1. Preparing for Pandemic Influenza: A Primer for EMS Personnel
5/10/2009
Preparing for Pandemic Influenza: A Primer for EMS Personnel
Michael D. Curtis, MD
Michael R. Clark, MD
September 2009

2. Overview Terminology Who is at risk Communications
Protecting responders
Unprotected exposures
Vaccination

3. What is Influenza? A respiratory illness caused by a virus
A form of bronchitis
Usually causes a fever (T≥100.0 oF) along with a cough or sore throat and other symptoms…

4. What is Influenza?
It often gets confused with another viral illness – gastroenteritis
Gastroenteritis is intestinal flu
Gastroenteritis usually involves diarrhea and often vomiting

5. What is Influenza?
“The flu” in everyday language usually refers to gastroenteritis
But the “flu shot” we get every fall protects us against influenza, not gastroenteritis
No wonder folks get confused!

6. What is seasonal influenza?
A wintertime epidemic
Spreads easily from human to human
The viruses mutate from year to year
New vaccine needed every year

7. What is pandemic influenza?
Influenza due to a novel virus
Pandemics occur about every 20 years
Previous vaccinations do not confer immunity

8. What is pandemic influenza?
Pandemics can persist for several years and cause illness all year long
Pandemics bring widespread illness and increased deaths

9. What’s in a name? 2009 Influenza A H1N1 Don’t call it “Swine Flu”
Swine, bird and human origins
Don’t call it “Swine Flu”
A disease of pigs, not humans
No pigs in US infected with the H1N1 virus
It is not spread from pork products to humans

10. Why do EMS providers need to know about pandemic influenza?
Like all healthcare providers…
EMS workers are at risk because of exposure to sick persons
EMS workers are essential to our community’s public safety infrastructure
EMS workers can spread it, placing others at risk

11. Who is most at risk?
Most healthy people will experience a mild illness
Children under 5 years of age
Pregnant women
Underlying disease of the heart, lung, liver, nervous system, plus blood and metabolic diseases

12. Who is most at risk? Patients with immunosuppression
Patients in nursing homes
Anyone over 65
Under 18 on long-term aspirin therapy

13. What emergency responders need to know!
Dispatch procedures
Limit exposure
Post-exposure prophylaxis
Vaccination

14. Dispatch Procedures Caller interrogation Scripted messaging
Fever or chills
Cough or sore throat
“Flu-like symptoms”
Scripted messaging
(+) “Respiratory PPE Advised”
(+) “Febrile respiratory illness”
(+) “Influenza-like illness”
(–) “Influenza screening negative”

15. Limit Exposures
Personal Protective Equipment
Special Considerations

16. Personal Protective Equipment
Masks
N95 for transport personnel
Fit testing required
Cover N95 with a surgical mask
Extends the life of the N95
Store in a vented bag and replace periodically
Surgical masks for first responders
Surgical masks for patients
Non-rebreather masks for patients with hypoxia

17. Personal Protective Equipment
Disposable gloves
Disposable gowns
Garbage bags
Alcohol based hand sanitizer
Driver of ambulance doffs PPE
Close off the pass through
Open the windows

18. Personal Protective Equipment
Eye ware
Vented goggles
Safety goggles
Surgical mask with shield
Splash shield

19. Special Considerations
The fewer care givers the better
Social distancing – 6 foot rule
Communicate with the hospital!
Decontaminate the ambulance and durable equipment
Soap and water
Disinfectants
Avoid exposing pregnant responders

20. Special Considerations
Affected patients are considered infectious for 7 days after the onset of illness
Symptomatic EMS workers should stay home for 7 days or until asymptomatic, whichever is longer
How will EMS workers be notified of exposure to H1N1?

21. Post-exposure Prophylaxis
Not required if PPE was worn
Unprotected exposures
Tamiflu® 75 mg once daily for 10 days
To be started before symptoms begin
Prevents symptoms from developing
Does not confer lasting immunity
Asymptomatic EMS workers on post-exposure prophylaxis may still work

22. Treatment Symptoms begin within about 2 days
Viral shedding 24 hours before symptoms
Tamiflu® 75 mg twice daily for five days
If infected, lasting immunity may occur

23. Vaccination Seasonal influenza vaccination Influenza H1N1 vaccination
EMS personnel are in the highest priority group to receive the H1N1 vaccination when it becomes available

24. For More Information… http://pandemicflu.gov/
Click on: Traffic Safety
Then click on: Emergency Medical Services 24

25. Summary Simple measures will help to protect
Responders
Family members
Persons at high risk of severe illness
Dispatchers warn responders
Responders warn the hospital
PPE is the first line of defense
Get vaccinated
Post-exposure prophylaxis and treatment