h1n1 influenza a (swine flu)

H1N1 Influenza AH1N1 Influenza A(Swine Flu)(Swine Flu)

Training for EMS PersonnelTraining for EMS Personnel

May 5, 2009May 5, 2009

GoalGoal The goal of this training module for EMS personnel The goal of this training module for EMS personnel

is guidance and recommendations for LEMSAs. is guidance and recommendations for LEMSAs. We encourage the LEMSAs to personalize the We encourage the LEMSAs to personalize the

implementation of this document for their specific implementation of this document for their specific region. region.

Coordination among PSAPs, the EMS system, Coordination among PSAPs, the EMS system, healthcare facilities (e.g. emergency departments), healthcare facilities (e.g. emergency departments), and the public health system is important for a and the public health system is important for a coordinated response to H1N1 Influenza A (swine coordinated response to H1N1 Influenza A (swine flu). flu).

Given the uncertainty of the disease, its treatment, Given the uncertainty of the disease, its treatment, and its progression, the ongoing role of LEMSA and its progression, the ongoing role of LEMSA medical directors is critically important. medical directors is critically important.

The guidance provided in this document is based on The guidance provided in this document is based on current knowledge of H1N1 Influenza A (swine flu). current knowledge of H1N1 Influenza A (swine flu).

Centers for Disease Control and Prevention (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm

TopicsTopics What is H1N1 Influenza A (swine flu)? What is H1N1 Influenza A (swine flu)? What the current status of its incidence is in What the current status of its incidence is in

CaliforniaCalifornia Definition of “Influenza-Like Illness” (ILI)Definition of “Influenza-Like Illness” (ILI) How EMS personnel should approach the care of How EMS personnel should approach the care of

ILI patients ILI patients Any EMS specific situational guidance Any EMS specific situational guidance

recommendationsrecommendations Personal Protective Equipment (PPE) availability Personal Protective Equipment (PPE) availability

and appropriate useand appropriate use Local surveillance and reporting of ILI for Public Local surveillance and reporting of ILI for Public

Health and EMSHealth and EMS Recommendations on Cleaning EMS VehiclesRecommendations on Cleaning EMS Vehicles Changes to local EMS policy (LEMSA) for Changes to local EMS policy (LEMSA) for

transport or destinations related to ILItransport or destinations related to ILI

What is H1N1 Influenza A Virus What is H1N1 Influenza A Virus

(Swine Flu)?(Swine Flu)? H1N1 (referred to as “swine flu” early on) is a

new influenza virus causing illness in people. This new virus was first detected in people in

April 2009 in the United States. Other countries, including Mexico and

Canada, have reported people sick with this new virus.

H1N1 Influenza A (swine flu) is transmitted by respiratory secretions

H1N1 Influenza A (swine flu) is a type of Influenza-like Illness (ILI)

Centers for Disease Control and Prevention (May 1, 2009). Questions & Answers H1N1 Flu (Swine Flu) and You. Retrieved May 1, 2009 fromhttp://www.cdc.gov/h1n1flu/swineflu_you.htm

Why is this New H1N1 virus Why is this New H1N1 virus Sometimes Called “Swine Flu”?Sometimes Called “Swine Flu”?

This virus was originally referred to as “swine This virus was originally referred to as “swine flu” because laboratory testing showed that many flu” because laboratory testing showed that many of the genes in this new virus were very similar of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in to influenza viruses that normally occur in pigs in North America. North America.

But further study has shown that this new virus is But further study has shown that this new virus is very different from what normally circulates in very different from what normally circulates in North American pigs. North American pigs.

It has two genes from flu viruses that normally It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian circulate in pigs in Europe and Asia and avian genes and human genes. genes and human genes.

Scientists call this a “quadruple reassortant” Scientists call this a “quadruple reassortant” virus. virus.


What is its Current Status What is its Current Status in California?in California?

The number of cases of The number of cases of H1N1 Influenza A (swine flu) in California and the world is changing dailyin California and the world is changing daily

The nature of disease outbreaks are different The nature of disease outbreaks are different than “typical” disasters (Earthquakes, Fires, than “typical” disasters (Earthquakes, Fires, Floods)Floods)

Must be prepared for long term operationsMust be prepared for long term operations Different local areas may respond differently Different local areas may respond differently

based upon the circumstances in their based upon the circumstances in their communitycommunity

Centers for Disease Control and Prevention. (April 29, 2009). Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/mitigation.htm

Can Humans Catch Can Humans Catch H1N1 Influenza A (swine flu)?swine flu)? Cases of human infection with this H1N1 Influenza

A virus were first confirmed in the United States in Southern California and near Guadalupe County, Texas; additionally, the outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this virus.

CDC and local and state health agencies are working together to investigate this situation.

CDC has determined that this new H1N1 Influenza A virus is contagious and is spreading from human to human; however, at this time, it is not known how easily the virus spreads between people.


What are the Signs & What are the Signs & Symptoms of Symptoms of H1N1 Influenza

A in Humans?in Humans?

The symptoms of this new influenza A H1N1 virus in people are similar to the symptoms of regular human flu and include fever (greater than 100.0º F or 37.8 º C), cough, sore throat, body aches, headache, chills and fatigue.

A significant number of people who have been infected with this virus also have reported diarrhea and vomiting.

Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.


How Does How Does H1N1 Influenza A Spread?pread?

Human-to-human transmission of H1N1 Influenza A predominantly occurs through direct droplet transmission (Usually within 6-10 feet).

This is thought to occur in the same way as seasonal flu, which is mainly person-to-person transmission through coughing or sneezing of infected people.

People may become infected by touching something with flu viruses on it and then touching their mouth or nose (moist mucous membranes).


How Long Can an Infected How Long Can an Infected Person Spread this Virus to Person Spread this Virus to

Others?Others? At the current time, CDC believes that this virus has At the current time, CDC believes that this virus has

the same properties in terms of spread as seasonal the same properties in terms of spread as seasonal flu viruses. flu viruses.

With seasonal flu, studies have shown that people With seasonal flu, studies have shown that people may be contagious from one day before they may be contagious from one day before they develop symptoms to up to 7 days after they get develop symptoms to up to 7 days after they get sick. sick.

Children, especially younger children, might Children, especially younger children, might potentially be contagious for longer periods. potentially be contagious for longer periods.

CDC is studying the virus and its capabilities to try CDC is studying the virus and its capabilities to try to learn more and will provide more information as to learn more and will provide more information as it becomes available. it becomes available.


How Can Someone with the How Can Someone with the H1N1 Influenza A Infect Infect

Someone Else?Someone Else? Droplets from a cough or sneeze of an Droplets from a cough or sneeze of an

infected person move through the air. infected person move through the air. Germs can be spread when a person touches Germs can be spread when a person touches

respiratory droplets from another person on a respiratory droplets from another person on a surface like a desk and then touches their own surface like a desk and then touches their own eyes, mouth or nose before washing their eyes, mouth or nose before washing their hands. hands.

Infected people may be able to infect others Infected people may be able to infect others beginning 1 day before symptoms develop & beginning 1 day before symptoms develop & up to 7 or more days after becoming sick. up to 7 or more days after becoming sick.


What Can I do to Keep What Can I do to Keep From Getting the Flu From Getting the Flu

(Influenza)?(Influenza)? Wash your hands. Wash your hands. Try to stay in good general health. Try to stay in good general health. Get plenty of sleep, be physically active, Get plenty of sleep, be physically active,

manage your stress, drink plenty of fluids, and manage your stress, drink plenty of fluids, and eat nutritious food. eat nutritious food.

Try not touch surfaces that may be Try not touch surfaces that may be contaminated with the flu virus. contaminated with the flu virus.

Avoid close contact with people who are sick. Avoid close contact with people who are sick.


What is the Infectious What is the Infectious Period?Period?

Persons with H1N1 Influenza A (swine flu) Persons with H1N1 Influenza A (swine flu) virus infection should be considered virus infection should be considered potentially infectious from one day before to 7 potentially infectious from one day before to 7 days following illness onset. days following illness onset.

Persons who continue to be ill longer than 7 Persons who continue to be ill longer than 7 days after illness onset should be considered days after illness onset should be considered potentially contagious until symptoms have potentially contagious until symptoms have resolved. resolved.

Children, especially younger children, might Children, especially younger children, might potentially be contagious for longer periods. potentially be contagious for longer periods.


What is the Infectious What is the Infectious Period?Period?

(continued)(continued) Non-hospitalized ill persons who are a confirmed or Non-hospitalized ill persons who are a confirmed or

suspected case of swine-origin influenza A (H1N1) suspected case of swine-origin influenza A (H1N1) virus infection are recommended to stay at home virus infection are recommended to stay at home (voluntary isolation) for at least the first 7 days after (voluntary isolation) for at least the first 7 days after checking with their health care provider about any checking with their health care provider about any special care they might need if they are pregnant or special care they might need if they are pregnant or have a health condition such as diabetes, heart have a health condition such as diabetes, heart disease, asthma, or emphysema. disease, asthma, or emphysema.

CDC guidance on care of patients at home can be CDC guidance on care of patients at home can be found at found at http://www.cdc.gov/h1n1flu/guidance_homecare.htmhttp://www.cdc.gov/h1n1flu/guidance_homecare.htm


EMS InformationEMS Information As a component of the nation’s critical infrastructure, As a component of the nation’s critical infrastructure,

emergency medical services (along with other emergency medical services (along with other emergency services) play a vital role in responding to emergency services) play a vital role in responding to requests for assistance, triaging patients, and requests for assistance, triaging patients, and providing emergency treatment to influenza patients. providing emergency treatment to influenza patients.

However, unlike patient care in the controlled However, unlike patient care in the controlled environment of a fixed medical facility, prehospital environment of a fixed medical facility, prehospital EMS patient care is provided in an uncontrolled EMS patient care is provided in an uncontrolled environment, often confined to a very small space, environment, often confined to a very small space, and frequently requires rapid medical decision-and frequently requires rapid medical decision-making, and interventions with limited information. making, and interventions with limited information.

EMS personnel are frequently unable to determine EMS personnel are frequently unable to determine the patient history before having to administer the patient history before having to administer emergency care. emergency care.


Interim Recommendations for Interim Recommendations for Assessment of “Influenza-Like Assessment of “Influenza-Like

Illness” (ILI)Illness” (ILI)Step 1Step 1

If there If there HAS NOTHAS NOT been H1N1 Influenza A virus been H1N1 Influenza A virus reported in the geographic area (reported in the geographic area (http://www.cdc.gov/h1n1flu/http://www.cdc.gov/h1n1flu/), EMS providers ), EMS providers should assess all patients as follows: should assess all patients as follows:

Step 1: EMS personnel should stay more than 6 Step 1: EMS personnel should stay more than 6 feet away from patients and bystanders with feet away from patients and bystanders with symptoms and exercise appropriate routine symptoms and exercise appropriate routine respiratory droplet precautions while assessing respiratory droplet precautions while assessing all patients for suspected cases of ILIall patients for suspected cases of ILI




Step 2: Assess all patients for symptoms of Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus acute febrile respiratory illness (fever plus one or more of the following: nasal one or more of the following: nasal congestion/rhinorrhea, sore throat, or congestion/rhinorrhea, sore throat, or cough). cough).

If no acute febrile respiratory illness, If no acute febrile respiratory illness, proceed with normal EMS care. proceed with normal EMS care.


If symptoms of acute febrile respiratory If symptoms of acute febrile respiratory illness, then assess all patients for travel to a illness, then assess all patients for travel to a geographic area with confirmed cases of geographic area with confirmed cases of H1N1 Influenza A (swine flu) within the last 7 H1N1 Influenza A (swine flu) within the last 7 days or close contact with someone with travel days or close contact with someone with travel to these areas. to these areas. If travel exposure, don appropriate PPE for If travel exposure, don appropriate PPE for

suspected case of H1N1 Influenza A (swine flu) suspected case of H1N1 Influenza A (swine flu) If no travel exposure, place a standard surgical mask If no travel exposure, place a standard surgical mask

on the patient (if tolerated) and use appropriate PPE on the patient (if tolerated) and use appropriate PPE for cases of acute febrile respiratory illness without for cases of acute febrile respiratory illness without suspicion of H1N1 Influenza A (swine flu).suspicion of H1N1 Influenza A (swine flu).



Local Surveillance & Reporting Local Surveillance & Reporting of ILI for Public Health & EMSof ILI for Public Health & EMS

Follow the policies of the local EMS agency (LEMSA) regarding surveillance & reporting of ILI patients.

This may include reporting suspected incidences of ILI to: Facility staff at the patient transport destination Your supervisor

Should include documentation on the Pre-Hospital Patient Care Report (PCR) of your significant findings


Illness” (ILI)Illness” (ILI) If the If the HASHAS CDC confirmed H1N1 Influenza A (swine CDC confirmed H1N1 Influenza A (swine

flu) in the geographic area hflu) in the geographic area http://www.cdc.gov/h1n1flu/ttp://www.cdc.gov/h1n1flu/

Step 1: Address scene safety: Step 1: Address scene safety: If PSAP advises potential for acute febrile respiratory illness If PSAP advises potential for acute febrile respiratory illness

symptoms on scene, EMS personnel should don PPE for symptoms on scene, EMS personnel should don PPE for suspected cases of H1N1 Influenza A (swine flu) prior to suspected cases of H1N1 Influenza A (swine flu) prior to entering scene. entering scene.

If PSAP has not identified individuals with symptoms of acute If PSAP has not identified individuals with symptoms of acute febrile respiratory illness on scene, EMS personnel should febrile respiratory illness on scene, EMS personnel should stay more than 6 feet away from patient and bystanders with stay more than 6 feet away from patient and bystanders with symptoms and exercise appropriate routine respiratory symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected droplet precautions while assessing all patients for suspected cases of H1N1 Influenza A (swine flu)cases of H1N1 Influenza A (swine flu)..

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Confirmed or Suspected Swine-Origin Influenza A (H1N1) Infection. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm


Illness” (ILI)Illness” (ILI)

Step 2: Assess all patients for symptoms of Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever plus acute febrile respiratory illness (fever plus one or more of the following: nasal one or more of the following: nasal congestion/rhinorrhea, sore throat, or cough). congestion/rhinorrhea, sore throat, or cough). If no symptoms of acute febrile respiratory illness, If no symptoms of acute febrile respiratory illness,

provide routine EMS care. provide routine EMS care. If symptoms of acute febrile respiratory illness, don If symptoms of acute febrile respiratory illness, don

appropriate PPE for suspected case of H1N1 appropriate PPE for suspected case of H1N1 Influenza A (swine flu) if not already on. Influenza A (swine flu) if not already on.


Personal Protective Personal Protective Equipment (PPE)Equipment (PPE)

EMS Personnel should ensure that they have EMS Personnel should ensure that they have the necessary personal protective equipment the necessary personal protective equipment

N95 mask, surgical masks, gloves, eye N95 mask, surgical masks, gloves, eye protection, gown, and other standard protection, gown, and other standard equipment for droplet precautionsequipment for droplet precautions

EMSA #216 Policy for PPEEMSA #216 Policy for PPE Sufficient Types & Quantities of PPE should Sufficient Types & Quantities of PPE should

be evaluated based upon local EMS policybe evaluated based upon local EMS policy


Personal Protective Equipment Personal Protective Equipment (PPE):(PPE):

Interim Recommendations: Interim Recommendations:

When treating a patient with a suspected case of H1N1 Influenza A (swine flu) as defined above, the following PPE should be worn:

Fit-tested disposable N95 respirator and eye protection (e.g., goggles; eye shield), disposable non-sterile gloves, and gown, when coming into close contact with the patient.



Interim Recommendations:Interim Recommendations: When treating a patient that is not a suspected When treating a patient that is not a suspected

case of swine-origin influenza but who has case of swine-origin influenza but who has symptoms of acute febrile respiratory illness, the symptoms of acute febrile respiratory illness, the following precautions should be taken: following precautions should be taken: Place a standard surgical mask on the patient, if Place a standard surgical mask on the patient, if

tolerated. tolerated. If not tolerated, EMS personnel may wear a standard If not tolerated, EMS personnel may wear a standard

surgical mask. surgical mask. Use good respiratory hygiene – use non-sterile gloves for Use good respiratory hygiene – use non-sterile gloves for

contact with patient, patient secretions, or surfaces that contact with patient, patient secretions, or surfaces that may have been contaminated. may have been contaminated.

Follow hand hygiene including hand washing or cleansing Follow hand hygiene including hand washing or cleansing with alcohol based hand disinfectant after contact. with alcohol based hand disinfectant after contact.



Interim Recommendations:Interim Recommendations:

Encourage good patient compartment vehicle airflow and ventilation to reduce the concentration of aerosol accumulation when possible.

EMS agencies should always practice basic infection control procedures including vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and proper use of FDA cleared or authorized medical personal protective equipment (PPE).


Infection ControlInfection ControlInterim Recommendations: Interim Recommendations:

Pending clarification of transmission patterns Pending clarification of transmission patterns for this virus, EMS personnel who are in close for this virus, EMS personnel who are in close contact with patients with suspected or contact with patients with suspected or confirmed H1N1 Influenza A (swine flu) cases confirmed H1N1 Influenza A (swine flu) cases should wear a fit-tested disposable N95 should wear a fit-tested disposable N95 respirator, disposable non-sterile gloves, eye respirator, disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and protection (e.g., goggles; eye shields), and gown, when coming into close contact with gown, when coming into close contact with the patient. the patient.


Infection ControlInfection ControlInterim Recommendations:Interim Recommendations:

All EMS personnel engaged in aerosol generating All EMS personnel engaged in aerosol generating activities (e.g. endotracheal intubation, nebulizer activities (e.g. endotracheal intubation, nebulizer treatment, treatments involving respiratory treatment, treatments involving respiratory secretions, and resuscitation involving emergency secretions, and resuscitation involving emergency intubation or cardiac pulmonary resuscitation) intubation or cardiac pulmonary resuscitation) should wear a fit-tested disposable N95 respirator, should wear a fit-tested disposable N95 respirator, disposable non-sterile gloves, eye protection (e.g., disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and gowngoggles; eye shields), and gown

Unless EMS personnel are able to rule out acute Unless EMS personnel are able to rule out acute febrile respiratory illness or travel to an endemic febrile respiratory illness or travel to an endemic area in the patient being treated. area in the patient being treated.


Infection ControlInfection ControlInterim Recommendations:Interim Recommendations:

All patients with acute febrile respiratory illness All patients with acute febrile respiratory illness should wear a surgical mask or approved should wear a surgical mask or approved respiratory barrier, if tolerated by the patient. respiratory barrier, if tolerated by the patient.


+ =

PPE ConsiderationsPPE Considerations When possible, safely utilize the manufacturer’s When possible, safely utilize the manufacturer’s

recommendations for removal of PPE. recommendations for removal of PPE. In the event that the manufacture’s information In the event that the manufacture’s information

is not available or the combination of PPE does is not available or the combination of PPE does not allow for safe removal of PPE this process not allow for safe removal of PPE this process could serve as a guide. could serve as a guide.

The guide may need modification due to The guide may need modification due to equipment variations or contamination patterns. equipment variations or contamination patterns.

When removing PPE make every attempt to When removing PPE make every attempt to avoid contact with contaminated areas and avoid contact with contaminated areas and wash hands before touching a clean area.wash hands before touching a clean area.


Sequence for Removing Sequence for Removing PPEPPE

GlovesGloves Face shield or gogglesFace shield or goggles GownGown Mask or respiratorMask or respirator

Centers for Disease and Prevention, (May 20, 2004). Guidance for the Selection and Use of Personal Protective Equipment (PPE) in Healthcare Settings. Retrieved May 1, 2009 from http://www.cdc.gov/ncidod/dhqp/ppe.html

How to Remove GlovesHow to Remove Gloves

Grasp outside edge near wristGrasp outside edge near wrist Peel away from hand, turning glove inside-Peel away from hand, turning glove inside-

outout Hold in opposite gloved handHold in opposite gloved hand


How to Remove GlovesHow to Remove Gloves(continued)(continued)

Slide ungloved finger under the wrist of the remaining Slide ungloved finger under the wrist of the remaining gloveglove

Peel off from inside, creating a bag for both glovesPeel off from inside, creating a bag for both gloves Discard in approved biomedical waste containerDiscard in approved biomedical waste container


Removing Goggles or Face Removing Goggles or Face ShieldShield

Grasp ear or head pieces with ungloved handsGrasp ear or head pieces with ungloved hands Lift away from faceLift away from face Discard in approved biomedical waste containerDiscard in approved biomedical waste container


Removing Isolation GownRemoving Isolation Gown

Unfasten tiesUnfasten ties Peel gown away from Peel gown away from

neck & shoulderneck & shoulder Turn contaminated Turn contaminated

outside toward the insideoutside toward the inside Fold or roll into a bundleFold or roll into a bundle Discard in approved Discard in approved

biomedical waste biomedical waste containercontainer


Removing a MaskRemoving a Mask

Untie the bottom, then top, tieUntie the bottom, then top, tie Remove from faceRemove from face Discard in approved biomedical waste Discard in approved biomedical waste

containercontainer


Removing a Particulate Removing a Particulate RespiratorRespirator

Lift the bottom elastic Lift the bottom elastic over your head firstover your head first

Then lift off the top Then lift off the top elasticelastic

Discard in approved Discard in approved biomedical waste biomedical waste containercontainer


Hand HygieneHand Hygiene

Perform hand hygiene immediately after removing PPE. If hands become visibly contaminated during PPE removal, wash

hands before continuing to remove PPE

Wash hands with soap and water or use an alcohol-based hand rub

Ensure that hand hygiene facilities are available at the point needed (sink or alcohol-based hand rub)


Interfacility Transport Interfacility Transport EMS personnel involved in the interfacility EMS personnel involved in the interfacility

transfer of patients with suspected or confirmed transfer of patients with suspected or confirmed H1N1 Influenza (swine flu) should use standard, H1N1 Influenza (swine flu) should use standard, droplet and contact precautions for all patient droplet and contact precautions for all patient care activities. care activities.

This should include wearing a fit-tested disposable This should include wearing a fit-tested disposable N95 respirator, wearing disposable non-sterile N95 respirator, wearing disposable non-sterile gloves, eye protection (e.g., goggles, eyeshield), gloves, eye protection (e.g., goggles, eyeshield), and gown, to prevent conjunctival exposure. and gown, to prevent conjunctival exposure.

If the transported patient can tolerate a facemask If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the minimize the spread of infectious droplets in the patient care compartment. patient care compartment.


Interfacility TransportInterfacility Transport(continued)(continued)

Encourage good patient compartment vehicle Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration of airflow/ ventilation to reduce the concentration of aerosol accumulation when possible. aerosol accumulation when possible.

If the transported patient can tolerate a facemask If the transported patient can tolerate a facemask (e.g., a surgical mask), its use can help to minimize (e.g., a surgical mask), its use can help to minimize the spread of infectious droplets in the patient care the spread of infectious droplets in the patient care compartment. compartment.

Encourage good patient compartment vehicle Encourage good patient compartment vehicle airflow/ ventilation to reduce the concentration of airflow/ ventilation to reduce the concentration of aerosol accumulation when possible. aerosol accumulation when possible.


Interim Guidance for Cleaning EMS Interim Guidance for Cleaning EMS Transport Vehicles After Transporting a Transport Vehicles After Transporting a Suspected or Confirmed H1N1 Influenza Suspected or Confirmed H1N1 Influenza

A (swine flu) Patient A (swine flu) Patient

The following are general guidelines for The following are general guidelines for cleaning or maintaining EMS transport cleaning or maintaining EMS transport vehicles and equipment after transporting a vehicles and equipment after transporting a suspected or confirmed H1N1 Influenza A suspected or confirmed H1N1 Influenza A (swine flu) patient. (swine flu) patient.

This guidance may be modified or additional This guidance may be modified or additional procedures may be recommended by the procedures may be recommended by the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC) as new information becomes available. (CDC) as new information becomes available.



A (swine flu) Patient A (swine flu) Patient Routine cleaning with soap or detergent and Routine cleaning with soap or detergent and

water to remove soil and organic matter, water to remove soil and organic matter, followed by the proper use of disinfectants, are followed by the proper use of disinfectants, are the basic components of effective the basic components of effective environmental management of influenza. environmental management of influenza.

Reducing the number of influenza virus Reducing the number of influenza virus particles on a surface through these steps can particles on a surface through these steps can reduce the chances of hand transfer of virus. reduce the chances of hand transfer of virus.

Influenza viruses are susceptible to Influenza viruses are susceptible to inactivation by a number of chemical inactivation by a number of chemical disinfectants readily available from consumer disinfectants readily available from consumer and commercial sources. and commercial sources.




After the patient has been removed and prior to After the patient has been removed and prior to cleaning, the air within the vehicle may be cleaning, the air within the vehicle may be exhausted by opening the doors and windows of exhausted by opening the doors and windows of the vehicle while the ventilation system is the vehicle while the ventilation system is running. running.

This should be done outdoors and away from This should be done outdoors and away from pedestrian traffic. pedestrian traffic.

Routine cleaning methods should be employed Routine cleaning methods should be employed throughout the vehicle and on non-disposable throughout the vehicle and on non-disposable equipment. equipment.




For additional detailed guidance on For additional detailed guidance on ambulance decontamination EMS personnel ambulance decontamination EMS personnel may refer to "Interim Guidance for Cleaning may refer to "Interim Guidance for Cleaning Emergency Medical Service Transport Emergency Medical Service Transport Vehicles during an Influenza Pandemic" Vehicles during an Influenza Pandemic" available at: available at: http://http://www.pandemicflu.gov/plan/healthcare/cleaninwww.pandemicflu.gov/plan/healthcare/cleaning_ems.htmlg_ems.html


EMS Transfer of Patient EMS Transfer of Patient Care to a Healthcare Care to a Healthcare

Facility Facility When transporting a patient with symptoms of When transporting a patient with symptoms of

acute febrile respiratory illness, EMS personnel acute febrile respiratory illness, EMS personnel should notify the receiving healthcare facility so should notify the receiving healthcare facility so that appropriate infection control precautions may that appropriate infection control precautions may be taken prior to patient arrival. be taken prior to patient arrival.

Patients with acute febrile respiratory illness Patients with acute febrile respiratory illness should wear a surgical mask, if tolerated. should wear a surgical mask, if tolerated.

Small facemasks are available that can be worn by Small facemasks are available that can be worn by children, but it may be problematic for children to children, but it may be problematic for children to wear them correctly and consistently. wear them correctly and consistently.

Moreover, no facemasks (or respirators) have Moreover, no facemasks (or respirators) have been cleared by the FDA specifically for use by been cleared by the FDA specifically for use by children. children.


Local EMS AgenciesLocal EMS Agencies

Some local EMS agencies may differ from Some local EMS agencies may differ from these recommendations.these recommendations.

If a conflict arises refer to the LEMSA If a conflict arises refer to the LEMSA Medical Director for clarificationMedical Director for clarification


Local EMS Policy for: Local EMS Policy for: Transport versus Non-Transport Transport versus Non-Transport

Related to ILIRelated to ILI

Based upon guidance from the local EMS agency (LEMSA), future consideration may include changes to either the decision to transport a patient under specified circumstances or the destination

Contact your supervisor or local EMS agency (LEMSA) for information on local transport considerations.


Antiviral Treatment for Antiviral Treatment for H1N1 Influenza A (Swine Flu) Infections Swine Flu) Infections

in Humansin Humans Antivirals may be used as either a treatment to a

confirmed or suspected case of H1N1 Influenza A (swine flu) or as prophylactic treatment to exposed individuals under specified conditions

At this time, prehospital treatment of patients with antiviral agents is not being utilized

CDC recommends the use of Tamiflu (oseltamivir phosphate) or Relenza (zanamivir) as part of the treatment and/or reduction of severity of infection with swine influenza viruses.

More information on treatment recommendations can be found at www.cdc.gov/flu/swine/recommendations.htm

Centers for Disease Control and Prevention. (April 29, 2009). Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts. Retrieved May 1, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm

VaccinationsVaccinations

There is no vaccine to protect humans There is no vaccine to protect humans from H1N1 Influenza A (swine flu) at from H1N1 Influenza A (swine flu) at this time.this time.

The seasonal influenza vaccine will The seasonal influenza vaccine will likely help provide partial protection likely help provide partial protection against swine H3N2, but not swine against swine H3N2, but not swine H1N1 viruses.H1N1 viruses.

Centers for Disease Control and Prevention. (May 2, 2009). Questions & Answers Key Facts About Swine Influenza. Retrieved May 2, 2009 from http://www.cdc.gov/h1n1flu/guidance_ems.htm

Recommendations for: Recommendations for: Vehicle DecontaminationVehicle Decontamination

Upon completion of patient care (single call), Upon completion of patient care (single call), clean all equipment that came in contact with clean all equipment that came in contact with or was within 6 feet of the suspected ILI or was within 6 feet of the suspected ILI patient with an approved disinfectant.patient with an approved disinfectant. The equipment may include stretchers, railings, The equipment may include stretchers, railings,

medical equipment control panels, adjacent medical equipment control panels, adjacent flooring, walls, ceilings and work surfaces, door flooring, walls, ceilings and work surfaces, door handles, radios, keyboards, and/or cell phones.handles, radios, keyboards, and/or cell phones.

Cleanse all surfaces within 6 feet of the Cleanse all surfaces within 6 feet of the patient or surfaces touched by the patient or patient or surfaces touched by the patient or caregivers with an approved disinfectant.caregivers with an approved disinfectant.

Unites States Department of Heath and Human Services. Interim Guidance for Cleaning Emergency Medical Service (EMS) Transport Vehicles during an Influenza Pandemic. Retrieved May 1, 2009 from http://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html#2a

Recommendations for:Recommendations for:Vehicle Decontamination Vehicle Decontamination

(Continued)(Continued) Large spills of bodily fluids (e.g., vomit) should Large spills of bodily fluids (e.g., vomit) should

first be managed by removing visible organic first be managed by removing visible organic matter with absorbent material.matter with absorbent material.

Place contaminated reusable patient care Place contaminated reusable patient care devices and equipment in biohazard bags.devices and equipment in biohazard bags.

Clean and disinfect non-patient-care areas of Clean and disinfect non-patient-care areas of the vehicle according to the vehicle the vehicle according to the vehicle manufacturer’s recommendations.manufacturer’s recommendations.

Cleaning should be done with detergent and Cleaning should be done with detergent and water and then disinfected using an EPA-water and then disinfected using an EPA-registered hospital disinfectant in accordance registered hospital disinfectant in accordance with the manufacturer's instructions.with the manufacturer's instructions.

Unites States Department of Heath and Human Services. Interim Guidance for Cleaning Emergency Medical Service (EMS) Transport Vehicles during an Influenza Pandemic. Retrieved May 1, 2009 from http://www.pandemicflu.gov/plan/healthcare/cleaning_ems.html#2a

Questions?Questions?

Please Check with your SupervisorPlease Check with your Supervisor Please Check with your Local EMS Agency Please Check with your Local EMS Agency

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