H1N1 Information for co-responders

Influenza A (H1N1) information for REMSA's employees and co-responding agencies

• World Health Organization's guidelines for care for H1N1 flu patients
• CDC guidelines for EMS workers
• CDC Guidance for Infection Control for Care of Patients in a Healthcare Setting
• CDC Guidelines for Managing Calls and Call Centers during a Large-Scale Influenza Outbreak

Updates to this page will be announced on twitter. Follow us at REMSAflu.

On 3/4/10, REMSA de-escalated its response to the H1N1 pandemic and has stopped the screening of all 911 calls for influenze like illness symptoms.

This is our current operational memo that has been provided to our medical and communications staff:

Operational Memo: Influenza A (H1N1)Response Plan

Division: Health & Safety

Effective Date: April 29, 2009
Updated: March 4, 2010

Purpose: To ensure that our employees are protected from risk of exposure in time of pandemic

Policy: The following policy will be adhered to at all times when encountering patients who are either highly suspected to have or are confirmed to have influenza A (H1N1).

Signs and symptoms include but are not limited to:

• Fever (greater than 100 °F or 37.8 °C)
• Cough
• Runny nose or nasal congestion
• Sore Throat
• Headache
• Body aches or joint aches
• Nausea / Vomiting / Diarrhea
• Fatigue
• No appetite

Procedure:

Uniforms

• NO CONTAMINATED UNIFORMS WILL BE TAKEN HOME.
• All crewmembers MUST keep a spare uniform in their locker, ambulance or personal vehicle while on duty.
• If a uniform becomes contaminated, the contaminated crewmember must notify the operations supervisor and change out of the uniform as soon as practically possible.
• Any contaminated uniforms should be red bagged prior to transportation to a laundry facility.
• Contaminated uniforms may be laundered using machines located at any of our outfitted locations.

Pre-Response/Dispatch

• Dispatch the call as usual, following current guidelines for sending First Responder responses.
• Call takers will not utilize the ProQA SRI button to further interrogate the caller unless unusual situations are present and at their discretion.
• System Status Controller will dispatch the call per normal protocols
• For the ProQA SRI screening to meet a positive criteria the patient must answer yes to either the "measured body temperature => 101" or "extremely hot to the touch in room temperature" and have either a "sore throat" or "cough".
• If the Pro QA SRI screening elicits a positive response, the System Status Manager will add the following statement to the end of the broadcast "UNIVERSAL PRECAUTIONS ARE REQUIRED".
• If the ProQA SRI screening does not elicit any positive answers, nothing further needs to be done after dispatching the call per protocol.

Patient Contact

• If advised that UNIVERAL PRECAUTIONS ARE REQUIRED –
  • Crews will don proper personal protective equipment (PPE) upon their arrival at scene and prior to contacting the patient.
  • Personal protective equipment WILL include the following:
    • a properly test fitted N95 mask,
    • eye protection,
    • gloves, and
    • gowns.
  • Upon contact with the patient, place either an appropriate mask (surgical, dust, or other Non N95 mask) or, depending on the patient’s respiratory status, a Non-Rebreather mask will be placed on the patient (reverse isolation precautions).
  • Crews will treat the patient per current protocol while minimizing droplet production.
  • Once in the back of the ambulance, appropriate engineering controls WILL be utilized. These controls include:
    • Blower vents on high
    • Front windows open
    • Exhaust fan on high
    • (Optional) drape the opening between the patient compartment and the front cab of the ambulance
  • Radio reports to hospitals should be completed as per protocol. If UNIVERSAL PRECAUTIONS are in place, advise the receiving hospital by adding, "UNIVERSAL PRECAUTIONS ARE IN USE" to the end of your report.
  • If after assessing the patient, it is determined that the patient has none of the above listed signs / symptoms and / or other signs / symptoms consistent with influenza infection the medical staff may remove PPE as appropriate. The medical staff will take in to consideration other signs / symptoms or procedures the patient may be experiencing or require that still require PPE use.
    • When the crew departs the scene, the medical staff will advise dispatch "UNIVERSAL PRECAUTIONS WERE NOT REQUIRED".
    • If not advised that Univeral PreCautions Are Required by dispatch
      • If REMSA Communications has not identified individuals with symptoms of acute febrile respiratory illness prior to arrival on scene, EMS personnel should stay more than 6 feet away from patients and bystanders with symptoms and exercise appropriate routine respiratory droplet precautions while assessing all patients for suspected cases of swine-origin influenza.
      • For all responses, crews will don appropriate PPE for that patient as outlined in REMSA’s Exposure Control Plan.
      • If once on-scene, the crew realizes that the patient is exhibiting some or all of the symptoms listed above, they will immediately treat the patient as if they had been advised that UNIVERAL PRECAUTIONS ARE REQUIRED and proceed as stated above.
      • When the crew departs scene, they will notify dispatch that they are transporting and add the following "UNIVERSAL PRECAUTIONS ARE IMPLEMENTED".
    • NOTE: If a crew takes UNIVERSAL PRECAUTIONS, the Crewmember in charge of patient care will document the use under the treatment section of their Sansio patient care report.
      
    • If dispatched to standby out of the area, crews may be approached by local law enforcement that may request PPE. Crews will offer and assist with proper use of the PPE without hesitation.

    Post Response

    According to the CDC, the influenza A (H1N1) virus can live on surfaces for up to 72 hours.

    • After contact with a suspected or confirmed case of influenza A (H1N1) and decontamination of the ambulance and equipment (see guidelines below), crews should remove their personal protective equipment  (PPE) and dispose of all disposable items in a red biohazard barrel. DO NOT DISPOSE OF ANY CONTAMINATED PPE IN PUBLIC TRASH RECEPTICALS.
    • If contaminated PPE cannot be placed in a biohazard barrel, it should be placed and sealed in a red biohazard bag and disposed of in a red biohazard barrel as soon as practically possible.
    • Immediately clean hands with soap and water or an alcohol-based hand gel. Avoid touching the face with gloved or unwashed hands.
    • Clean and disinfect all surfaces within the non-patient-care areas of the vehicle using a broad-spectrum disinfectant such as "Blue Skies", "Lysol IC", "Caviwipes", etc. This included but is not limited to the steering wheel, door handles, microphones, etc.
    • Dispose of any food or drink that may have been contaminated.
    • Clean and disinfect all surfaces within the patient-care area of the vehicle with a broad-spectrum disinfectant such as "Blue Skies", "Lysol IC", "Caviwipes", etc. Pay particular attention to frequently touched surfaces in patient-care compartments (including stretchers, railings, medical equipment control panels, adjacent flooring, walls, ceilings and work surfaces, door handles, radios, keyboards and cell phones) that become directly contaminated with respiratory secretions and other bodily fluids during patient care, or indirectly by touching the surfaces with gloved hands.
    • Clean any small spills of bodily fluids (e.g., vomit from an ill patient) by cleaning with a broad-spectrum disinfectant such as"Blue Skies", "Lysol IC", "Caviwipes", etc.
    • Large spills of bodily fluids (e.g., vomit) should first be managed by removing visible organic matter with absorbent material (e.g., disposable paper towels discarded into a leak-proof properly labeled container). The spill should then be cleaned and disinfected as above.
    • Place contaminated reusable patient care devices and equipment in biohazard bags clearly marked for cleaning and disinfection or sterilization as appropriate.
    • After cleaning, remove and dispose of your PPE as instructed earlier.
    • Immediately clean hands with soap and water or an alcohol-based hand gel. Avoid touching the face with gloved or unwashed hands.

    Note: For large cleanups or post transport of confirmed influenza A (H1N1) cases, crews should advise the Communications Supervisor as soon as practically possible. The Communications Supervisor may either bring the crew back to Edison or send the Biohazard Clean-up Assistance Team (e.g. VSTs) for clean-up and return to service.

    Personal Hygiene
    Crewmembers are reminded that key to staying healthy is to

    • Cover your nose and mouth with a tissue or shirt sleeve (elbow area) when you cough or sneeze. Throw the tissue in the trash after you use it.
    • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.
    • Avoid touching your eyes, nose or mouth. Germs spread that way.
    • Most Importantly - Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.

    Exposure Reporting
    All unprotected exposures or PPE equipment failure must be reported immediately to your operations supervisor or Director of Health and Safety on an Exposure Report Form as outlined in protocol.

    Change Tracking

    • 5/1/09 - changed reference to flu to reflect current World Health Organization definition.
    • 5/1/09 - added section on removal of PPE for certain patients.
    • 5/7/09 - updated Pre-response / Dispatch section.
    • 10/1/09 - Revised list of signs/symptoms, revised SRI screening criteria and added a documentation requirement for use of universal precautions.
    • 3/4/10 - Removed 911 call screening criteria as part of de-escalation of response to pandemic.