Severe Respiratory Pathogens

Section 3 - RESPIRATORY

3.05 SEVERE RESPIRATORY PATHOGENS

This is a working document subject to change as advisements are received from the Department of Health and the CDC. Any Changes will be circulated to all agencies via Fire and EMS Chief’s email.

These procedures are intended to establish a safe environment for personnel and reduce the risk of exposure to unknown and /or potentially lethal diseases and prevent the epidemic-like spread of more common pathogens, including SARS (Severe Acute Respiratory Syndrome), Avian Flu, Swine Flu or any other severe disease spread by respiratory droplets.

Symptoms

The symptoms associated with a severe respiratory pathogens are: fever, cough, chills, body aches, sore throat, shortness of breath, and sometimes nausea and vomiting. As with any flu, the symptoms manifest rapidly.

These levels will apply to any call where there is a primary medical situation that would meet the symptoms or criteria related to a severe respiratory pathogen or other classified epidemic-like case. In all situations of this kind, a minimal amount of crew will be used to handle the alarm in order to limit the chances of exposure.

Personnel shall monitor related reports from the Center for Disease Control and will respond accordingly. In any case that is in doubt; the shift supervisor will determine the level of response.

All levels

The risk of infection is minimal if precautions are taken.

For all levels of response to an unknown, known, or highly suspect case of a severe respiratory pathogen, certain precautions should be considered and usually followed. 1. Place a surgical mask on the patient unless they need supplemental 02, then use a non–rebreather. Remember, neither effectively stops all respiratory droplets, but they help.

2. Use “social distancing” as much as possible.

• Try to interview, examine, and treat patients outdoors, if possible
• Even if other patient contacts appear healthy, keep 3-5 feet of distance
• If there are multiple people in a room, ask the people to move to another room

3. Respiratory pathogens can remain infective for hours on environmental surfaces. Be aware! All surfaces must be cleaned after a transport of a patient with possible severe respiratory pathogen.

4. If the patient is transported, ventilate the rescue unit as much as possible: open windows, turn A/C on fresh air, etc.

5. If a patient is transported, notify the ER that you have a patient that needs respiratory isolation.

Normal

Normal Conditions, no reported severe respiratory pathogens or classified “epidemic” type cases in the United States

• Practice accepted universal precautions (BSI)

Guarded

Confirmed case of severe respiratory pathogens or classified “epidemic” type cases in the United States.

• Practice accepted universal precautions; look for symptoms of severe respiratory pathogens, interview patient for recent travel from affected areas. If symptomatic or high risk: follow “Acute” BSI Protocol.

Elevated

Confirmed or suspected a severe respiratory pathogens or classified “epidemic” type cases in Florida or when one hospital opens a triage center other than the ED, such as a tent in the parking lot.

• One crewmember shall make initial patient contact using HEPA filter mask (N95), gown, and gloves and approved eye protection. The crewmember shall make the determination if any patient meets the criteria. If symptomatic: follow “Acute” BSI Protocol.

Acute

Confirmed or suspected native case of a severe respiratory pathogen or any classified “epidemic” type cases in Central Florida will be transported to the nearest facility or when any hospital states their resources are overwhelmed. Personnel will triage patients for transport in the field. Patients with apparent infectious disease can be further triaged for transport/non-transport

• Patients with stable vitals, without any signs of respiratory distress or cardiovascular compromise who do not have signs or symptoms of sepsis or do not exhibit any potential instability or complication can be triaged as non-transport. These patients will be given further information on where to seek care.
• All crewmembers shall wear a HEPA filter mask (N95), gown, and gloves and approved eye protection. Indoor use of gown(s) is mandatory, outdoor use of gown(s) is discretionary.
• We will follow disaster guidelines for transport and destination

The Communications Center has added additional screening questions to their Protocols that will better define and identify potential flu symptoms and exposure risks.