By Maveric Vu
EMS1 News Editor
It has been more than seven days since reports began of the first major outbreak in swine flu. Since then, more than 360 cases have been confirmed in 13 countries, with thousands of suspected cases.
As reports of possible infections and school closures continue to surface, many EMS officials are relaying one message.
“Now is not the time for anyone to panic,” said Gary Wingrove, president of the National EMS Management Association.
The Centers for Disease Control and Prevention released interim guidelines for EMS providers Thursday that assist in the treating and transport of potentially infected patients.
“The problem is you just never know who’s going to be impacted,” Wingrove said. “Having plans ready on the shelf, and having reviewed them and knowing they’re current…those are all critical for everyone to do right now.”
For American Medical Response employees, pieces of information started circulating from managers last Friday evening, the first day swine flu reports became public.
Since then, safety and assessment guidelines have been disseminated to regional chief operating officers and on the AMR employee portal, said Scott Bourn, director of clinical programs for AMR.
“Our greatest risk in the patient arena is probably in the period before the patient has influenza,” Bourn said. “There are things we can do to protect our crews.”
The first step in protecting EMS providers — identified by the CDC — is for 911 dispatchers to get as much information as possible when dealing with a potential influenza call and to inform the first responder.
The CDC guidelines offer the following precautions for EMS providers entering a call with a suspected swine flu patient:
- EMS personnel should stay more than six feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions.
- Wear fit-tested disposable N95 respirator and eye protection, disposable non-sterile gloves, and gown, when coming into close contact with the patient.
Some providers were concerned that the recommended distance away from patients would hinder proper assessment.
“If this is out of your realm of comfort, put a N95 mask on before you even approach the patient,” Bourn said. “You need to have a conversation at a distance or a conversation behind the relative safety of a N95 mask.”
CDC guidelines also say to assess all patients for symptoms of acute febrile respiratory illness, which is fever with nasal congestion/ rhinorrhea, sore throat, or cough.
Considered a “hallmark” indicator of influenza, Bourn said providers should ask if the patient has a fever as part of the initial assessment if there is no thermometer available.
Since swine flu, or Influenza A (H1N1) can be spread through the air, the CDC recommends infection control precautions in any areas that the suspected patient inhabited.
This includes proper ventilation and decontamination of the ambulance, as well as informing the receiving facility, which may have a designated area established for influenza cases.
“There is a fairly decent likelihood that some other people (in the household or school) have the flu as well,” Bourn said. “In addition to putting a mask on the patient, put a mask on anyone riding in the ambulance.”
Bourn said that an extra level of consideration is necessary for paramedics and EMTs to protect themselves against swine flu, especially since health officials are still unsure of the severity of the situation.
“You don’t know what the disease will be exactly or how it will progress,” Bourn said. “You can’t really know what you need, or what it really is, until you get in the middle of it.”
According to Wingrove, he has encouraged EMS managers from around the globe to share best practices on the NEMSMA Web site in hopes of approaching a solution “globally.”
“Talking to people this past week, I was amazed at the number of services that haven’t done any planning so far,” he said.
Wingrove said it is the responsibility of impacted EMS departments to seek out resources in these initial stages, until the federal government decides how it will act.
“I know people are frustrated with not getting things faster from their state EMS office,” Wingrove said, “[But] what I see going on is a real attempt on the part of the federal government to be comprehensive and to be accurate.”
As cases continue to sprout up in countries around the world, EMS providers should continue to rely on information from the CDC and the World Health Organization.
“The hard thing is that [swine flu] looks so pedestrian. People may look at the symptoms and ask, ‘what’s the big deal?’” Bourn said. “The blessing is that it’s not hard to protect against.”
For more information on Influenza A (H1N1), including tips for EMS providers, visit the Centers for Disease Control and Prevention at http://www.cdc.gov/h1n1flu/.
Also on the Web:
- National EMS Management Association: www.nemsma.org.