Ebola or Not? Evaluating the Ill Traveler From Ebola-Affected Countries in West Africa

Fairley, Jessica K.; Kozarsky, Phyllis E.; Kraft, Colleen S.; Guarner, Jeannette; Steinberg, James P.; Anderson, Evan; Jacob, Jesse T.; Meloy, Patrick; Gillespie, Darria; Espinoza, Tamara R.; Isakov, Alexander; Vanairsdale, Sharon; Baker, Esther; Wu, Henry M.

Outpatients who met criteria for PUI were triaged by on-call infectious disease physicians to the tropical medicine clinic, ED, or ETU for further management [14, 16] , depending on the level of suspicion for EVD and symptoms. Whenever possible, PUI with low epidemiologic risk for EVD and without "wet" symptoms (such as active diarrhea, vomiting, or bleeding) were triaged to the tropical medicine clinic. Persons under investigation for EVD were triaged to the ED if they required evaluation outside of clinic hours, reported "wet" symptoms, or had any medical indication for ED-level care. Triage to the ETU was made on a case-by-case basis and reserved for patients for whom there were high levels of concern for EVD, based on epidemiologic risk factors and clinical symptoms. Persons under investigation referred to EHC by public health authorities (after identification through active monitoring and screening programs) were also triaged in a similar manner. For the outpatients evaluated at the tropical medicine clinic, a detailed protocol for receiving the patient in an isolated ambulance entrance, security-escorted transport to the clinic, and evaluation in the clinic was developed and described elsewhere [14] . When possible, physicians at the Emory tropical medicine clinic, ED, or ETU were notified in advance of a patient meeting PUI criteria. For patients arriving unexpectedly, screening protocols were integrated into the check-in procedures in the EDs and clinics to identify and isolate PUI [14, 16] . Patients screening positive in areas not designated to evaluate PUI were urgently evaluated by an on-call infectious disease staff to confirm their status and arrange transport to the tropical medicine clinic or ED if needed.