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PANDEMICS. AND. UNIVERSAL PRECAUTIONS. MARILYN EVANS CAPITAL DISTRICT FIREFIGHTERS IN-HOUSE TRAINING Dec.12, 2005. OBJECTIVES. Understand the Virus Review the history Understanding of the epidemiology Our roles Exercise. UNDERSTANDING. THE VIRUS. WHAT IS INFLUENZA?. - PowerPoint PPT Presentation
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PANDEMICS
MARILYN EVANS
CAPITAL DISTRICT FIREFIGHTERS IN-HOUSE TRAINING
Dec12 2005
AND
UNIVERSAL PRECAUTIONS
OBJECTIVES
Understand the Virus
Review the history
Understanding of the epidemiology
Our roles
Exercise
UNDERSTANDING
THE VIRUS
WHAT IS INFLUENZA
INFLUENZA ndash Acute onset of respiratory illness with fever (gt38 C1004 F) and cough with one or more of the following ndash sore throat joint pain muscle aches headache malaise
Severe illness lasting 7 to 10 days In people 65 and older fever may not be
present Other symptoms in the elderly may
include change in behavior chest congestion decrease in appetite
DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES
bullDIRECT CONTACTbullINDIRECT CONTACTbullBLOOD AND BLOODY BODY FLUIDSbullVECTORSbullDROPLET INFECTIONSbullAIRBORNE INFECTIONS
COMMUNICABLE DISEASES
Modes of Disease Transmission
Airborne a more common method of transmission bacteria or viruses suspended in air water
droplets or dust particles (coughing sneezing) can be widely scattered via air currents examples TB rubeola (measles) chicken pox
Direct Contact straight from one person to another examples kissing sexual contact blood
dripping into a wound touching feces eating or smoking with contaminated hands
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
OBJECTIVES
Understand the Virus
Review the history
Understanding of the epidemiology
Our roles
Exercise
UNDERSTANDING
THE VIRUS
WHAT IS INFLUENZA
INFLUENZA ndash Acute onset of respiratory illness with fever (gt38 C1004 F) and cough with one or more of the following ndash sore throat joint pain muscle aches headache malaise
Severe illness lasting 7 to 10 days In people 65 and older fever may not be
present Other symptoms in the elderly may
include change in behavior chest congestion decrease in appetite
DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES
bullDIRECT CONTACTbullINDIRECT CONTACTbullBLOOD AND BLOODY BODY FLUIDSbullVECTORSbullDROPLET INFECTIONSbullAIRBORNE INFECTIONS
COMMUNICABLE DISEASES
Modes of Disease Transmission
Airborne a more common method of transmission bacteria or viruses suspended in air water
droplets or dust particles (coughing sneezing) can be widely scattered via air currents examples TB rubeola (measles) chicken pox
Direct Contact straight from one person to another examples kissing sexual contact blood
dripping into a wound touching feces eating or smoking with contaminated hands
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
UNDERSTANDING
THE VIRUS
WHAT IS INFLUENZA
INFLUENZA ndash Acute onset of respiratory illness with fever (gt38 C1004 F) and cough with one or more of the following ndash sore throat joint pain muscle aches headache malaise
Severe illness lasting 7 to 10 days In people 65 and older fever may not be
present Other symptoms in the elderly may
include change in behavior chest congestion decrease in appetite
DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES
bullDIRECT CONTACTbullINDIRECT CONTACTbullBLOOD AND BLOODY BODY FLUIDSbullVECTORSbullDROPLET INFECTIONSbullAIRBORNE INFECTIONS
COMMUNICABLE DISEASES
Modes of Disease Transmission
Airborne a more common method of transmission bacteria or viruses suspended in air water
droplets or dust particles (coughing sneezing) can be widely scattered via air currents examples TB rubeola (measles) chicken pox
Direct Contact straight from one person to another examples kissing sexual contact blood
dripping into a wound touching feces eating or smoking with contaminated hands
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
WHAT IS INFLUENZA
INFLUENZA ndash Acute onset of respiratory illness with fever (gt38 C1004 F) and cough with one or more of the following ndash sore throat joint pain muscle aches headache malaise
Severe illness lasting 7 to 10 days In people 65 and older fever may not be
present Other symptoms in the elderly may
include change in behavior chest congestion decrease in appetite
DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES
bullDIRECT CONTACTbullINDIRECT CONTACTbullBLOOD AND BLOODY BODY FLUIDSbullVECTORSbullDROPLET INFECTIONSbullAIRBORNE INFECTIONS
COMMUNICABLE DISEASES
Modes of Disease Transmission
Airborne a more common method of transmission bacteria or viruses suspended in air water
droplets or dust particles (coughing sneezing) can be widely scattered via air currents examples TB rubeola (measles) chicken pox
Direct Contact straight from one person to another examples kissing sexual contact blood
dripping into a wound touching feces eating or smoking with contaminated hands
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES
bullDIRECT CONTACTbullINDIRECT CONTACTbullBLOOD AND BLOODY BODY FLUIDSbullVECTORSbullDROPLET INFECTIONSbullAIRBORNE INFECTIONS
COMMUNICABLE DISEASES
Modes of Disease Transmission
Airborne a more common method of transmission bacteria or viruses suspended in air water
droplets or dust particles (coughing sneezing) can be widely scattered via air currents examples TB rubeola (measles) chicken pox
Direct Contact straight from one person to another examples kissing sexual contact blood
dripping into a wound touching feces eating or smoking with contaminated hands
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Modes of Disease Transmission
Airborne a more common method of transmission bacteria or viruses suspended in air water
droplets or dust particles (coughing sneezing) can be widely scattered via air currents examples TB rubeola (measles) chicken pox
Direct Contact straight from one person to another examples kissing sexual contact blood
dripping into a wound touching feces eating or smoking with contaminated hands
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Indirect contact touching a contaminated surface amp most likely bringing
your hands to your face examples telephones door handles steering wheels
faucets BP cuffs EKG cables swimming in contaminated water
Vector-borne infectious agent transferred by common carrier (animal amp
insect bites blood transfusions needle stick injuries transplants) from 1 personsource to another
examples rabies lyme disease malaria West Nile disease HBV HIV
Modes of Disease Transmission
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
About Influenza
Period of Communicability 104870724 hours before onset 10487073-5 days after onset 1048707Hard surfaces 24-48 hours 1048707Porous surfaces 8-12 hours 1048707Hands 5 minutes
Incubation 10487071-3 days
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Influenza Virus
There are three types of influenza viruses
Types A B and C
The viruses are transmitted among humans by respiratory secretions through sneezing coughing and contact with contaminated articles
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Influenza Virus
Type C influenza Virus
Restricted to humans
Relatively Stable
Causes mild sporadic illness among humans
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Symptom Influenza Common Cold
Fever Often high sudden onset 38degC ndash 40degC and lasts 3-4 days
Rare
Headache Frequently Rare
Aches and pains Usual often quite severe Slight
Weakness Moderate to extreme may last up to one month
RareMild
Bedridden Frequently may last up to 5-10 days
Rare
Runny stuffy nose Sometimes Common
Sneezing Sometimes Usual
Chest discomfort Usual and can be severe Sometimes but mild to moderate
Complications Respiratory failure complicate a chronic condition
Congestion sinus or ear infection
Prevention Influenza vaccine frequent handwashing cover your cough
Frequent handwashing cover your cough
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Influenza Virus
Type B influenza Virus
Restricted to humans Can change slowly over time More Stable than Influenza A Has been associated with widespread
illness among humans Causes milder disease than influenza A
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Influenza virus
Type A influenza Virus
Many different sub-types Various subtypes infect humans pigs
horses aquatic animals birds and most recently dogs
Can change frequently and dramatically Can sweep across continents and around the
world in massive epidemics called pandemics Causes excess mortality and mordidity
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Epidemic
Affects a large population in a geographic area
Abrupt onset Rapid spread Occurs at
unpredictable intervals
Not seasonal
Massive global epidemic caused by a antigenic shift in the Influenza A virus
Pandemics are usually worldwide
Pandemic
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Recipe for a Pandemic
1048707Bird flu virus can mix with human flu virus and create new subtype of virus
1048707The world would have little or no immunity to this new virus
1048707If this virus replicates in humans and causes serious diseasehelliphelliphelliphellip AND
1048707If this virus can be spread from person to person efficiently then it may cause ahellipPANDEMIC
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Phase Level Definition
0 0 Inter-Pandemic Period Annual epidemics with 3-4 circulating influenza strains worldwide
0 1 Initial Report of New Strain in Humans Novel virus reported no clear evidence of person-to-person spread or outbreak activity
0 2 Novel Virus Alert Infection in gt2 humans confirmed ability to spread and cause severe disease questionable
0 3 Human Transmission Confirmed Person-to-person transmission confirmed or new virus found in several countries at least one outbreak lasting gt 2 weeks
1 Confirmation of Onset of Pandemic Efficient person-to-person spread with outbreaks in gt1 country and evidence of severe morbidity and mortality
Phases of an Influenza Pandemic
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Phases of an Influenza Pandemic
End of Pandemic Infection rates return to pre-pandemic levels no more large scale ldquowavesrdquo of infection expected May take 2 or more years
5
Second or Later Waves 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak
4
End of First Pandemic Wave Influenza activity stops in initially affected regions and continues elsewhere
3
Regional and Multi-Regional Epidemics Outbreaks and epidemics in multiple countries around the world
2
DefinitionPhase
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
ReviewPandemic History
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Past Influenza Pandemics
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Mortality during the pandemic of1918-19AH1N1 ndash Spanish influenza
1048707 3 epidemic waves in close succession
1048707 March 1918 Sept 1918 Feb 1919
1048707 Est 40 million deaths world-wide
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Pandemic Influenza 1918 Influenza Pandemic
20-40 million persons died worldwide possibly more
Death rate 25 times higher than previous epidemics
Ten times as many Canadians died of flu than died in WW I
The epidemic preferentially affected and killed younger healthy persons
The epidemic was so severe that the average life span in Canada was depressed by 10 years
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Understanding of the Understanding of the epidemiologyepidemiology
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Evidence suggests most epidemics emerge from China
Close mingling of pigs chickens ducks and humans allows reassortment of viruses
Where does it start
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Antigenic Variation
Influenza viruses change frequently Changes or mutations in the virus
are referred to as ldquoantigenic variationrdquo
These variations cause epidemics and pandemics
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Antigenic Variation
Antigenic variation is referred to as drift or shift depending on whether the variation is small or great
The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Antigenic shift affects the Influenza A virus only and causes major changes within the virus This can occur every 10-40 years leading to a pandemic
There is no relationship between the surface antigens of the old and the new virus therefore a new virus subtype emerges
The population will have no immunity to the new subtype
Antigenic Variation
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
The current reality
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
ldquoDonrsquot worry about it itrsquos probably just a head coldrdquo
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia
We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemichellip
Dr Shigeru Omi the WHOs Western Pacific Regional Director 23 February 2005
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
PANDEMIC
ldquoThe pandemic clock is ticking ndash we just donrsquot know what time it isrdquo
Edgar MarcuseUniversity of Washington School of Medicine
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
The Pandemic Challenge
Senior officials are being asked to
ndash Cope with present realities bull An avian influenza epidemic ndash Prepare for an uncertain future bull A human influenza pandemic ndash Be ready for major disruption bull Reaction to the pandemic
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Pandemic Influenza Potential Impact of Pandemic Influenza inCanada
Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability
Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population
Healthcare system will be overwhelmed Risk of sudden shortages of key personnel in
critical community services police fire powerutilities transportation air traffic controllers etc
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
What do we knowhellip
bull Pandemic influenza will happen (at some point) bull It is more likely now than three years ago bull It could be mild bull It could be severe bull It could be extremely severe bull It affects younger age groups than normal influenza
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Are You Prepared
What is knownhellip An influenza pandemic will happen The timing and pattern will be
unpredictable A short lead time will exist from first
identification to full scale pandemic Outbreaks will occur simultaneously in
multiple waves with devastating societal impact
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
What do we know - Two
bull It could come once or in waves bull It will probably come quickly bull Work forces will be badly affected bull Maybe infectious before symptoms appear bull There are infections with no symptoms
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
What do we know - Three
bull An effective vaccine will take several months to develop
bull There will probably be few anti-viral medicines available and the emergence of resistance is possible
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
What do we know - Four
bull Influenza is infectious ndash but not as highly infectious as measles bull Not everyone will be infected bull There are ways of reducing the numbers affected bull If an infectious and damaging virus emerges containment of people may be justified bull Need for epidemiological information
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Pandemic Impact
Health Care System Extreme staffing shortages
Shortage of beds facility space supplies
Hospital morgues Medical Examiner and mortuary services overwhelmed
Infrastructure Significant disruption of transportation public works
commerce utilities energy and communications emergency response
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Our roles
Safeguarding front-line personnel
Educate and Inform
Continuity of Operations Planning
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
UNIVERSAL PRECAUTIONS
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
ldquoThe only thing more difficult than planning for an emergency is having
to explain why you didnrsquotrdquo
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Vaccinations
not all are mandatory many available to protect the individual
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident
Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes
bull Standard Precautionsbull Contact Precautionsbull Airborne Precautionsbull Droplet Precautions
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
apply to blood all body fluids secretions non-intact skin mucous membranes and excretions for all patients Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids Appropriate hand hygiene is always necessary
Standard Precautions
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
include the use of gloves and a gown if clothing is likely to have contact with patient environmental surfaces or patient care equipment
Contact Precautions
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
include a properly ventilated areaambulanceroom and appropriate respiratory protection such as the N95 respirator and placing a mask on the patient
Airborne Precautions
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
include the use of a disposable gown gloves and mask when working on or within 65 feet of a patient For patients who are coughing if possible and not contraindicated by respiratory difficulties place a surgical mask on the patient to prevent droplet spread inside the ambulanceroom When transferring or moving a patient from room to room inside the hospital or any enclosed building place a mask on the patient to prevent contamination of other persons
Droplet Precautions
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Reminder Even though EMS providers wear gloves during a call vigorous handwashing with soap and water or waterless handcleaners must be done after each patient contact This will help reduce the potential for contamination
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Influenza Prevention
bull Stay home when sick
bull Cover your cough
bull Wash hands regularly and use alcohol hand gel
bull Avoid touching eyes nose mouth
Pandemic Preparedness Responsibilities of All Partners
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Wet your hands
Add soap and lather hands
including backs and
wrists
Wash each finger and
scrub 15- 20 seconds
Rinse under
running water
Dry hands with paper
towel
Turn off water using paper towel
Check hands and fingernails
for cleanliness
The 8 steps of washing your hands
EMS personnel should use waterless hand wash as an adjunct to handwashing to help prevent the
risk of transmission of microorganisms
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Using amp Removing Gloves
Put on eyewear first then face mask then gloves When finished remove face mask first then
eyewear lastly gloves To remove gloves
grasp cuff remove glove by peeling off of hand amp fingers turn glove inside out as it is being removed dispose in proper receptacle
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
SAFE REMOVAL DISPOSAL OF PPE
SOME HEALTHCARE WORKERS APPEAR TO HAVE ACQUIRED SARS INFECTION DUE TO THE IMPROPER REMOVAL amp DISPOSAL OF PPE
PROVIDERS MUST USE CARE TO AVOID THE OUTER PART OF PPE (MASK DISPOSABLE GOWNS BOOTIES ETC) FROM COMING INTO CONTACT WITH SKIN OR CLOTHING
ITEMS SHOULD GO DIRECTLY INTO BIOHAZARD DISPOSAL BAGS
MASKS SHOULD BE THE SECOND TO LAST ITEM REMOVED FOLLOWED BY GLOVES
THOROUGH HANDWASHING WITH EITHER SOAP amp WATER OR WATERLESS DISINFECTANT SHOULD TAKE PLACE IMMEDIATELY AFTER ALL PPE IS REMOVED
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Respiratory Protection
Goal is to wear a mask that will cover the nose amp mouth amp not gap at the sides or chin
Patients are to wear surgical or standard masks when being transported
EMS providers are to wear the N95 mask to protect by filtering particles out of the air you breathe risk of exposure
Additional masks may be available for special situations or based on the stock supplied
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
MASKS
TWO LEVELS OF AIRBORNE PERSONAL PROTECTIVE EQUIPMENT (PPE) ARE AVAILABLE amp PRACTICAL FOR EMS
SURGICAL MASK N-95 MASK
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
MASKS
A SURGICAL MASK IS OFTEN RECOMMENDED FOR AIRBORNE PATHOGENS EXCEPT TUBERCULOSIS AND SARS PATHOGENS
STRONG CONSIDERATION SHOULD BE MADE FOR PLACING A SURGICAL MASK ON THE PATIENT AS WELL AS THE EMS PROVIDER
SURGICAL MASK REQUIRES NO FIT TESTING
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
MASKS
AN N-95 MASK IS RECOMMENDED BY CDC FOR CONTACT WITH KNOWN OR SUSPECTED SARS PATIENTS
FOR AN N-95 MASK TO HAVE MAXIMUM EFFECTIVENESS A FIT-TEST PROCEDURE MUST BE DONE BY A QUALIFIED INDIVIDUAL
FIT TESTING DETERMINES WHICH SIZE MASK TO WEAR WHETHER A PROPER SEAL IS POSSIBLE WHETHER THE EMS PROVIDER HAS ANY MEDICAL
CONTRAINDICATIONS TO USING AN N-95 MASK
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
MASKS
A PROVIDER MAY BE UNABLE TO ACHIEVE A PROPER FIT FOR AN N-95 MASK FOR SEVERAL REASONS (SUCH AS A
BEARD)OTHER OPTIONS SUCH AS AVOIDING PATIENT CONTACT
OR USE OF A POWERED BREATHING DEVICE MAY BE REQUIRED
THE CDC SAYS THAT THE USE OF A SURGICAL MASK (IF N-95 NOT AVAILABLE) WILL PROVIDE SOME LEVEL OF
PROTECTION AGAINST SARS
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
HOW WILL YOU KNOW WHICH TO USE
ITrsquoS RECOMMENDED THAT THE USE OF
AIRBORNE PPE BECOMES A ROUTINE PRACTICE FOR INTERACTIONS WITH ALL AT-RISK RESPIRATORY AND FEVER PATIENTS
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
HOW WILL YOU KNOW WHICH TO USE
THE CDC ADVOCATE THE USE OF N-95
MASKS AS THE DEVICE OF CHOICE FOR EMS PROVIDERS TO WEAR FOR CONTACT WITH ALL PATIENTS WITH ANY POSSIBLE RESPIRATORY COMMUNICABLE DISEASE
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
CPR Barriers amp Masks Checking PPE equipment includes
readiness of emergency CPR devices gloves CPR masks face shields ambu bag
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
WHEN SHOULD YOU BE THINKING ABOUT APPLYING PPE
DISPATCH INFORMATION
SCENE SAFETY ASSESSMENT
PATIENT ASSESSMENT
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
WHEN SHOULD YOU CONSIDER APPLYING PPE
DISPATCH INFORMATION RESPIRATORY DISTRESS SOB DIFFICULTY
BREATHING FEVER RASH ldquoSICK PERSONrdquo or ldquoILL CALLrdquo
SHOULD GET YOU THINKING AND PREPARED TO DON APPE ON SCENE
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
WHEN SHOULD YOU CONSIDER APPLYING PPE
SCENE SAFETY ASSESSMENT
AT THE DOORWAY ENTERING THE ROOM - IS THE SCENE SAFE
IS THE PATIENT COUGHING IF YES YOU SHOULD APPLY YOUR MASK
BEFORE PROCEEDING
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
WHEN SHOULD YOU CONSIDER APPLYING PPE
PATIENT ASSESSMENT
IN ADDITION TO ROUTINE QUESTIONS BASED ON CHIEF COMPLAINT ( AND EARLY IN THE ASSESSMENT ) THE EMS PROVIDER SHOULD DETERMINE
DOES THE PATIENT HAVE A FEVER PTCAREGIVER HAS TAKEN A TEMP PT THINKS HESHE HAS A FEVER EMS PROVIDERS TAKE A TEMP
IS THE PATIENT COUGHING DOES THE PATIENT HAVE A RASH
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
IF YES TO ANY OF THE PREVIOUS QUESTIONShellip
AND YOU HAVENrsquoT PUT PPE ON YET - YOU SHOULD BE DOING IT NOW
ALSO ASK IF THE PATIENT HAS BEEN OUTSIDE THE CANADA WITHIN THE PAST 10 DAYS IF SO DOCUMENT WHERE THEY TRAVELED
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
PPE ALGORITHM
MAY FEVER
APPLY PRESENT PPE
YES NO
APPLY PPE MAY NOT PPE BE NECESSARY
CHIEF COMPLAINTCHIEF COMPLAINT
TYPICAL OPQRST QUESTIONSTYPICAL OPQRST QUESTIONS
IS PATIENT IS PATIENT COUGHINGCOUGHING
NONOYESYES
NONOYESYES
DOES PT APPLYDOES PT APPLY
HAVE RASHHAVE RASH PPE PPE
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
YOU MADE THE DECISION TO APPLY PPE NOW EVALUATE THE EFFECTIVENESS
IS THE PATIENTrsquoS MOUTH amp NOSE COVERED
ARE ALL PROVIDERS IN CONTACT WITH PT WEARING MASKS
HAVE YOU EVALUATED THE RISK ALERT LEVEL CLINICAL CRITERIA TRAVEL TO INFECTED AREA CONTACT WITH INFECTED PATIENT
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
IF HIGH LIKELIHOOD OF INFLUENZA
ENSURE N-95 MASKS ARE USED BY FIT TESTED PERSONNEL USING THE RIGHT SIZE MASK
ALSO USING EYE PROTECTION GLOVES GOWN CAP amp BOOTIES
AND OTHER PROTECTION
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
OTHER PROTECTION
LIMITATION OF PERSONNEL ISOLATE THE PATIENT COMPARTMENT OF
THE AMBULANCE IF POSSIBLE LIMITING SOME PROCEDURES (ie Nebulizer
) HEPA FILTRATION - BVM SUCTION DISINFECTION PRACTICES BIOHAZARD WASTE DISPOSAL PRACTICES -
MANY HEALTHCARE WORKERS HAVE BECOME CONTAMINATED BY IMPROPER REMOVAL OF PPE
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
OTHER CONSIDERATIONS
ADVISE THE EMERGENCY DEPT THAT RESPIRATORY PRECAUTIONS ARE IN PLACE EITHER ROUTINE OR REPORT SPECIFIC CLINICAL FINDINGS
ADVISE THE PATIENT AND FAMILY THAT RESPIRATORY PRECAUTIONS ARE A ROUTINE PRACTICE NOW TO PROTECT EVERYONE
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
SO REMEMBERhellip
N-95 MASK FOR YOURSELFamp
SURGICAL MASK OR O2 MASK FOR YOUR PATIENT
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Infection ControlrsquosGolden Rule
If itrsquos wet and itrsquos not yourshellip
DONrsquoT TOUCH
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Decontamination Considerations
Decontamination of victims at a scene is the responsibility of responding HazMat andor fire department personnel This includes decontamination procedures for both people and equipment
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
People
In general decontamination of infectious disease patients is not necessary People exposed to a biological agent need only to remove their clothing if heavily contaminated and use shampoo soap and water on themselves (shower) Diluted bleach solutions should NEVER be used on people
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Equipment Patient care equipment must be
appropriately cleaned sterilized or disinfected between patients Environmental surfaces can be decontaminated with diluted chlorine beach (110 dilution of household bleach) or an EPA-approved hospital disinfectant
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
EMS Role in Disease Surveillance
EMS personnel should be alert to illness patterns and diagnostic clues that might signal an act of bioterrorism (BT) The following clinical and epidemiological clues are suggestive of a BT event
A rapidly increasing incidence of disease in the community
Unusual increases in the number of people seeking medical care calling for an ambulance especially with fever respiratory or gastrointestinal symptoms
An unusual number of people with flu-like symptoms particularly during the non-traditional flu season
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Any suspected or confirmed communicable disease that is NOT COMMON in New Brunswick (eg plague anthrax smallpox or viral hemorrhagic fever) Note As smallpox has been eradicated in its natural state one case of smallpox must be viewed as caused intentionally
Any unusual age distribution or clusters of disease (eg chickenpox or measles in adults)
Simultaneous outbreaks in human and animal populations
Any unusual clustering of illness (eg persons who attended the same public event)
EMS Role in Disease Surveillance
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Careful observations and understanding of historic disease patterns in the community can help identify a biological incident or epidemic early It is the early detection of any epidemic that can prevent or contain the spread of disease in a community
This rule applies to intentionally spread disease or naturally occurring disease EMS personnel should advise hospital triage staff of any concerns or patterns in patient presentation as hospital staff may have received similar patients from other ambulance services
EMS Role in Disease Surveillance
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Our best defense against the potentially
devastating effects of pandemic influenza is to take a proactive approach and develop a comprehensive community-specific plan that incorporates the unique needs and strengths of our communities
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Exercise
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
Pandemic Influenza Contingency PlanningScenario
You return to your community from this workshop and lead a process to develop a respiratory illness emergency plan You want to integrate this with the plans for fire and flood evacuations since many of the same people and processes are involved You discover that your communityrsquos fire and flood plan is an empty folder Describe what you will do and who should be involved in what you propose
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