Before the unexpected event happens — whether it’s a possible Ebola patient or someone with another dangerous infectious disease coming to your office — physicians in the outpatient setting should be aware of the recommendations for personal protective equipment and environmental infection control measures in ambulatory settings. The North Carolina Medical Society (NCMS) urges you to study that document and make sure you are prepared.

After that, protecting yourself, your staff and your patients from Ebola starts with your telephone. Train your office staff to ask each person who calls your office for an appointment if he or she has symptoms of a febrile illness (fever, cough, nausea, vomiting, diarrhea, etc.).

Per the U.S. Centers for Disease Control and Prevention (CDC), if a patient reports a fever, staff should next ask about travel history in the past 30 days.

The emergency department (ED) is the proper place for their evaluation if the patient’s travel history includes any of the following countries:

• West Africa in the past 21 days (give the caller the specific date). This includes Guinea, Liberia, and Sierra Leone. These patients are in an Ebola risk group.
• Countries in or near the Arabian Peninsula in the past 14 days. This includes Bahrain, Iraq, Iran, Israel, the West Bank and Gaza, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syria, the United Arab Emirates (UAE) and Yemen. These patients should be evaluated for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection.

Immediately contact the ED about the patient to determine how the department wants the patient to travel to and enter the facility. If the patient is self-transporting, ask where the patient should park.

Call the patient back with specific instructions regarding how to get to and enter the ED and where to park (if applicable). It is important that the patient not mingle with other waiting patients.

If a febrile patient has already presented in your office, have your staff obtain a travel and exposure history. If Ebola or MERS-CoV is possible:

1. Immediately isolate the patient as best you can.
2. If you have a mask, have the patient put it on.
3. Have the patient perform hand hygiene with an alcohol-based product.
4. Have all staff in the room or in contact with the patient use gloves, gowns and a mask, if available.
5. Assess the patient’s travel and disease history and exposure history.
6. Perform a limited assessment without drawing a blood specimen.

If you feel the patient might have either Ebola or MERS-CoV:

• Call the ED about the patient and for instructions about entering the ED and parking.
• Make a list with contact information of everyone in the office (staff, patients, etc.), and notify them of their potential exposure.

Immediately contact your local health department or the North Carolina Division of Public Health for further instructions.

NOTE: This information is consistent with CDC guidelines that exist on the topic. As the Ebola situation continues to change and evolve, the NCMS encourages physicians to constantly monitor any new guidance and advice from the CDC and the North Carolina Department of Health and Human Services.

To help allay your patients’ fears and answer their questions, here is a one-page information sheet (PDF) you may print out and place in your waiting areas.

For additional information, see CDC’s Ebola Preparedness Considerations for Outpatient/Ambulatory Care Settings (PDF) and the NCMS website.