Swine Flu: What You Must Do Now

By Mike McEvoy

AP Photo/Alberto Saiz A medical staff member, left, leads two patients who are undergoing tests for the swine flu virus at a hospital in Valencia, Spain Monday.

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The swine flu buzz is causing information overload. There are three things pertinent to first responders that must be implemented immediately to protect your members, provide excellent patient care, and be a good public health partner. Here's a list based off of an EMS Chiefs of Canada report:

EMS Providers

• Request additional information from dispatch when sent to respiratory, sick person and fever related calls if limited initial dispatch information is provided.
• Perform initial interview of all patients from at least 2 meters (6.5 feet) away to determine if personal protective equipment precautions are necessary.
• Place a mask on all patients with suspected influenza symptoms before approach. Use a surgical mask or non-rebreather mask (when oxygen is required).
• Avoid droplet producing procedures whenever possible including nebulizers, bag-valve-mask, suctioning or intubation. If bag-valve-masks are needed, use BVMs with HEPA filters whenever possible.
• Recommended PPE for taking care of ill/potentially infected patients includes: gloves and N95 or better respirators. PPE should be donned and doffed according to published guidelines to prevent cross contamination, including faceshield/eye and gown protection when splash or airborne contamination is possible.
• Alert receiving hospital personnel of the possibility of an infectious patient as soon as possible and hold suspected infectious patients in the ambulance until their destination in the hospital is known, rather than immediately moving them into the emergency department.
• Perform a thorough cleaning of the stretcher and all equipment that has come in contact with or been within 2 meters (6.5 feet) with an approved disinfectant, upon completion of the call following CDC interim guidelines for cleaning EMS transport vehicles.

Service Leaders

• Immediately notify all members and staff of the emerging problem.
• Review your plans using the CDC EMS Pandemic Preparedness checklist.
• Set up an email list and web site to provide continual updates and info for your members.
• Monitor news reports and government resources. Communicate with your local public health officials. Use the CDC minute-to-minute swine flu update site.

Communications Center/Dispatch Leaders

• Implement severe respiratory infection (SRI) screening for all callers with chest pain, difficulty breathing, headache, or general illness (sick person). If using the Medical Priority Dispatch System (MPDS), activate the SRI drop down on ProQA or add the following questions to paper card numbers 6, 10, 18, and 26 for further interrogation: (a) has the patient recently been in Mexico (or other outbreak location) or exposed to anyone who has (paying particular attention to those who stayed for 7 days or longer)? (b) are they febrile or have a fever and, if so, is it higher than 101 F (38 C) and (c) do they have a cough or other respiratory illness symptoms?
• Relay responses to these questions to EMS units before they arrive on scene.

Remember that this is a continually evolving situation. The most severe flu cases so far have been mostly adults from ages 25 to 45, but patients of all ages have been infected, so the same precautions should be used for all patients. We need to stay on heightened alert until this threat has been controlled. As with all infectious diseases, always remember that hand washing is the number one way to decrease transmission!

References
Updated Best Practices for EMS Agencies Identified by EMS Chiefs of Canada:
http://www.nemsma.org/Portals/0/Flu/FINAL-04282009-EMSCC-NEMSMA-Swine%20Flu%20Best%20Practices.pdf.