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

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

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…

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

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!

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

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

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

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

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

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

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

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

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”

Limit Exposures Personal Protective Equipment Special Considerations

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

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

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

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

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?

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

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

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

For More Information… http://pandemicflu.gov/ http://www.cdc.gov/h1n1flu/ http://pandemic.wisconsin.gov http://www.nhtsa.dot.gov/ Click on: Traffic Safety Then click on: Emergency Medical Services 24

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