Whether it’s measles, the flu, or some other communicable illness, EMS providers are particularly susceptible to exposure to infectious diseases. Dispatch sends a crew to a scene and often there is no advanced warning that they are responding to a literal cesspool of germs. And even though all EMS providers are trained to don PPF gear and take precautions, sometimes that process seems lax.
If the caller informs the 911 dispatcher of a potential infectious condition, then it is ideal if the dispatcher can pass this information on to a responding crew. Unfortunately, we all know that sometimes the information given to a 911 operator is far from complete. It’s imperative to always use basic personal protective gear protection just in case, and if there has been more complete info passed along, the crew should then definitely consider additional protections. If there is a known epidemic in an area, there should also be a list of questions which could help identify infections, (such as recent travel, exposure to diseases, and symptoms).
If there is a possibility of infection, in addition to personal protective gear, only those vital to immediate patient care should be in close proximity to the patient; non-vital personnel should be at least six feet away. Potentially infectious bodily fluids and airborne particles can and will contaminate any gear (AND protective outfits), and can cross-contaminate others, the rig, and even the receiving ER. The arriving crew should carry only necessary equipment into the scene so that the exposure to infection is limited.
If possible, when a potentially infectious patient is coughing, a surgical mask should be placed over their mouth and nose to limit the possibility of contamination. If the patient has diarrhea or other body fluids evident and access to the full body is not vital during transport, the crew should cocoon the patient in a non-permeable cloth. Responders should use protective outer covering such as barrier gowns, goggles, face masks, and gloves with all possible infections, even if the patient or family members are disturbed by the sight. It’s a good idea to try to calm the patient/family reaction and do the best to reassure them. It is important to reduce the risk of contamination to anyone else. Be careful about personal contact with other family members on scene, as they may be in the incubator stage of the infection and still able to pass the germs around.
Agencies should be practicing both the donning of personal protective gear and the transport of infectious patients continually. It would be a good idea to coordinate this training with a receiving hospital so that every part of response through patient delivery is done with as little contamination as possible. It is also vital to know how to completely decon the ambulance and equipment used so that no infection is passed along to other crews and patients. Some agencies or counties may have specialized transport units for such situations. All agencies need to be able to protect the patient compartments during transport to limit the exposure. Thorough handwashing and knowing how to change protective gear is another skill that needs to be reinforced by repetitive training.
A good planning resource for EMS agencies, their providers and medical directors is the EMS Infectious Disease Playbook provided by the U.S. Department of Health and Human Services (HHS)/Office of the Assistant Secretary for Preparedness and Response (ASPR), and can be downloaded at https://bit.ly/2E7mOuc