By Diane Carman

While physicians, airline flight crews, even schoolteachers are learning how to take precautions to avoid acquiring or spreading Ebola should the disease occur here, it is the state’s nurses who may be the most vulnerable.

Colorado nurses are joining the nationwide call for much better training on Ebola prevention, thorough investigations of how Ebola has spread so far and open information sharing.

The only Ebola cases acquired in the U.S. were in two nurses who cared for Thomas Eric Duncan in Dallas. Duncan was exposed to Ebola in Liberia and developed the disease after traveling to Dallas to be with his fiancée. He died on Oct. 8.

Two nurses who cared for him at the hospital in Dallas are being treated for the disease.

While some in the health care community have speculated that the nurses were responsible for becoming infected because they made missteps in the protocols for “donning and doffing” protective equipment, Colleen Casper, executive director of the Colorado Nurses Association, emphasized, “I don’t think this is a good time to point fingers.”

No one yet knows how the nurses became infected with the virus, she said. “This is a highly infectious disease. … We need to collaborate and work together to get the evidence.”

Casper said hospitals do thorough investigations of incidents “where we have an unintended outcome. We look for what went wrong and how to prevent it from happening again.”

In talking to members of the nurses association, Casper said, “The first reaction of nurses here is actually sympathy and compassion for the nurses who find themselves in the situation where they have contracted Ebola.

“The next reaction is, ‘What do I need to do so this does not happen to me and the patients we care for.’ ”

It is just exactly this kind of information that nurses all across the country are seeking.

Dr. Larry Wolk, director of Colorado’s Department of Public Health and Environment, said the U.S. Centers for Disease Control and Prevention sent new guidelines this week on the proper use of personal protective equipment.

In addition, many of the protocols developed by Doctors Without Borders working on the ground in clinics in Liberia, Sierra Leone and Guinea are being recommended for health care workers here.

Those protocols include using gear that covers the body completely, removing it in a strict sequence so as not to transfer the virus from the outside of the protective equipment to the skin, frequent washing of hands and gear with chlorinated water, and always working with a buddy to supervise the process.

While the public health system across the country and across Colorado is responding aggressively to educate people and prepare everyone to handle the Ebola challenge, Casper said there’s always the chance that the message isn’t getting across to every health care worker.

“There’s probably some health care provider someplace — somebody on the front lines — who isn’t informed,” she said. “It might be someone who works a night shift and might not know how to handle the precautions. It’s why we have to help each other. We have to collaborate across all disciplines.”

Wolk told a packed media briefing Tuesday that new information, precautions and instructions to health care workers for dealing with Ebola patients are produced almost daily by the CDC.

But he said the most important message comes down to three words:

Ask. Isolate. Call.

“The expectation is that everyone has a responsibility as a health care provider to perform these tasks,” Wolk said to a packed media briefing on Tuesday.

By everyone, he said he means staff members in emergency departments, hospitals, infection prevention departments, ambulance services, public safety agencies, laboratories, public health agencies, schools, child care centers as well as coroners, home health care workers, cleaning crews. The list is almost endless.

That means that every patient who comes into an emergency room, a doctor’s office, a clinic or even a child who comes to the school nurse with a fever must be asked about recent travels, potential exposure to persons with Ebola and what symptoms he or she is experiencing.

If the answer to any of the questions raises concerns, the patient must be isolated and the caregiver must call CDPHE immediately.

While the general directive is simple, implementation is hugely complicated.

Wolk said the department has been conducting frequent training and information sessions to prepare health care workers and provide them with up-to-date information for self-protection and to keep the virus from spreading if it is identified.

Last week, the department identified three Colorado hospitals that are fully equipped to handle an Ebola case should one be identified here: University of Colorado Hospital, Denver Health Medical Center and Children’s Hospital.

Specially trained and equipped ambulance crews will be identified if a patient needs to be transferred, and protocols for self-isolation and monitoring of persons who may be exposed to an active case of Ebola also are being communicated to health care workers around the state.

No case of Ebola has been reported in Colorado.

Ken Green, senior vice president of operations for Denver International Airport, said the airport has no direct flights from West Africa (no U.S. airports have direct flights from the Ebola-affected region), but it is taking precautions in case an infected traveler arrives here by plane.

If a passenger suspected of having Ebola is identified when a plane is in the air, flight crews are instructed to isolate the passenger as much as possible before landing. The plane then would be taken to a remote area at the airport away from the gate while the sick person is taken to a hospital and other passengers are taken from the plane.

“DIA stands ready,” Green said.

Two Frontier Airlines planes were decontaminated after a nurse who later came down with Ebola had flown from Dallas to Cleveland and back. Green said the plane that carried her from Dallas to Cleveland, before she had any symptoms of Ebola, is back in service. The aircraft that carried her from Cleveland to Dallas, when she may have been experiencing early symptoms of the disease, remains out of service in Denver.

The flight crews are on leave and doing 21 days of self-monitoring for signs of the virus, Green said, and no one has reported any problems yet.

Casper said nurses and all health care workers are eager to have the latest information, the best personal protective equipment and the best training as soon as possible.

“Information is power,” she said.

Wolk encouraged health care workers and the public to contact CDPHE with any questions. Information is available online at www.colorado.gov/ebola or by phone at 303-389-1688 or 1-877-462-2911.