ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training DOT National Standard EMT-Intermediate/85 Refresher DOT National Standard EMT-Intermediate/85 Refresher Welcome!

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training MEDICAL EMERGENCIES Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease Allergic reaction Possible overdose Near-drowning ALOC Diabetes Seizures Heat & cold emergencies Behavioral emergencies Suspected communicable disease

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training MEDICAL EMERGENCIES SUSPECTED COMMUNICABLE DISEASE Perspective Pathophysiology Epidemiology PE & Diagnostic Findings S/S Differential considerations Tx

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Bacteremia >> Sepsis >> Septic Shock Skin & soft tissue infections Tetanus Meningitis & Encephalitis Brain Abscess Sexually transmitted diseases Lyme Disease Rocky Mountain Spotted Fever Other Tick-Borne Diseases Bacteremia >> Sepsis >> Septic Shock Skin & soft tissue infections Tetanus Meningitis & Encephalitis Brain Abscess Sexually transmitted diseases Lyme Disease Rocky Mountain Spotted Fever Other Tick-Borne Diseases

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Tuberculosis Infectious Mononucleosis Influenza HIV Toxic Shock Syndrome Parasitic Disease Blood & Body fluid exposure to the health care worker Food poisoning Tuberculosis Infectious Mononucleosis Influenza HIV Toxic Shock Syndrome Parasitic Disease Blood & Body fluid exposure to the health care worker Food poisoning

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Required Training Bloodborne Pathogens 29 CFR Revised OSHA Bloodborne Pathogens Compliance Directive (CPL2-2.44D) Bloodborne Pathogens 29 CFR Revised OSHA Bloodborne Pathogens Compliance Directive (CPL2-2.44D)

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Pathogenic microorganisms present in human blood that can lead to diseases Human Immunodeficiency Virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV) Pathogenic microorganisms present in human blood that can lead to diseases Human Immunodeficiency Virus (HIV) Hepatitis B (HBV) Hepatitis C (HCV)

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Despite the introduction of a safe & effective vaccine in 1982, HepB (HBV) remains a potential occupational hazard among health care workers

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective About 1.2 million Americans are chronically infected w/ HBV, forming a large pool of potential exposures to emergency care providers

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective In one study of paramedics & EMTs, about 1 in 4 remained unvaccinated against HBV

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Another recently published study of US hosptial workers also reported a 75% HBV vaccination coverage level

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective Seroprevalence studies indicate that health care workers who have frequent contact with blood have a threefold to sixfold increase in seropositivity over that of the general population 15%-30% vs. 5% Seroprevalence studies indicate that health care workers who have frequent contact with blood have a threefold to sixfold increase in seropositivity over that of the general population 15%-30% vs. 5%

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective It is also apparent that the more frequent the blood contact, the higher the rate of seroconversion

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training epidemiology In studies of emergency medical personnel during the 80s, emergency physicians exhibited a 12% to 16% seroprevalence rate EMS 16-25% ED RNs 30% In studies of emergency medical personnel during the 80s, emergency physicians exhibited a 12% to 16% seroprevalence rate EMS 16-25% ED RNs 30%

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training epidemiology Though the incidence of HBV infection in 2005 has declined by > than 3/4 since 1990, unvaccinated health care workers remain at significant risk

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training perspective HBV vaccination plays the central role in prevention of disease among health care workers & has reduced the # of HBV cases, hospitalizations, & deaths by about 80% since pre-vaccine levels

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training pathophysiology HBV can survive for at least 1 week in dried blood Infection may lead to chronic liver disease, liver cancer, and death HBV can survive for at least 1 week in dried blood Infection may lead to chronic liver disease, liver cancer, and death

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training HIV HIV is the virus that leads to AIDS HIV depletes the immune system HIV does not survive well outside the body Saliva, tears, sweat HIV is the virus that leads to AIDS HIV depletes the immune system HIV does not survive well outside the body Saliva, tears, sweat

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training HIV The CDC has conducted several studies on HIV concentrations outside the body. When these concentrations are dried, the virus is reduced by anywhere from 90 to 99 % over several hrs. In these studies, the HIV concentrations are significantly higher than they would be outside a laboratory, making theoretical environmental transmission outside the body nearly zero. The CDC has conducted several studies on HIV concentrations outside the body. When these concentrations are dried, the virus is reduced by anywhere from 90 to 99 % over several hrs. In these studies, the HIV concentrations are significantly higher than they would be outside a laboratory, making theoretical environmental transmission outside the body nearly zero.

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Hepatitis C Hepatitis C is the most common chronic bloodborne infection in the US Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent N/V May lead to chronic liver disease & death Hepatitis C is the most common chronic bloodborne infection in the US Symptoms include: jaundice, fatigue, abdominal pain, loss of appetite, intermittent N/V May lead to chronic liver disease & death

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training pathophysiology

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Potentially Infectious Bodily Fluids Blood Saliva, vomit, urine Semen or vaginal secretions Skin, tissue, cell cultures Other body fluids Blood Saliva, vomit, urine Semen or vaginal secretions Skin, tissue, cell cultures Other body fluids

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Potential Transmission Contact with another person’s blood or bodily fluid that may contain blood Mucous membranes: eyes, mouth, nose Non-intact skin Contaminated sharps/needles Contact with another person’s blood or bodily fluid that may contain blood Mucous membranes: eyes, mouth, nose Non-intact skin Contaminated sharps/needles

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Potential Exposures Industrial accident Administering first aid Postaccident cleanup Janitorial or maintenance work Industrial accident Administering first aid Postaccident cleanup Janitorial or maintenance work

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Exposure Control Plan Potential exposure determination Safe work practices Decontaminating equipment Selecting and using PPE Handling biowaste Labels and signs Training requirements Recordkeeping requirements Potential exposure determination Safe work practices Decontaminating equipment Selecting and using PPE Handling biowaste Labels and signs Training requirements Recordkeeping requirements

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Who must be trained? All employees with occupational exposure to blood or other potentially infectious material (OPIM) Employees who are trained in first aid and CPR All employees with occupational exposure to blood or other potentially infectious material (OPIM) Employees who are trained in first aid and CPR

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Universal Precautions Treat all blood and bodily fluids as if they are contaminated Proper cleanup and decontamination Treat all blood and bodily fluids as if they are contaminated Proper cleanup and decontamination

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Protective Equipment Bleeding control—latex gloves Spurting blood—latex gloves, protective clothing (smocks or aprons), respiratory mask, eye/face protection (goggles, glasses, or face shield) Postaccident cleanup— latex gloves Janitorial work—latex gloves Bleeding control—latex gloves Spurting blood—latex gloves, protective clothing (smocks or aprons), respiratory mask, eye/face protection (goggles, glasses, or face shield) Postaccident cleanup— latex gloves Janitorial work—latex gloves

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Decontamination Wear protective gloves Disinfectant/cleaner provided in bodily fluid disposal kit Solution of 1/4 cup bleach per gallon of water Properly dispose of contaminated PPE, towels, rags Wear protective gloves Disinfectant/cleaner provided in bodily fluid disposal kit Solution of 1/4 cup bleach per gallon of water Properly dispose of contaminated PPE, towels, rags

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Safe Work Practices Remove contaminated PPE or clothing as soon as possible Clean and disinfect contaminated equipment and work surfaces Thoroughly wash up immediately after exposure Properly dispose of contaminated items Remove contaminated PPE or clothing as soon as possible Clean and disinfect contaminated equipment and work surfaces Thoroughly wash up immediately after exposure Properly dispose of contaminated items

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Regulated Medical Waste Liquid or semiliquid blood or OPIM (other potentially infectious materials) Contaminated items that would release blood or OPIM when compressed Contaminated sharps Pathological and microbiological waste containing blood or OPIM Liquid or semiliquid blood or OPIM (other potentially infectious materials) Contaminated items that would release blood or OPIM when compressed Contaminated sharps Pathological and microbiological waste containing blood or OPIM

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Labels & Signs Labels must include the universal biohazard symbol, and the term “Biohazard” must be attached to: –containers of regulated biohazard waste –refrigerators or freezers containing blood or OPIM –containers used to store, transport, or ship blood or OPIM Labels must include the universal biohazard symbol, and the term “Biohazard” must be attached to: –containers of regulated biohazard waste –refrigerators or freezers containing blood or OPIM –containers used to store, transport, or ship blood or OPIM

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Hep B vaccinations Strongly endorsed by medical communities Shown to be safe for infants, children, and adults Offered to all potentially exposed employees Provided at no cost to employees Declination form Strongly endorsed by medical communities Shown to be safe for infants, children, and adults Offered to all potentially exposed employees Provided at no cost to employees Declination form

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Exposure Incident A specific incident of contact with potentially infectious bodily fluid If there are no infiltrations of mucous membranes or open skin surfaces, it is not considered an occupational exposure Report all accidents involving blood or bodily fluids Postexposure medical evaluations are offered A specific incident of contact with potentially infectious bodily fluid If there are no infiltrations of mucous membranes or open skin surfaces, it is not considered an occupational exposure Report all accidents involving blood or bodily fluids Postexposure medical evaluations are offered

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Post Exposure Evaluation Confidential medical evaluation Document route of exposure Identify source individual Test source individuals blood (with individuals consent) Provide results to exposed employee Confidential medical evaluation Document route of exposure Identify source individual Test source individuals blood (with individuals consent) Provide results to exposed employee

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Record Keeping Medical records include: Hepatitis B vaccination status Postexposure evaluation and follow-up results Training records include: Training dates Contents of the training Name and qualifications of trainer Medical records include: Hepatitis B vaccination status Postexposure evaluation and follow-up results Training records include: Training dates Contents of the training Name and qualifications of trainer

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Bloodborne Disease Training Basics of Bloodborne Diseases Exposure Prevention Basics of Bloodborne Diseases Exposure Prevention

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training SUMMARY Universal precautions PPE and safe work practices Decontamination Exposure incident Universal precautions PPE and safe work practices Decontamination Exposure incident

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment Pathophysiology Epidemiology Physical Exam Findings Diagnostic Findings Signs and Symptoms Differential considerations Treatment

ICEnAXES ICEnAXES EMS & Wilderness Emergency Care Training Questions? References –Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA –Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York –Wolfson, Allan B. ed., Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA References –Marx, John A. ed, Hockberger & Walls, eds et al. Rosen’s Emergency Medicine Concepts and Clinical Practice, 7th edition. Mosby & Elsevier, Philadelphia: PA –Tintinalli, Judith E., ed, Stapczynski & Cline, et al. Tintinalli’s Emergency Medicine A Comprehensive Study Guide, 7th edition. The McGraw-Hill Companies, Inc. New York –Wolfson, Allan B. ed., Hendey, George W.; Ling, Louis J., et al. Clinical Practice of Emergency Medicine, 5th edition. Wolters Kluwer & Lippincott Williams & Wilkings, Philadelphia: PA 2010.