In response to confirmed cases of swine influenza in Mexico, California, Ohio, New York and Texas, all personnel should be aware when responding to calls for patients experiencing flu-like symptoms including fever, cough, sore throat, body aches, headaches, chills and fatigue.  Swine flu is a respiratory infection caused by Type-A influenza viruses that regularly does not normally infect humans. At this point we do not know how easily this particular strain can be passed from humans or the severity of the illness.  Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions. Every ambulance should be equipped with additional supplies to enhance your protection while treating patients with cough and sneeze symptoms.

We are providing the following recommendations with respect to the potential Swine influenza outbreak. This aggressive approach will help us limit the spread of influenza to pre-hospital care providers, our families, and our patients.

The Swine flu  just like the seasonal flu is a contagious respiratory illness caused by influenza viruses.  It can cause mild to severe illness, and at times can lead to death.  Some people are at high risk for serious flu complications, such as elderly, young children, pregnant woman, and people with chronic health conditions.

Influenza transmission occurs by large respiratory droplets that are expelled from the respiratory tract during coughing or sneezing. The patient compartment of ambulance should be considered an area at risk for transmission when transporting a suspected influenza patient.

To keep you and your family healthy during this period, please follow theses guidelines when responding to patients with potential flu like symptoms.  For our purposes, symptoms of the flu will include a cough and fever but also may include any of the following sore throat, body aches, headaches, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu.

The Patient

To reduce the spread of respiratory droplets patient with flu like symptoms that are not in respiratory distress should be asked to wear a surgical mask (this is not an N95 mask).  Patients with respiratory distress should be placed on oxygen via a non re-breather mask.

Personnel should enhance the patient interview to include specific inquiry as to recent travel, with an emphasis on Mexico, or contact with someone who has recently traveled to Mexico.  Additionally, personnel should also establish if a relationship exists with anyone who has been at or in contact with a known high risk location. This information shall be passed on to the receiving hospital.

Offer tissue and advise patient on cough etiquette.

The Crew

To reduce exposure during treatment and transport EMS crews are suggested to wear appropriate BSI.

Maintain an initial three (3) to six (6) foot standoff distance from the patient as possible with one Paramedic conducting the assessment when possible.

Gloves must be worn for all patient contact.

While interacting with the patient, crew members should wear an N-95 mask.

Wear a gown if soiling of clothing is likely from secretions

Use of eye protection when working within 3 feet of patient recommended

Cough-generating procedures should be avoided inside the ambulance (e.g., nebulizer treatments). Contact command if these procedures are medically necessary.

Prior to arrival at the hospital, notify the receiving hospital that you are transporting a possible influenza patient.

Wash or decontaminate your hands frequently, avoid cross contaminating surfaces or equipment.

Avoid eating, drinking, application of cosmetics, and handling of contact lenses in the patient compartment area.

After The Call

Patient-care compartments (including stretchers, railings, etc.,) should be cleaned using an EPA-registered hospital disinfectant.

EMS crews should wash their hands as often as possible before patient contact, after patient contact and before returning in service from the Emergency Department.

Clearly the manner in which we approach this potential outbreak may change as new information becomes available.

For more information from the CDC concerning concerning Swine Flu and EMS Personnel please click here.