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April 28, 2009
A recent outbreak of the flu in Mexico has been
linked to cases of flu in Canada and the United
States by the World Health Organization. The EMS
Chiefs of Canada are leading a process to
identify and disseminate key strategies for EMS
organizations to implement to protect their
paramedics and to be public health partners in
managing the care of the sick.
Last week, the EMSCC's Membership Services
Committee coordinated an international
teleconference to reveal best practices. A
follow up call was held today. The strategies
identified last week have been updated by
today's call and changes are reflected below.
The National EMS Management Association, First
Watch and the National Academies of Emergency
Dispatch are participating in EMSCC's process.
Reference documents are being compiled by the
EMS Chiefs of Canada. US reference documents are
available on the National EMS Association's
website (www.nemsma.org)
on the Flu Resources tab.
Changes in the best practices from our April 25th
message are in red. New words are in red,
deleted words are in red and in strikeout.
By Administrators:
-
Notification to staff of the emerging
problem.
-
Reviewing and updating local plans.
-
Daily communication with hospitals and
public health departments.
-
Monitoring news reports and government
resources, such as:
-
Identify a technical advisor to provide
advice to paramedics and to track patients
on a regional or state- or province-wide
level
-
Resolve issues of pay for paramedics who are
quarantined.
-
Establish procedures with local public
health agencies to identify and pre-screen
migrant workers entering the area
-
Keep an accurate inventory of masks and
other personal protective equipment, and an
inventory of ventilators available in the
service area.
-
Develop a policy for limiting the dispatch
of first responders to non-critical patients
with flu symptoms, be ready to implement it
when deemed necessary by medical directors
-
In cooperation with medical direction,
develop a treat and release protocol and
patient information card for patients with
minor flu symptoms. Implement the protocol
and card when advised to in consultation
with medical direction. Consider performing
swabs in the home and deliver them to the
identified local collection area (local
public health, clinic or hospital) to be
routed for testing. Consider the use of
alternative care destinations like clinics
or urgent care centers or identified
receiving areas within the hospital away
from the ED.
-
Work with local Health Districts to
establish hotlines where the public can
receive more information
By Paramedics:
-
Requesting more information from dispatchers
when sent to respiratory, sick person and
fever related calls if limited initial
information is provided upon dispatch.
-
Initial interrogation of the patient from at
least 2 meters (6.5 feet) away to determine
if personal protective equipment precautions
are necessary.
-
Recommended PPE for taking care of
ill/potentially infected patients includes:
disposable gowns, gloves, goggles/face
shields and N95 or better respirators. PPE
should be donned and doffed according to
published guidelines to prevent cross
contamination, including eye and gown
protection when splash or airborne
contamination is possible.
-
Wear goggles when intubating patients or
providing nebulizer treatments.
-
Placing a mask, and
taking a temperature, on all patients
with respiratory
symptoms, using filtered oxygen masks when
available, or non-rebreather masks when
oxygen is required.
Place an N95 mask on patients with
respiratory symptoms that do not require
oxygen. Droplet producing procedures
should be avoided whenever possible
including nebulizers, bag-valve-mask,
suctioning or intubation. If bag-valve-masks
are needed, use those with HEPA filters
whenever possible.
-
Alert receiving hospital personnel of the
possibility of an infectious patient as soon
as possible and hold suspected infectious
patients in the ambulance until their
destination in the hospital is known, rather
than immediately moving them into the
emergency room.
-
Perform a thorough cleaning of the stretcher
and all equipment that has come in contact
with or been within 2 meters (6.5 feet) with
an approved disinfectant, upon completion of
the call. Wash
hands frequently.
By Dispatchers:
-
When using ProQA software flagging MPDS
protocols 6, 10, 18 and 26 for further
interrogation, and using the drop down SRI
(severe respiratory infection [flu-like]
symptoms) screen to obtain, at a minimum,
the following:
-
-
Are they febrile or have a fever, and if
so, is it higher than 38° C (101°F)?
-
Do they have a cough or any other
respiratory symptoms like difficulty
breathing?
-
Use card 36 as soon as it is available
-
For dispatch centers not using ProQA
software (paper-based cards only), gathering
the above information from all callers on
protocol cards 6, 10, 18 and 26.
Use card 36 as soon
as it is available.
-
For dispatch centers not using cards or
software, include the questions above when
the caller reports flu, breathing difficulty
or fever.
-
Dispatchers should report the responses to
these questions to the paramedics before
they arrive on the scene.
The worst cases of flu that have presented so
far have been mostly adults from ages 25 to 45,
but patients of all ages have been infected, so
the same precautions should be used for all
patients.
To view or print this information in a PDF
document, click
here.
The Emergency Medical Services Chiefs of
Canada/Directeurs des services medicaux
d'urgence du Canada (EMSCC/ DSMUC) is a National
organization led by Chiefs and Directors of
Canada's EMS services across the country. The
goal of the EMSCC is to advance and align
emergency medical leadership across Canada. More
information is available at
www.emscc.ca.
The NAED is a national arm of the International
Academy of Emergency Dispatch (IAED): a
non-profit, standard-setting organization
promoting safe and effective emergency dispatch
services worldwide. Comprised of three allied
Academies for medical, fire and police
dispatching, the NAED supports first
responder-related research, unified protocol
application, legislation for emergency call
center regulation, and strengthening the
emergency dispatch community through education,
certification and accreditation. Since 2003, the
IAED has been working through its CBRN Committee
to define and improve ways to capture
information for calls related to chemical,
biological, radiation, nuclear, and severe
respiratory. More information is available at
www.emergencydispatch.org
The National EMS Management Association
represents 1,600 EMS management professionals
and is dedicated to continually improving the
care delivered to EMS patients by discovering,
developing, and promoting the best EMS
management practices. More information is
available at
www.nemsma.org.
NEMSMA has offered to be the secretariat to the
EMSCC National Outbreak Discussion Group. In
return, meeting minutes and resource source
lists will be distributed to our members.
FirstWatch is commercial-off-the-shelf (COTS)
software that enables real-time Dashboard views
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a Situational Awareness, Public Health,
Operational or Homeland Security standpoint.
FirstWatch analyzes real-time data from 9-1-1
(EMS, Fire and Police) CAD systems, ProQA,
Paramedic ePCR's, Hospital Emergency
Departments, Hospital Diversion systems, Poison
Control Centers and more - in real time,
automatically. Chosen by agencies in 85+ metro
areas across the US and Canada, representing
more than 61,000,000 citizens. Learn more online
at:
www.firstwatch.net.
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