EMS Agency Ebola Plan

[frdude1000]

Does your EMS agency have a plan in place for treating patients under investigation (PUI) for Ebola?

Have you made any changes to your PPE or when you employ such gear?

Is your dispatch center asking travel history questions to callers that complain of EVD symptoms?

I want to start a thread for any and all discussion pertaining to this matter.

 

[Jim37F]

We just got an email today from our Chief saying that dispatch has "added multiple questions to their list of inquires when receiving 911 phone calls from potential Ebola patients. As a result, you may receive additional information on patients after the initial dispatch. This additional information will come in the form of a supplemental text added to the call." (We have MDTs that we get supplemental info from dispatch on)

The email reminds us to "Please adhere to the following precautions as recommended by our medical director:
In the event of receiving a supplemental text stating “Patient has recent travel to Africa” or “Potential Ebola exposure”, it is the recommendation of our medical director for all patient contact personnel to wear the “full isolation kit” PPE. After the call, the PPE must be treated as contaminated material. Replacement kits may be ordered through the shopkeeper."

It is also recommended by our medical director for all personnel to wear N95 masks when responding to patients with flu like symptoms between now and next March.

 

[DesertMedic66]

We added more PPEs to our units. We are to ask patients additional travel questions when they appear to have the flu and relay the info to the hospital.

If the patient doesn't absolutely need an IV or breathing treatment in the field then we are asked to wait and let the hospital staff do it.

 

[OnceAnEMT]

Good call on the dispatcher changes, didn't think of that. Not sure if that's happened here though.

No change in protocol, just informed and given specific emphases. Notification of onboard or potential infectious disease to the ED is already in protocols, and PPE is part of any other infectious disease. Travel-related questions have been around for a while.

Honestly, if there was no TB vaccination we would probably be more susceptible to that than Ebola. Probably still are with the vaccination anyway...

 

[DesertMedic66]

Good call on the dispatcher changes, didn't think of that. Not sure if that's happened here though.

No change in protocol, just informed and given specific emphases. Notification of onboard or potential infectious disease to the ED is already in protocols, and PPE is part of any other infectious disease.

Honestly, if there was no TB vaccination we would probably be more susceptible to that than Ebola. Probably still are with the vaccination anyway...

TB vaccination? We get tested for it but that's all

 

[OnceAnEMT]

TB vaccination? We get tested for it but that's all

Guess its not that common. Further emphasizes my point

 

[Underoath87]

They're putting a huge duffel bag with several haz-mat suits on each unit, which effectively kills any free space in the vanbulances. IMO we would be better served with company issued shotguns for some apocalyptic scenario (over hazmat suits to transport an ebola patient at an IFT company at a moment's notice).

 

[TransportJockey]

I haven't seen aynthing about new Ebola protocols... but then again I've been on my week off. The hospital I work PRN at made sure our hazmat decon room is fully stocked and ready to go at a short notice.

 

[OnceAnEMT]

The hospital I work PRN at made sure our hazmat decon room is fully stocked and ready to go at a short notice.

Oooo... I want one of those. They'd be going into a negative pressure room here.

 

[CentralCalEMT]

We just got new guidelines from the regional EMS agency. We are to ask about travel to the affected countries when dealing with patients with non specific complaints that involve fevers or other flu like symptoms. In the unlikely event that we do encounter one who has all the risk factors, we are to use full isolation kits (each ambulance all ready has at least 4 to begin with) and not take the patient out of the back of the ambulance until the hospital decides where they want to put the patient and the best way to get the patient there.

I also find it strange how many agencies are giving instructions about witholding breathing treatments in possible cases unless absolutely necessary when we hear time and time again on TV, it is not an airborne virus and would have to mutate to become transmitted by airborne means. I am not a huge fan of the fact there seems to be a lack of accurate information one way or another. I am going to treat any patient the best I can regardless, it would just be nice to know what we are up against.

 

[DesertMedic66]

We just got new guidelines from the regional EMS agency. We are to ask about travel to the affected countries when dealing with patients with non specific complaints that involve fevers or other flu like symptoms. In the unlikely event that we do encounter one who has all the risk factors, we are to use full isolation kits (each ambulance all ready has at least 4 to begin with) and not take the patient out of the back of the ambulance until the hospital decides where they want to put the patient and the best way to get the patient there.

I also find it strange how many agencies are giving instructions about witholding breathing treatments in possible cases unless absolutely necessary when we hear time and time again on TV, it is not an airborne virus and would have to mutate to become transmitted by airborne means. I am not a huge fan of the fact there seems to be a lack of accurate information one way or another. I am going to treat any patient the best I can regardless, it would just be nice to know what we are up against.

However there are other "experts" who are saying they don't yet fully understand it or how it can be transmitted.

 

[Carlos Danger]

I also find it strange how many agencies are giving instructions about witholding breathing treatments in possible cases unless absolutely necessary when we hear time and time again on TV, it is not an airborne virus and would have to mutate to become transmitted by airborne means. I am not a huge fan of the fact there seems to be a lack of accurate information one way or another. I am going to treat any patient the best I can regardless, it would just be nice to know what we are up against.

Because saliva can potentially be aerosolized?

 

[avdrummerboy]

We have another Card 36 situation here lol. I'm sure that there will be a whole slew of questions for this on the dispatch side and it'll probably be company level based who does what. I know that once a few more people are found with ebola it won't be long before everyone who has a fever and a stomach ache will be calling in saying that they have ebola! As for my company, we really haven't vamped up any protocols for it and only received a 'fact sheet' about ebola from our local EMSA.

 

[OnceAnEMT]

Because saliva can potentially be aerosolized?

Exactly. If the CDC is recommending the limiting/avoidance of procedures that may produce aerosols, then it is airborne. I don't care what the TV says, and I sure hope you aren't basing your treatment off of what the TV says.

 

[CentralCalEMT]

Because saliva can potentially be aerosolized?

Lol I would never base my treatment on what they say on TV, but they make it seem like it is a hard disease to catch when the talking heads are on TV. I just wonder if it is easier to catch than some people are saying to avoid the public panicking. It just seems strange to not treat someone in respiratory distress unless the risk is so great to the provider that it is necessary. We start lines on people with various diseases on a daily basis potentially putting ourselves at risk, we give breathing treatments to people with extremely courageous respiratory conditions on a somewhat frequent basis. We are around many communicable diseases daily, many of which are potentially fatal. I have never heard of a medic not starting a line on a patient because they had Hepatitis C, or not giving a breathing treatment because they patient had a serious respiratory infection. It just seems like this is being treated as the most serious disease ever.

 

[OnceAnEMT]

Lol I would never base my treatment on what they say on TV, but they make it seem like it is a hard disease to catch when the talking heads are on TV. I just wonder if it is easier to catch than some people are saying to avoid the public panicking. It just seems strange to not treat someone in respiratory distress unless the risk is so great to the provider that it is necessary. We start lines on people with various diseases on a daily basis potentially putting ourselves at risk, we give breathing treatments to people with extremely courageous respiratory conditions on a somewhat frequent basis. We are around many communicable diseases daily, many of which are potentially fatal. I have never heard of a medic not starting a line on a patient because they had Hepatitis C, or not giving a breathing treatment because they patient had a serious respiratory infection. It just seems like this is being treated as the most serious disease ever.

I completely agree that those procedures shouldn't be avoided competely, for the reasons you've stated. I just believe that because of the high fatality rate (I believe we are 74% now?) it helps to balance the cost:benefit scale by either raising the bar for invasive procedures or doing the procedures in a more controlled environment (as I mentioned before, starting an IV on scene instead of in a bouncing ambulance).

That said, if y'all haven't already, look into the R naught data comparing Ebola to common transmittable diseases. I feel the hype here is not because of the low transmission rate, but the extremely high fatality rate.

 

[Carlos Danger]

I completely agree that those procedures shouldn't be avoided competely, for the reasons you've stated. I just believe that because of the high fatality rate (I believe we are 74% now?) it helps to balance the cost:benefit scale by either raising the bar for invasive procedures or doing the procedures in a more controlled environment (as I mentioned before, starting an IV on scene instead of in a bouncing ambulance).

That said, if y'all haven't already, look into the R naught data comparing Ebola to common transmittable diseases. I feel the hype here is not because of the low transmission rate, but the extremely high fatality rate.

http://www.npr.org/blogs/health/201...are&utm_source=facebook.com&utm_medium=social

 

[OnceAnEMT]

http://www.npr.org/blogs/health/201...are&utm_source=facebook.com&utm_medium=social

Bingo. There is also a complete research study determining the R naught.

 

[vcuemt]

Can't really base what mortality rates will be in the US off of West African stats... our health care system is light years ahead of theirs, and basic supportive care is often the difference in surviving vs. dying with ebola.

 

[jrm818]

http://www.npr.org/blogs/health/201...are&utm_source=facebook.com&utm_medium=social

It's interesting that they chose to flank ebola with two diseases which, though they have a similar R0, have totally different disease characteristics. hepatitis and HIV take many years to infect their 2ish people, and do so primarily through extremely intimate contact, as opposed to the 1 week time period for ebola with much less intimate contact. While the R0 may be the same, the risk posed to an individual healthcare provider is not even close to similar.

The claim that ebola isn't' contagious enough to worry about just doesn't pass the sniff test. It takes only a very small inocculum to be infected, the virus is present in sweat and oral secretions, and it can almost certainly become aerosolized. There's been exactly one patient evacuated to anywhere Europe so far (Spain)....and that patient managed to infect a nurse's aid wearing some sort of supposedly appropriate biohazard gear in the 4 days he had before he died. Remind me how this is at all similar to measles or HIV.