H1n1 influenza a swine flu
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H1N1 Influenza A (Swine Flu). Training for EMS Personnel May 5, 2009. Goal. The goal of this training module for EMS personnel is guidance and recommendations for LEMSAs. We encourage the LEMSAs to personalize the implementation of this document for their specific region.

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H1n1 influenza a swine flu

H1N1 Influenza A(Swine Flu)

Training for EMS Personnel

May 5, 2009


H1n1 influenza a swine flu

Goal

  • The goal of this training module for EMS personnel is guidance and recommendations for LEMSAs.

  • We encourage the LEMSAs to personalize the implementation of this document for their specific region.

  • Coordination among PSAPs, the EMS system, healthcare facilities (e.g. emergency departments), and the public health system is important for a coordinated response to H1N1 Influenza A (swine flu).

  • Given the uncertainty of the disease, its treatment, and its progression, the ongoing role of LEMSA medical directors is critically important.

  • The guidance provided in this document is based on current knowledge of H1N1 Influenza A (swine flu).

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Topics

Topics

  • What is H1N1 Influenza A (swine flu)?

  • What the current status of its incidence is in California

  • Definition of “Influenza-Like Illness” (ILI)

  • How EMS personnel should approach the care of ILI patients

  • Any EMS specific situational guidance recommendations

  • Personal Protective Equipment (PPE) availability and appropriate use

  • Local surveillance and reporting of ILI for Public Health and EMS

  • Recommendations on Cleaning EMS Vehicles

  • Changes to local EMS policy (LEMSA) for transport or destinations related to ILI


What is h1n1 influenza a virus swine flu

What is H1N1 Influenza A Virus (Swine Flu)?

  • H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people.

  • This new virus was first detected in people in April 2009 in the United States.

  • Other countries, including Mexico and Canada, have reported people sick with this new virus.

  • H1N1 Influenza A (swine flu) is transmitted by respiratory secretions

  • H1N1 Influenza A (swine flu) is a type of Influenza-like Illness (ILI)

Centers for Disease Control and Prevention (May 1, 2009). Questions & Answers H1N1 Flu (Swine Flu) and You. Retrieved May 1, 2009 fromhttp://www.cdc.gov/h1n1flu/swineflu_you.htm


Why is this new h1n1 virus sometimes called swine flu

Why is this New H1N1 virus Sometimes Called “Swine Flu”?

  • This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America.

  • But further study has shown that this new virus is very different from what normally circulates in North American pigs.

  • It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes.

  • Scientists call this a “quadruple reassortant” virus.

Centers for Disease Control and Prevention (May 1, 2009). Questions & Answers H1N1 Flu (Swine Flu) and You. Retrieved May 1, 2009 fromhttp://www.cdc.gov/h1n1flu/swineflu_you.htm


What is its current status in california

What is its Current Status in California?

  • The number of cases of H1N1 Influenza A (swine flu) in California and the world is changing daily

  • The nature of disease outbreaks are different than “typical” disasters (Earthquakes, Fires, Floods)

  • Must be prepared for long term operations

  • Different local areas may respond differently based upon the circumstances in their community

Centers for Disease Control and Prevention. (April 29, 2009). Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/mitigation.htm


Can humans catch h1n1 influenza a swine flu

Can Humans Catch H1N1 Influenza A (swine flu)?

  • Cases of human infection with this H1N1 Influenza A virus were first confirmed in the United States in Southern California and near Guadalupe County, Texas; additionally, the outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this virus.

  • CDC and local and state health agencies are working together to investigate this situation.

  • CDC has determined that this new H1N1 Influenza A virus is contagious and is spreading from human to human; however, at this time, it is not known how easily the virus spreads between people.

Centers for Disease Control and Prevention (May 1, 2009). Questions & Answers H1N1 Flu (Swine Flu) and You. Retrieved May 1, 2009 fromhttp://www.cdc.gov/h1n1flu/swineflu_you.htm


What are the signs symptoms of h1n1 influenza a in humans

What are the Signs & Symptoms of H1N1 Influenza A in Humans?

  • The symptoms of this new influenza A H1N1 virus in people are similar to the symptoms of regular human flu and include fever (greater than 100.0º F or 37.8 º C), cough, sore throat, body aches, headache, chills and fatigue.

  • A significant number of people who have been infected with this virus also have reported diarrhea and vomiting.  

  • Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.

Centers for Disease Control and Prevention (May 1, 2009). Questions & Answers H1N1 Flu (Swine Flu) and You. Retrieved May 1, 2009 fromhttp://www.cdc.gov/h1n1flu/swineflu_you.htm


How does h1n1 influenza a s pread

How Does H1N1 Influenza A Spread?

  • Human-to-human transmission of H1N1 Influenza A predominantly occurs through direct droplet transmission (Usually within 6-10 feet).

  • This is thought to occur in the same way as seasonal flu, which is mainly person-to-person transmission through coughing or sneezing of infected people.

  • People may become infected by touching something with flu viruses on it and then touching their mouth or nose (moist mucous membranes).

Centers for Disease Control and Prevention. (April 29, 2009). Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/mitigation.htm


How long can an infected person spread this virus to others

How Long Can an Infected Person Spread this Virus to Others?

  • At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses.

  • With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. 

  • Children, especially younger children, might potentially be contagious for longer periods.

  • CDC is studying the virus and its capabilities to try to learn more and will provide more information as it becomes available.

Centers for Disease Control and Prevention (May 1, 2009). Questions & Answers H1N1 Flu (Swine Flu) and You. Retrieved May 1, 2009 fromhttp://www.cdc.gov/h1n1flu/swineflu_you.htm


How can someone with the h1n1 influenza a infect someone else

How Can Someone with the H1N1 Influenza A Infect Someone Else?

  • Droplets from a cough or sneeze of an infected person move through the air.

  • Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

  • Infected people may be able to infect others beginning 1 day before symptoms develop & up to 7 or more days after becoming sick.

Centers for Disease Control and Prevention. (April 29, 2009). Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/mitigation.htm


What can i do to keep from getting the flu influenza

What Can I do to Keep From Getting the Flu (Influenza)?

  • Wash your hands.

  • Try to stay in good general health.

  • Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.

  • Try not touch surfaces that may be contaminated with the flu virus.

  • Avoid close contact with people who are sick.

Centers for Disease Control and Prevention. (April 29, 2009). Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/mitigation.htm


What is the infectious period

What is the Infectious Period?

  • Persons with H1N1 Influenza A (swine flu) virus infection should be considered potentially infectious from one day before to 7 days following illness onset.

  • Persons who continue to be ill longer than 7 days after illness onset should be considered potentially contagious until symptoms have resolved.

  • Children, especially younger children, might potentially be contagious for longer periods.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


What is the infectious period continued

What is the Infectious Period?(continued)

  • Non-hospitalized ill persons who are a confirmed or suspected case of swine-origin influenza A (H1N1) virus infection are recommended to stay at home (voluntary isolation) for at least the first 7 days after checking with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema.

  • CDC guidance on care of patients at home can be found at http://www.cdc.gov/h1n1flu/guidance_homecare.htm

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Ems information

EMS Information

  • As a component of the nation’s critical infrastructure, emergency medical services (along with other emergency services) play a vital role in responding to requests for assistance, triaging patients, and providing emergency treatment to influenza patients.

  • However, unlike patient care in the controlled environment of a fixed medical facility, prehospital EMS patient care is provided in an uncontrolled environment, often confined to a very small space, and frequently requires rapid medical decision-making, and interventions with limited information.

  • EMS personnel are frequently unable to determine the patient history before having to administer emergency care.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Interim recommendations for assessment of influenza like illness ili step 1

Interim Recommendations for Assessment of “Influenza-Like Illness” (ILI)Step 1

  • If there HAS NOT been H1N1 Influenza A virus reported in the geographic area (http://www.cdc.gov/h1n1flu/), EMS providers should assess all patients as follows:

  • Step 1: EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of ILI

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Interim recommendations for assessment of influenza like illness ili step 2

Interim Recommendations for Assessment of “Influenza-Like Illness” (ILI)Step 2

  • Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/rhinorrhea, sore throat, or cough).

  • If no acute febrile respiratory illness, proceed with normal EMS care.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Interim recommendations for assessment of influenza like illness ili step 21

Interim Recommendations for Assessment of “Influenza-Like Illness” (ILI)Step 2

  • If symptoms of acute febrile respiratory illness, then assess all patients for travel to a geographic area with confirmed cases of H1N1 Influenza A (swine flu) within the last 7 days or close contact with someone with travel to these areas.

    • If travel exposure, don appropriate PPE for suspected case of H1N1 Influenza A (swine flu)

    • If no travel exposure, place a standard surgical mask on the patient (if tolerated) and use appropriate PPE for cases of acute febrile respiratory illness without suspicion of H1N1 Influenza A (swine flu).


Local surveillance reporting of ili for public health ems

Local Surveillance & Reporting of ILI for Public Health & EMS

  • Follow the policies of the local EMS agency (LEMSA) regarding surveillance & reporting of ILI patients.

  • This may include reporting suspected incidences of ILI to:

    • Facility staff at the patient transport destination

    • Your supervisor

  • Should include documentation on the Pre-Hospital Patient Care Report (PCR) of your significant findings


Interim recommendations for assessment of influenza like illness ili

Interim Recommendations for Assessment of “Influenza-Like Illness” (ILI)

  • If the HAS CDC confirmed H1N1 Influenza A (swine flu) in the geographic area http://www.cdc.gov/h1n1flu/

  • Step 1: Address scene safety:

    • If PSAP advises potential for acute febrile respiratory illness symptoms on scene, EMS personnel should don PPE for suspected cases of H1N1 Influenza A (swine flu) prior to entering scene.

    • If PSAP has not identified individuals with symptoms of acute febrile respiratory illness on scene, EMS personnel should stay more than 6 feet away from patient and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of H1N1 Influenza A (swine flu).

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Interim recommendations for assessment of influenza like illness ili1

Interim Recommendations for Assessment of “Influenza-Like Illness” (ILI)

  • Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus one or more of the following: nasal congestion/rhinorrhea, sore throat, or cough).

    • If no symptoms of acute febrile respiratory illness, provide routine EMS care.

    • If symptoms of acute febrile respiratory illness, don appropriate PPE for suspected case of H1N1 Influenza A (swine flu) if not already on.

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Personal protective equipment ppe

Personal Protective Equipment (PPE)

  • EMS Personnel should ensure that they have the necessary personal protective equipment

  • N95 mask, surgical masks, gloves, eye protection, gown, and other standard equipment for droplet precautions

  • EMSA #216 Policy for PPE

  • Sufficient Types & Quantities of PPE should be evaluated based upon local EMS policy

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Personal protective equipment ppe interim recommendations

Personal Protective Equipment (PPE):Interim Recommendations:

  • When treating a patient with a suspected case of H1N1 Influenza A (swine flu) as defined above, the following PPE should be worn:

  • Fit-tested disposable N95 respirator and eye protection (e.g., goggles; eye shield), disposable non-sterile gloves, and gown, when coming into close contact with the patient.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Personal protective equipment ppe interim recommendations1

Personal Protective Equipment (PPE):Interim Recommendations:

  • When treating a patient that is not a suspected case of swine-origin influenza but who has symptoms of acute febrile respiratory illness, the following precautions should be taken:

    • Place a standard surgical mask on the patient, if tolerated.

    • If not tolerated, EMS personnel may wear a standard surgical mask.

    • Use good respiratory hygiene – use non-sterile gloves for contact with patient, patient secretions, or surfaces that may have been contaminated.

    • Follow hand hygiene including hand washing or cleansing with alcohol based hand disinfectant after contact.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Personal protective equipment ppe interim recommendations2

Personal Protective Equipment (PPE):Interim Recommendations:

  • Encourage good patient compartment vehicle airflow and ventilation to reduce the concentration of aerosol accumulation when possible.

  • EMS agencies should always practice basic infection control procedures including vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and proper use of FDA cleared or authorized medical personal protective equipment (PPE).

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Infection control interim recommendations

Infection ControlInterim Recommendations:

  • Pending clarification of transmission patterns for this virus, EMS personnel who are in close contact with patients with suspected or confirmed H1N1 Influenza A (swine flu) cases should wear a fit-tested disposable N95 respirator, disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and gown, when coming into close contact with the patient.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Infection control interim recommendations1

Infection ControlInterim Recommendations:

  • All EMS personnel engaged in aerosol generating activities (e.g. endotracheal intubation, nebulizer treatment, treatments involving respiratory secretions, and resuscitation involving emergency intubation or cardiac pulmonary resuscitation) should wear a fit-tested disposable N95 respirator, disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and gown

  • Unless EMS personnel are able to rule out acute febrile respiratory illness or travel to an endemic area in the patient being treated.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Infection control interim recommendations2

Infection ControlInterim Recommendations:

  • All patients with acute febrile respiratory illness should wear a surgical mask or approved respiratory barrier, if tolerated by the patient.

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Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Ppe considerations

PPE Considerations

  • When possible, safely utilize the manufacturer’s recommendations for removal of PPE.

  • In the event that the manufacture’s information is not available or the combination of PPE does not allow for safe removal of PPE this process could serve as a guide.

  • The guide may need modification due to equipment variations or contamination patterns.

  • When removing PPE make every attempt to avoid contact with contaminated areas and wash hands before touching a clean area.

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Sequence for removing ppe

Sequence for Removing PPE

  • Gloves

  • Face shield or goggles

  • Gown

  • Mask or respirator

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


How to remove gloves

How to Remove Gloves

  • Grasp outside edge near wrist

  • Peel away from hand, turning glove inside-out

  • Hold in opposite gloved hand

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


How to remove gloves continued

How to Remove Gloves(continued)

  • Slide ungloved finger under the wrist of the remaining glove

  • Peel off from inside, creating a bag for both gloves

  • Discard in approved biomedical waste container

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


Removing goggles or face shield

Removing Goggles or Face Shield

  • Grasp ear or head pieces with ungloved hands

  • Lift away from face

  • Discard in approved biomedical waste container

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


Removing isolation gown

Removing Isolation Gown

  • Unfasten ties

  • Peel gown away from neck & shoulder

  • Turn contaminated outside toward the inside

  • Fold or roll into a bundle

  • Discard in approved biomedical waste container

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


Removing a mask

Removing a Mask

  • Untie the bottom, then top, tie

  • Remove from face

  • Discard in approved biomedical waste container

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


Removing a particulate respirator

Removing a Particulate Respirator

  • Lift the bottom elastic over your head first

  • Then lift off the top elastic

  • Discard in approved biomedical waste container

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


Hand hygiene

Hand Hygiene

  • Perform hand hygiene immediately after removing PPE.

    • If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE

  • Wash hands with soap andwater or use an alcohol-based hand rub

  • Ensure that hand hygiene facilities are available at the point needed (sink or alcohol-based hand rub)

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html


Interfacility transport

Interfacility Transport

  • EMS personnel involved in the interfacility transfer of patients with suspected or confirmed H1N1 Influenza (swine flu) should use standard, droplet and contact precautions for all patient care activities.

  • This should include wearing a fit-tested disposable N95 respirator, wearing disposable non-sterile gloves, eye protection (e.g., goggles, eyeshield), and gown, to prevent conjunctival exposure.

  • If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the patient care compartment.  

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Interfacility transport continued

Interfacility Transport(continued)

  • Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration of aerosol accumulation when possible.

  • If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the patient care compartment.  

  • Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration of aerosol accumulation when possible.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


H1n1 influenza a swine flu

Interim Guidance for Cleaning EMS Transport Vehicles After Transporting a Suspected or Confirmed H1N1 Influenza A (swine flu) Patient

  • The following are general guidelines for cleaning or maintaining EMS transport vehicles and equipment after transporting a suspected or confirmed H1N1 Influenza A (swine flu) patient.

  • This guidance may be modified or additional procedures may be recommended by the Centers for Disease Control and Prevention (CDC) as new information becomes available. 

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


H1n1 influenza a swine flu

Interim Guidance for Cleaning EMS Transport Vehicles After Transporting a Suspected or Confirmed H1N1 Influenza A (swine flu) Patient

  • Routine cleaning with soap or detergent and water to remove soil and organic matter, followed by the proper use of disinfectants, are the basic components of effective environmental management of influenza.

  • Reducing the number of influenza virus particles on a surface through these steps can reduce the chances of hand transfer of virus.

  • Influenza viruses are susceptible to inactivation by a number of chemical disinfectants readily available from consumer and commercial sources.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


H1n1 influenza a swine flu

Interim Guidance for Cleaning EMS Transport Vehicles After Transporting a Suspected or Confirmed H1N1 Influenza A (swine flu) Patient

  • After the patient has been removed and prior to cleaning, the air within the vehicle may be exhausted by opening the doors and windows of the vehicle while the ventilation system is running.

  • This should be done outdoors and away from pedestrian traffic.

  • Routine cleaning methods should be employed throughout the vehicle and on non-disposable equipment. 

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


H1n1 influenza a swine flu

Interim Guidance for Cleaning EMS Transport Vehicles After Transporting a Suspected or Confirmed H1N1 Influenza A (swine flu) Patient

  • For additional detailed guidance on ambulance decontamination EMS personnel may refer to "Interim Guidance for Cleaning Emergency Medical Service Transport Vehicles during an Influenza Pandemic" available at:  http://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Ems transfer of patient care to a healthcare facility

EMS Transfer of Patient Care to a Healthcare Facility

  • When transporting a patient with symptoms of acute febrile respiratory illness, EMS personnel should notify the receiving healthcare facility so that appropriate infection control precautions may be taken prior to patient arrival. 

  • Patients with acute febrile respiratory illness should wear a surgical mask, if tolerated.  

  • Small facemasks are available that can be worn by children, but it may be problematic for children to wear them correctly and consistently.

  • Moreover, no facemasks (or respirators) have been cleared by the FDA specifically for use by children.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Local ems agencies

Local EMS Agencies

  • Some local EMS agencies may differ from these recommendations.

  • If a conflict arises refer to the LEMSA Medical Director for clarification

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Local ems policy for transport versus non transport related to ili

Local EMS Policy for: Transport versus Non-Transport Related to ILI

  • Based upon guidance from the local EMS agency (LEMSA), future consideration may include changes to either the decision to transport a patient under specified circumstances or the destination

  • Contact your supervisor or local EMS agency (LEMSA) for information on local transport considerations.

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Antiviral treatment for h1n1 influenza a swine flu infections in humans

Antiviral Treatment for H1N1 Influenza A (Swine Flu) Infections in Humans

  • Antivirals may be used as either a treatment to a confirmed or suspected case of H1N1 Influenza A (swine flu) or as prophylactic treatment to exposed individuals under specified conditions

  • At this time, prehospital treatment of patients with antiviral agents is not being utilized

  • CDC recommends the use of Tamiflu (oseltamivir phosphate) or Relenza (zanamivir) as part of the treatment and/or reduction of severity of infection with swine influenza viruses.

  • More information on treatment recommendations can be found at www.cdc.gov/flu/swine/recommendations.htm

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Vaccinations

Vaccinations

  • There is no vaccine to protect humans from H1N1 Influenza A (swine flu) at this time.

  • The seasonal influenza vaccine will likely help provide partial protection against swine H3N2, but not swine H1N1 viruses.

Centers for Disease Control and Prevention. (May 2, 2009). Questions & Answers Key Facts About Swine Influenza. Retrieved May 2, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Recommendations for vehicle decontamination

Recommendations for: Vehicle Decontamination

  • Upon completion of patient care (single call), clean all equipment that came in contact with or was within 6 feet of the suspected ILI patient with an approved disinfectant.

    • The equipment may include stretchers, railings, medical equipment control panels, adjacent flooring, walls, ceilings and work surfaces, door handles, radios, keyboards, and/or cell phones.

  • Cleanse all surfaces within 6 feet of the patient or surfaces touched by the patient or caregivers with an approved disinfectant.

Unites States Department of Heath and Human Services. Interim Guidance for Cleaning Emergency Medical Service (EMS) Transport Vehicles during an Influenza Pandemic.Retrieved May 1, 2009 fromhttp://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html#2a


Recommendations for vehicle decontamination continued

Recommendations for:Vehicle Decontamination (Continued)

  • Large spills of bodily fluids (e.g., vomit) should first be managed by removing visible organic matter with absorbent material.

  • Place contaminated reusable patient care devices and equipment in biohazard bags.

  • Clean and disinfect non-patient-care areas of the vehicle according to the vehicle manufacturer’s recommendations.

  • Cleaning should be done with detergent and water and then disinfected using an EPA-registered hospital disinfectant in accordance with the manufacturer's instructions.

Unites States Department of Heath and Human Services. Interim Guidance for Cleaning Emergency Medical Service (EMS) Transport Vehicles during an Influenza Pandemic.Retrieved May 1, 2009 fromhttp://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html#2a


Questions

Questions?

  • Please Check with your Supervisor

  • Please Check with your Local EMS Agency (LEMSA) for policy direction

  • H1N1 Influenza A (swine flu) Information related to EMS

  • www.emsa.ca.gov


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