Identified by EMS Chiefs of Canada

April 25, 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.

This is the second time the EMSCC’s Membership Services Committee has coordinated a national teleconference series during outbreaks, the first was for the 2003 SARS outbreak. Lessons learned by Toronto EMS from the SARS outbreak in 2003 demonstrate the critical period for the outbreak will continue until the end of May. Select international agencies were invited to attend yesterday’s EMSCC national discussions for the first time. The National EMS Management Association, FirstWatch and the National Academies of Emergency Dispatch are participating in EMSCC’s process.

There are a number of strategies that EMS agencies should put in place to identify potential victims, protect their paramedics, provide excellent patient care and participate in the public health process. EMSCC will continue to facilitate national discussions between its members and guests until the event is concluded; continuing to identify trends, sharing best practices and disseminating information to the EMS community at large. Individual agencies are asked to share their experiences, policies, procedures and other relevant information through their respective organization.

A conference call led by EMSCC yesterday revealed the following practices being implemented. Reference documents will be made available soon.

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:

Public Health Agency of Canada

Centers for Disease Control

Pandemicflu.gov
CDC Swine Influenza Dispatch
CDC Antiviral Recommendations 

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.
• Placing a mask on all patients with suspected symptoms, using filtered oxygen masks when available, or non-rebreather masks when oxygen is required. 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.

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:

– Have they recently been in Mexico or been exposed to anyone that has been in Mexico, and how long the person was in Mexico (paying particular attention to those who stayed for 7 days or longer)?
– 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?

• 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.
• 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.
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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 on the EMSCC web site.