What is the most appropriate action for a patient with Ebola who insists on leaving the hospital to buy a drink?

Management of Ebola Patient Attempting to Leave Isolation

Immediately consult hospital administrators (Option D) while simultaneously engaging the patient and calling security to prevent departure until legal quarantine measures can be invoked. 1

Why Hospital Administration Must Be Involved

The hospital administrator has the unique authority to contact state and local public health departments to invoke mandatory quarantine orders that individual clinicians cannot implement alone. 1 This is not a bedside clinical decision—it requires institutional and governmental authority to legally detain a patient with a highly consequential infection like Ebola. 1

The Critical Public Health Context

• Ebola patients must have movement restricted to patient care areas only to prevent community transmission of this lethal disease. 1
• The 2014 Dallas Ebola case demonstrated the catastrophic consequences of inadequate containment: the index patient died and two nurses became infected, highlighting why individual patient autonomy is superseded by public health obligations in this scenario. 1
• Ebola transmission occurs through direct contact with bodily fluids, and the disease has a high case-fatality rate with potential for multi-organ failure. 2, 3

Immediate Action Algorithm

While awaiting administrative response:

1. Keep the patient engaged in conversation to delay departure while hospital administration is being contacted. 1
2. Call security simultaneously to provide physical presence at the door, but understand that security alone cannot legally detain the patient without proper authority. 1
3. Hospital administrators should immediately contact state/local public health authorities to invoke mandatory quarantine orders. 1

Why Other Options Are Insufficient

• Calling security alone (Option A) addresses the immediate physical threat but lacks the legal framework to enforce detention. 1
• Referring to infectious disease (Option B) delays action and provides no mechanism for legal detention.
• Signing DAMA (Option C) is ethically and legally inappropriate—you cannot allow a confirmed Ebola patient to leave and potentially expose the community to a lethal pathogen. 1

Common Pitfalls to Avoid

• Never attempt to handle this situation at the bedside level alone—this requires institutional and governmental authority that individual clinicians do not possess. 1
• Do not delay notification of administration—every minute increases the risk the patient may successfully leave the facility and expose the community. 1
• Do not prioritize patient autonomy over public health safety in cases of highly contagious, lethal diseases where legal quarantine authority exists. 1