Ebola Virus Disease Patient Management

Section 5 -MEDICAL

5.21 Ebola Virus Disease Patient Management

PREAMBLE: This is a working document subject to change as information from the Florida Department of Health and the CDC. Updates will be distributed to all agencies as quickly as possible.

These procedures 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 Ebola Virus Disease (EVD) pathogens.

SYMPTOMS The symptoms associated with EVD are:

• Fever (greater than 100.4°F or 38° C)
• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhage (bleeding or bruising)

The presentation of symptoms can develop anywhere from 2 to 21 days after exposure. As new cases are identified, this time frame may be adjusted. Most cases to date appear to show symptoms between 8-10 days. Agencies shall monitor all related reports from the Center for Disease Control and will respond accordingly. When in doubt personnel MUST err in the side of safety and take all available precautions to prevent exposure and contact with blood or bodily fluids from the patient.

TRANSMISSION Ebola is transmitted through DIRECT contact with blood or body fluids (blood, urine, feces, sweat, tears, semen) from a patient who is ACTIVELY sick with the disease. Asymptomatic individuals cannot transmit the disease.

SCREENING PROCEDURES The Seminole County Communications Center will conduct a screening process FOLLOWING APPROVED Emergency Medical Dispatch Procedures of EMS requests for service in an attempt to identify individuals that present a high index of suspicion of EBV.

• Keep in mind that the SCCC dispatcher may or may not be given accurate responses to the screening questions from the caller.
• Personnel should always maintain a high index of suspicion on all incidents.

PATIENT CARE PROCEDURES

• Responses to a suspected case of EBV, proper PPE precautions must be considered and closely followed prior to patient contact. Keep in mind that the majority of these patients will most likely be hemodynamically stable, therefore, it is imperative that personnel minimize or eliminate any direct contact with the patient’s blood or bodily fluids by donning the recommended PPE PRIOR TO ENTRY and patient contact.
  • Current PPE recommendation is complete body protection with Ty-Chem or equivalent suit, boot covers, double gloves, headgear, mask, eye protection with an overlying full-face splash shield, all seams to boots and wrist cuffs taped.
    • Donning and doffing procedures must be performed in accordance with the most current CDC and agency’s policy and doctrine.
  • The ultimate goal is total skin protection with no exposed skin.
• Personnel who identify a patient as having a high risk of EBV after making initial entry and patient contact should withdraw and don their appropriate PPE before reengaging with the patient.
• Only one person should engage in patient interview procedures.
  • Even if the patient appears healthy, keep 3-5 feet of distance.
  • Have the patient put a surgical mask on.
• Minimize physical contact. In patients appearing stable, withhold taking vital signs or connecting them to the cardiac monitor.
  • Do not bring electronic devices, bags or equipment such as tablets or monitors into the patient space.
• No invasive procedures are recommended. Even if the patient is in critical condition, a determination must be made regarding the level of intervention that should be performed based on a risk vs. gain determination.
• Patients in cardiac arrest with a history fever, travel to the affected areas or who have been in contact with a person suffering from EBV with unexplained bleeding and fitting the criteria for EBV risk are not to be resuscitated.

TRANSPORT

• Before transporting patients, personnel should take precautions to minimize the exposure to equipment and patient compartment area of the transport unit. This may include draping and covering equipment.
  • Keep in mind that these patients are most likely stable allowing the crew the time to properly prepare for the transport.
• Contact the receiving hospital via cell phone before transporting and advise the charge nurse that this patient meets criteria for high risk suspicion of EVD. A radio report may be given enroute avoiding any further references of EVD on an open frequency.
• During transport, proper PPE and distancing must be maintained at all times. Again, no invasive procedures should be done particularly when the vehicle is in motion.

HOSPITAL ARRIVAL

• Upon arrival to the hospital, the patient shall remain in the unit. The driver will secure the vehicle, dismount and make contact with the charge nurse. At that point, the hospital will provide further direction as to when and how the patient will be offloaded from the unit, properly isolated and transferred to their hospital bed.
  • Emphasis is placed that these patients are most likely stable, not requiring immediate interventions, therefore, it is imperative that personnel take their time in communicating with the hospital and coordinating the transfer while minimizing any potential healthcare provider or bystander exposure.

CALL COMPLETION AND DECON

• Upon completion and transfer of the patient to the hospital staff, the crew shall follow their respective PPE doffing and decontamination procedures.
• The unit may be placed in an “out of service” status for decontamination and the crew may be retained in the ED depending on the level of exposure. It is imperative that the affected crew notify their respective Battalion Chief and await for further instructions and procedures.