During the 2014 to 2016 West African Ebola outbreak, the highly infectious disease wasn’t the only obstacle health care workers faced. Outfitted with many protective layers, the heat and humidity made providing patient care a huge challenge. Now, a unique Sunnybrook-led study is hoping to uncover the health impacts of this heat. Study co-investigator Dr. Neill Adhikari explains.
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Tell me about your work at Sunnybrook and in Ebola affected areas
In my regular job, I work in the intensive care units at Sunnybrook. In early 2015, I deployed to Sierra Leone, in the late stages of the 2014 to 2016 West African Ebola outbreak, to help with patient management and mentoring as part of the World Health Organization (WHO). My colleague and co-principal investigator of this study, Dr. Rob Fowler, had already spent several months in West Africa and facilitated deployments of other University of Toronto-based clinicians, including Dr. Adrienne Chan and Dr. Sharmistha Mishra.
What is the focus of this current study?
One of the major challenges in Ebola care is delivering supportive medical care, such as intravenous fluids and medications, in a hot and humid environment while dressed in non-breathable personal protective equipment (PPE). These layers help keep healthcare workers safe from contact with infected fluids, but the temperature inside can hit over 40 degrees, with 100 percent humidity.
The current study is meant to assess health-care workers’ performance and comfort while performing medical tasks that are relevant for Ebola care, all while in PPE and in either hot/humid or more usual room temperature conditions. The study is taking place in a simulated environment at Defence Research and Development Canada (DRDC).
It’s interesting that you are teaming up with DRDC. How did that partnership come about?
We reached out to DRDC because of their expertise in studying human performance in extreme climactic conditions, both cold and hot, in specially constructed chambers. They have been terrific and enthusiastic partners, with a lot of expertise in heat physiology among their team, headed by DRDC Scientist Len Goodman.
Most people have no idea what it’s like working in extreme heat wearing PPE. How would you best describe that experience and how it affects a person’s ability to function?
In West Africa, the experience was a major challenge because there were many sick patients to be cared for, but most healthcare workers could only stay comfortable and clear thinking in PPE for about one hour. At the end of that time, one would be drenched in sweat and often feeling light-headed. Wearing glasses and keeping them fog-free without adjusting one’s face shield or hood — not allowed because of the risk of self-contamination with Ebola-infected bodily fluids — was also a challenge. Under these conditions, most patients did not receive the best possible care. This situation was in complete contrast to conditions in one Ebola treatment centre in Sierra Leone established by an international humanitarian agency late in the outbreak. It was air-conditioned, and it was quite comfortable to spend hours in the unit providing basic supportive care in addition to organ-supporting intensive care, such as dialysis and mechanical ventilation.
What do you hope will result from this research?
We hope to show that standard medical interventions for the care of Ebola patients are completely feasible to perform, and that health-care workers can remain comfortable and safe when the indoor climate is appropriately cooled. Although this conclusion may seem obvious even before this project, studies have not quantified performance in Ebola PPE and whether performance can be improved by adjusting environmental conditions.
Are there other members of the research team you would like to mention?
We are very fortunate to be working with a talented team that is bringing this study to life. Dr. Peter Kiiza is a clinician from Uganda who spent considerable time in West Africa training local clinicians in safe PPE use and in Ebola patient care. He is coordinating this study for one to two years. Koren Teo, a pharmacist in the Canadian Forces, and Sarah Mullin, a senior undergraduate student at York University, are also helping with everything from designing our case report forms to navigating processes at DRDC to data collection. Finally, Len Goodman has provided considerable intellectual and practical input into the study design and operations.
Any final thoughts?
Although the threat of an unconfined regional or global Ebola epidemic is lower now than four years ago because of the availability of an experimental vaccine, the challenges of caring for patients with Ebola in the Democratic Republic of the Congo – the site of a current and recent outbreaks — remain formidable. We hope our research will help improve the care of future patients by demonstrating ways of providing effective medical care while keeping health-care workers comfortable and safe.
