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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Recognition is the key nn

8. 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

9. Petechia

10. Possible Travel History

11. 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

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

13. N95 Mask

14. 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

15. 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

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

17. 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

18. 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