Submitted by: Susan Henry Keith Noble An EMS Training Plan for Treatment and Recognition of Viral Hemorrhagic Fever Submitted by: Susan Henry Keith Noble

Program Goals Educate first responders on the following: Background information on Viral Hemorrhagic Fever (VHF) Recognition of signs and symptoms of VHF Treatment of patients with S/S of VHF Transport of patients with VHF Proper personal protection equipment (PPE) guidelines Notification guidelines

Program Initiatives Focus on the recognition, treatment, and transport of suspects VHF patients Deliver training via an online format Simple online test Printable easy to read chart

Viral Hemorrhagic Fever (VHF) A family of viruses causing severe multisystem syndrome Damages the vascular system Prevents self regulation ability Can cause mild conditions or life threatening conditions

Zoonotic Category A agent A disease of animals that may be transmitted to man under natural conditions Category A agent Easily transmitted from human to human High mortality rate Require special action from public health agenices

Four Types of VHF Arenaviruses: Lassa & Latin American Fever Carried by rats and mice Transmitted by feces and urine Bunyaviruses: Crimean-Congo & Rift Valley Transmitted though a arthropod vector Filoviruses: Ebola & Marburg Host of virus is unknown, possible bats Hemorrhagic Flaviviruses: Yellow & Dengue Arthropod vector

Recognition is the key nn

Signs and Symptoms Minor Signs and Symptoms Severe Signs and Symptoms Travel history Fever Fatigue, weakness Dizziness Muscle aches Headache Sore throat Severe Signs and Symptoms Travel history Petechia (bleeding under the skin) Bleeding from internal organs Signs of shock Bleeding from external orifices Nervous system malfunction Coma, AMS, SZ

Petechia

Possible Travel History

Modes of Transmission Animal to Human Human to Human Contact with Urine Feces Saliva Other body fluids Bites Human to Human Contact with body fluid Contact with contaminated surfaces Up to 3 weeks No agreement as far as airborne transmission Shown in monkeys, but not humans

Protective Measures Double Gloves Gowns Masks Shoe Covers Eye wear N95 Also place on patient

N95 Mask

Decontamination After exposure Non exposure Limit exposure with proper PPE Wash with soap and water Irrigate exposed mucous membranes Non exposure Disposable equipment discarded Non-disposable autoclaved Interior of ambulance needs to be disinfected Disinfection EMS clothing and footwear

Protocol Proper PPE Immediately notify supervisor if you suspect VHF – isolate location if possible Coordinate transport & reception at hospital prior to leaving scene Hospital needs to be secure Able to handle isolates patients Supervisor to contact local and state public health departments

Treatment Treatment is normally supportive in care Fever control Electrolyte control Fluid replacement Blood pressure control Pain management

Post Incident Actions No current post exposure prophylaxis A fever of over 101F will trigger isolation and treatment Will be isolated at home or hospital Supportive treatment as needed Information will be provided on how to protect family

Ebola Hemorrhagic Fever Common Types of VHF Signs and Symptoms PPE Required Treatment Transport Considerations Notes Ebola Hemorrhagic Fever Rapid onset of fever, headache, joint pain, weakness, diarrhea, vomiting, and abdominal pain, rash, red eyes, internal and external bleeding may be present Spread by direct contact and blood Standard PPE Outer gown Rubber boots HEPA Filter Mask Eye Protection Class C Haz-Mat suit No standard treatment Supportive in nature Fluids and O2 Isolation Proper PPE Often Fatal Filoviridae Virus Obtained from infected non-human primates Lassa Fever Nonspecific S/S. May include fever, chest pain, back pain, N/V/D, hearing loss, tremors Spread by direct contact and contaminated food Gowns, protective eyewear Ribavirin (antiviral drug) Supportive Care Arenaviridae Virus No S/S in 80% infected Most common in West Africa, Spread from rodents to humans Marburg Hemorrhagic Fever Rapid onset of fever. After 5 days of exposure possible N/V/D, maculpapular rash, weight loss, massive hemorrhage Spread from direct contact and blood Rare Spread via Marburg Bat Common in mine workers Dengue Fever High fever, headache, severe pain behind eyes, joint pain, muscle and bone pain, rash, and mild bleeding Spread by mosquitoes Limit mosquito opportunities Rest Fluids Protect from mosquitoes Spread by infected mosquitoes Yellow Fever S/S after 3 to 6 days: Fever, chills, headache, back pain, bleeding from GI tract Only spread from infected mosquitoes Vaccination available Information obtained from the Centers for Disease Control