed hospital trusts reported undertaking preparedness activities for suspected cases of EVD, and 97% reported that they were ready to assess suspected cases. Most hospital trusts had considered scenarios in accident & emergency (97%). However, fewer hospital trusts had considered specific obstetric (61%) and paediatric scenarios (79%), the provision of ventilatory and renal support (75%), or resuscitation in the event of cardiorespiratory arrest (56%). Thirty-four hospital trusts reported issues with timely access to category A couriers for sample transportation. Challenges included the choice, use and procurement of personal protective equipment (71%), national guidance interpretation (62%) and resource allocation/management support (38%).
  
  
  CONCLUSIONS
  English hospital trusts have engaged well with EVD preparedness. Although subsequent national guidance has addressed some issues identified in this study, there remains further scope for improvement, particularly in a practical direction, for acute care services encountering suspected cases of EVD.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK. Electronic address: Thomas.martin@cantab.net.
authors.forename: T C S
authors.initials: TC
authors.lastname: Martin
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK; Public Health England, London, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Chand
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Bogue
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Aryee
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Mabey
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Douthwaite
authors.affiliation: Public Health England, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Reece
authors.affiliation: La Jolla Country Day, San Diego, CA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Stoller
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Price
mesh_terms: D003430:Cross-Sectional Studies; D004189:Disaster Planning / Q000379:methods / Q000458:organization & administration*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control / Q000628:therapy* / Q000635:transmission; D006739:Hospital Administration / Q000379:methods*; D006801:Humans; D009313:National Health Programs / Q000458:organization & administration*; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: Ebola virus disease; Preparedness