Feature

Ebola Update 2026: What EMS Clinicians Need to Know

05/26/2026

The words “Ebola outbreak” immediately bring many EMS professionals back to the fear and uncertainty of 2014. For many EMS clinicians, that outbreak represented the first time they seriously considered the possibility of encountering a highly lethal viral hemorrhagic fever in the field. Yet the FDNY EMS and New York City Department Health and Mental Hygiene’s response as whole was exemplary and can serve as a positive lesson learned and template for Ebola response for other EMS professionals.¹

In 2026, Ebola is again dominating international public health discussions, this time involving the Bundibugyo strain of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) and Uganda.^2-3 The World Health Organization (WHO) has declared the outbreak a Public Health Emergency of International Concern because of the rapid geographic spread, urban involvement, healthcare worker infections, and cross-border transmission.^2-3

For EMS agencies across the United States, the important question is not whether Ebola is likely to become a widespread domestic epidemic. Current evidence suggests the risk to the U.S. remains low. The real question is operational: What should EMS personnel reasonably expect, and how should they prepare if a patient with Ebola virus, or suspected Ebola virus, enters the 9-1-1 system?

Understanding Ebola Virus

The disease known as Ebola is a severe viral hemorrhagic fever caused by several species of orthoebolaviruses. The current outbreak involves the Bundibugyo strain, which differs from the more widely known Zaire strain associated with the 2014 West African epidemic. Unlike the Zaire strain, there are currently no approved vaccines or specific antiviral therapies for Bundibugyo virus disease.^4-9

Ebola initially presents with nonspecific symptoms, which is one reason it poses such a challenge for prehospital clinicians. Early symptoms commonly include fever, malaise, generalized myalgia, weakness, headache, abdominal pain, nausea, vomiting, and diarrhea. This presentation could easily be norovirus or some other benign GI disorder.^2,10,11

As the disease progresses, patients may develop hypovolemia, electrolyte abnormalities, distributive shock, coagulopathy, with internal and external hemorrhagic presentations. Multi-organ dysfunction can rapidly follow.^2,10,11

From a pathophysiologic perspective, Ebola causes widespread endothelial injury, which in and of itself causes distributive shock, dysregulation of the immune response, capillary leak syndrome, and profound intravascular volume depletion. The resulting shock state can resemble severe septic shock, with progressive cardiovascular collapse and impaired tissue perfusion.^2,10,11

How Ebola Is Transmitted

One of the most important facts EMS providers must remember is that Ebola is not considered an airborne disease under normal circumstances. Ebola transmission occurs through direct contact with infected blood or other body fluids, including vomitus, diarrhea, urine, saliva, sweat, breast milk, semen, and contaminated fomites or surfaces.^2,11

This distinction matters operationally. Ebola transmission risk is highest when patients are symptomatic and actively producing infectious body fluids. The greatest danger to healthcare workers historically has occurred during direct patient care, particularly involving uncontrolled vomiting, diarrhea, bleeding, airway management, or inadequate PPE donning and doffing procedures.

Healthcare-associated transmission remains a major concern in the current outbreak. WHO reports multiple healthcare worker deaths and infections associated with gaps in infection prevention and control measures.⁴

For EMS, that means the threat is not simply the patient, it’s exposure during care delivery.

Could Ebola Arrive in the United States?

Yes. In today’s globally interconnected transportation network, international spread of infectious disease is always possible. Imported cases have occurred before, including during the 2014–16 epidemic. Current CDC guidance acknowledges the possibility of travel-associated cases entering the United States and has already triggered enhanced screening and travel restrictions involving affected regions.¹³

However, EMS professionals should avoid sensationalism. Ebola doesn’t spread like influenza, COVID-19, measles, or tuberculosis. Casual contact is not considered a major transmission route. The operational concern for EMS is more likely to involve isolated imported patients presenting through airports, emergency departments, urgent care centers, or the 9-1-1 system.

The bigger challenge may actually be recognition. Early Ebola symptoms resemble influenza, malaria, gastroenteritis, COVID-19, or sepsis. A patient with fever, weakness, vomiting, and recent international travel may initially appear relatively routine.

That is where EMS screening becomes critically important.

What EMS Should Expect Operationally

Most EMS agencies will never encounter a confirmed Ebola patient. However, many agencies may eventually encounter a “person under investigation” (PUI). Operationally, this distinction matters.

EMS dispatch centers, telecommunicators, EMTs, and paramedics should expect that identification of Ebola risk will depend heavily on two factors:

Clinical symptoms
Travel and exposure history

Questions regarding recent travel to outbreak regions or contact with infected individuals are essential. Current CDC and WHO advisories identify the DRC and Uganda as active areas of concern.^3-7

In practical EMS operations, the highest-risk presentations involve:^2,10

Fever combined with vomiting or diarrhea
Visible bleeding
Significant weakness with recent international travel
Known contact with infected individuals
Patients recently arriving from outbreak zones

Dispatch screening protocols should be updated to identify these factors before crews arrive.

Treatment

Patient treatment should be focused on treating patients symptomatically. Maintaining an airway, supporting respirations, maintaining blood pressure.

Oxygen is important, with that in mind minimize aerosol generating procedures (AGP’s, e.g., intubation, suctioning, nebulized medications, CPAP). Anything that is an AGP has a high degree of making spreading infectious bodily fluids. Use HEPA filtration on your BVM’s exhalation port. Aggressive infusion of crystalloid fluids, lactated ringers, and vasopressors to maintain profusion, will be essential.^2,10

PPE: Practical Reality for American EMS

One of the lessons learned from previous outbreaks is that most American EMS agencies already possess the foundational PPE needed to safely manage suspected Ebola patients—if personnel use it correctly.^2,10

This isn’t what has been depicted in the movies, like “Outbreak” or “Contagion.” First many organizations don’t have the capability to outfit their entire service in Level 4 biohazard suits, and in this author’s opinion, except for certain EMS systems in the U.S., no EMS service has implemented CDC containment protocols on a local level.

For the vast majority of EMS responses and interfacility transport providers involving suspected Ebola disease, standard contact and droplet precautions with enhanced barrier protection are appropriate.^2-10 This includes:

Fluid impermeable gown or coverall
Double gloves
Eye protection
N95 respirator or higher-level respiratory protection; a half-face or full-face respirator may be best
Face shield and goggles
Fluid-resistant footwear protection

Single use PPE (masks, gloves, gowns, etc.) should never be reused or decontaminated for reuse with Ebola. More importantly, Ebola preparedness is less about exotic equipment and more about disciplined infection control practices.

Donning and doffing procedures for PPE need to be practiced; a haphazard approach to either one can spell disaster. This is an important factor, as the most dangerous moment may not be patient contact itself. Historically, contamination frequently occurs during PPE removal. EMS agencies should train repeatedly on donning and doffing procedures using a trained observer whenever possible.

Think about it like this: are you donning and doffing your PPE on the side of the road in high winds, or when it’s 100 degrees Fahrenheit outside? What do you do when it’s 10 below zero?

Agencies should also recognize operational realities:

Ambulances are confined environments
Vomiting and diarrhea create significant contamination hazards
Airway procedures increase provider exposure risk
Small staffing models may complicate safe decontamination

Decontamination and Ambulance Operations

Ambulance contamination planning must be realistic and operationally feasible. Ebola virus can persist on surfaces contaminated with body fluids. Thorough decontamination using EPA-registered hospital disinfectants effective against enveloped viruses is essential. Sodium hypochlorite is one option recommended by the CDC.

Operationally, agencies should consider:

Dedicated transport pathways
Separation of cab from patient compartment
Limiting equipment brought into the patient compartment
Medical equipment decontamination
Using disposable equipment when feasible—never reuse disposable PPE, discard after every patient encounter with Ebola
Preplanning receiving hospitals
Restricting unnecessary personnel exposure
Post-exposure contact tracing and family care of EMS members if they are exposed and inadvertently bring it home

The receiving hospital should be notified as early as possible so isolation precautions can begin before patient arrival.

Resources

Timely and reliable resources are crucial to any response. One is NETEC, the National Emerging Special Pathogens Training and Education Center. It is a U.S. public health organization funded by the CDC and Department of Health and Human Services Administration for Strategic Preparedness and Response (HHS ASPR) to prepare hospitals and EMS clinicians to safely and effectively manage high-consequence infectious diseases (Ebola, avian flu, and hantavirus).

You will find training, protocols, podcasts, and webinars covering topics from education to operations, including EMS, ED, and ICU. NETEC has information and content developed specifically for EMS. If you’re a clinical educator, an EMS operations officer, or an EMS chief, NETEC should be bookmarked on your tablet and phone. Information is updated real time, and they also offer consultation services as well. Nothing is behind a paywall, and all of the content and services is free.

An essential resource for every EMS organization is the ASPR TRACIE EMS Infectious Disease Playbook, Version 2.0.

Another outstanding resource is Project ECHO. Offered by HHS ASPR and the University of New Mexico, Project ECHO’s clinical readiness learning covers everything from wildfires and patient protection, to leveraging AI for disaster response. During the COVID-19 pandemic they were instrumental in conveying the current state of care, real time, as the body knowledge was just being understood. You can register for Project ECHO webinars here.

The Human Factor

One of the most important lessons from prior outbreaks is that fear can become operationally dangerous. Panic leads to errors. So does complacency.

EMS leaders must strike a balance between vigilance and realism. Providers should understand that Ebola is serious, but also understand that proper PPE and disciplined infection control significantly reduce risk.

The profession should also remember that EMS clinicians are often the first healthcare contact for emerging infectious diseases. Whether the threat is Ebola, COVID-19, m-pox, measles, or an unidentified pathogen, EMS is the canary in the coal mine and the tip of spear for healthcare systems.

Preparedness therefore cannot be episodic. It must become part of organizational culture. Resources that will help with readiness, whether you are preparing for the future or responding to an immediate threat, is NETEC and Project ECHO.

The current Ebola outbreak in Central Africa deserves close monitoring by EMS leaders across the United States. While the overall risk of widespread domestic transmission remains low, isolated imported cases are entirely possible in an era of global travel.³

Citations

Centers for Disease Control and Prevention. (2015). Ebola virus disease in a humanitarian aid worker: New York City, October 2014. Morbidity and Mortality Weekly Report, 64(12), 321–323. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6412a3.htm
National Emerging Special Pathogens Training and Education Center. (2021). EMS infectious disease playbook: Ebola. https://repository.netecweb.org/exhibits/show/ebola2021/ebola
Centers for Disease Control and Prevention. (2026). Ebola disease: Current situation. CDC Ebola Situation Summary
World Health Organization. (2026). Epidemic of Ebola disease caused by Bundibugyo virus in the Democratic Republic of the Congo and Uganda determined a public health emergency of international concern. WHO Ebola Emergency Declaration
Centers for Disease Control and Prevention. (2026). Ebola Bundibugyo virus disease in Uganda – Level 1: Practice usual precautions. CDC Travelers’ Health. CDC Travelers’ Health Notice
Centers for Disease Control and Prevention. (2026, May 19). Ebola disease outbreak in the Democratic Republic of the Congo and Uganda (CDCHAN-00530). Health Alert Network (HAN). https://www.cdc.gov/han/php/notices/han00530.html
Madad, S. (2026, May 20). 8 things to know about the Ebola outbreak now spreading in DRC and Uganda. New York Academy of Sciences Ebola Article
Reuters. (2026, May 19). WHO chief concerned at speed and scale of Ebola outbreak cases rise. Reuters Ebola Outbreak Report
Reuters. (2026, May 23). Uganda confirms three new Ebola cases, bringing total to five. Reuters Uganda Ebola Cases
American Academy of Orthopaedic Surgeons. (2023). Nancy Caroline’s emergency care in the streets (9th ed.). Jones & Bartlett Learning
Centers for Disease Control and Prevention. (2026). Ebola disease frequently asked questions. CDC Ebola FAQ
Centers for Disease Control and Prevention. (2026). CDC statement on the use of public health travel restrictions related to the Ebola outbreak in the Democratic Republic of the Congo and Uganda. https://www.cdc.gov/ebola/situation-summary/title-42-order.html
Centers for Disease Control and Prevention. (2026). Health Alert Network (HAN) advisory: Ebola disease outbreak in the Democratic Republic of the Congo. CDC HAN Advisory HAN00530