pandemic inservice.draft3
DESCRIPTION
Power Points for EMS EducationTRANSCRIPT
PANDEMIC PLANNING
INFORMATION INSERVICE FORTHE PREHOSPITAL CARE TEAM
First, some acronyms
• H1N1 – the ‘pig’ flu• I.L.I. (ILI) – Influenza Like Illness• EMS – Emergency Medical Services• PPE – Personal Protective Equipment• YCDC – Yukon Centre for Disease Control• EHOT – Emergency Health Operations Team
H1N1 – What is it?• H1N1 is a new type of Influenza A virus that has not
previously infected humans.
• Infection results in symptoms such as:- Fever - Cough- Runny nose - Sore throat- Body aches - Fatigue- Difficulty breathing - Loss of appetite
• H1N1 symptoms and methods of transmission are similar to those associated with seasonal flu.
H1N1 Virus
• 7 Day incubation period & infectious for about 7 days
• May be infectious for up to 2 days before signs/symptoms appear
• Travels in waves of 6-8 weeks during Fall/Spring
So What?
• Prediction: 2+ weeks of 15-30% absenteeism from work disrupting normal course of affairs.
• Increases demand on health care services and their support networks.
How does it spread?
Two routes of transmission (vectors)• INHALATION (very small particles that are
exhaled into the surrounding air that enter a host directly via the airways.)
• CONTACT (larger “ballistic” particles that can survive on other surfaces. These must be transferred from the contaminated surface to an airway opening for infection to occur.)
Inhalation
• All particles of inhalable size may contribute to influenza infection.
• Risk of acquiring respiratory pathogens decreases with distance.
• There is evidence that most influenza pathogens are transferred at close range (< 2 meters.)
Contact
• Direct Contact – infection-bearing particles are transferred directly onto the mucous membranes of a new host (e.g. through kissing or direct intake of ballistic particles.)
• Indirect Contact – infection-bearing particles are conducted from a contaminated surface to a location where they may enter the new host’s airway (i.e. from table to hand to nose/mouth.)
How long can it live outside the body?
Hard Surfaces: 24 – 48 HoursSoft Surfaces/Clothing: 8 – 12 hours
Skin/hands: 5 minutes
• However it will only infect a person for up to 8 hours after being deposited on a hard surface and minutes on a soft surface or skin. This is why routine hand washing and cleaning of surfaces are so important.
The Evidence
Council for Canadian Academics: 1. Influenza is transmitted primarily at close
range (< 2 meters). 2. Influenza enters a new host primarily through
the oral or nasal airways. 3. Adopting a Hierarchy of Controls will deter
the spread of influenza – no single level of deterrence will be effective on its own.
So how do we protect ourselves?The Hierarchy of Control
Vaccines/Anti-viral Medications
Engineering - Barriers (the 2m. Rule)Environmental Controls/Ventilation
Administrative – Screening/SequestrationHand HygieneRespiratory Etiquette
Personal Protective Equipment –Masks/GlovesGlasses/Gowns
How does this work?Vaccines – introduce a small amount of the virus into
your body to encourage the development of immunity.(A vaccine is on-line to be delivered in November.)
Anti-viral medication – if your body can not fight off thevirus on its own, there are two anti-viral medications effective against H1N1:- Tamiflu (Oseltamivir)- Relenza (Zanamivir)
(Both have been distributed throughout the Territory for use in specific cases under the direction of YCDC.)
How does this work?Engineering Controls
- Environmental controls that lower humidity and temperature decrease the life-time of influenza
pathogens outside a host’s body.- Air filtering and venting prevents the re-circulation of
air thus removing infected particles from the immediate environment.
- Maintaining a 2 meter distance from suspected hosts of influenza decreases likelihood of inhalational or
direct contact with infected particles.
How does this work?
Administrative Controls- Hand hygiene prevents the transfer of
pathogens from contaminated surfaces to areas around your mouth and nose where
they can be inhaled.
- Routine cleaning prevents surfaces from remaining contaminated.
- Respiratory etiquette (“sneeze in your sleeve”) prevents contamination of surfaces.
How does this work?
P.P.E. - “The last line of defense”Masks – Filter particles that are small enough to enter the lungs.Gloves – Prevent contamination of your hands.Gowns – Prevent contamination of your clothes.Glasses – Prevent direct contact between ballistic particles and your eyes.
Personal Protective Equipment(Getting ready)
Gownthen
Maskthen
Glasses then
Gloves
Personal Protective Equipment(Taking it off)
Remove GLOVES then
Remove GOWNthen
PERFORM HAND HYGIENEthen
Remove GLASSES (set aside)
thenRemove MASK
thenPlace in a GARBAGE BAG
andWASH YOUR HANDS again.
Screening
A series of questions asked by 811, central ambulance dispatch or a community health practitioner to determine if flu symptoms are suspected.
Aim: 1. To determine if PPE should be worn2. To determine where initial care should
be performed (home vs. hospital) 3. To prevent swamping health care
facilities
Screening Questions:1. Is there evidence of a respiratory illness? (Shortness
of breath, new cough or fever?)AND
2. Is there a report of a sore throat, weakness, excessive fatigue, joint pain or muscle pain?
3. Is there a recent history of contact with another person who has any of the above symptoms?(Recent travel may be relevant but should not be used to determine whether or not Influenza-likesymptoms are present. “Yes” to #1 and ONE othersymptom indicates need for pre-hospital PPE.)
Screening Duties• 811 – Will answer questions from the public and to
perform initial screening of reported flu symptoms.• CENTRAL AMBULANCE DISPATCH– If the Computer
Aided Dispatch (CAD) system identifies a call-type linked to shortness of breath, chest pain, general illness or “unknown” the screening tool will be applied and PPE recommended to the EMS crew when indicated.
• COMMUNITY NURSING– Before sending a rural ambulance crew to a residence, the community nurse should determine whether PPE should be worn by the responding crew. (If this information is not passed to the EMS crew, they should ask if PPE is required.)
Medevac
• During the Triage/Nursing Report, the lead Medevac attendant will determine if there is evidence of ILI.
• The Medevac Lead Attendant will be responsible for informing the flight crew and other EMS staff when PPE are to be worn.
• The Medevac Lead Attendant will be responsible for informing the receiving facility whenever a patient with ILI symptoms is being transported.
Ground EMS
• Ambulance Crews – on arrival at scene, if the symptoms outlined by the screening tool are recognized the crew members should retreat, apply PPE and then re-enter to provide care.
• Contaminated PPE must not be worn in the driving compartment of the vehicle. If PPE is worn in the driving compartment, the entire vehicle must be cleaned after the call.
Patient Transport
• Whenever an EMS attendant is within 2 meters of a patient with ILI symptoms full PPE will be worn.
• Before driving the ambulance, all PPE must be removed by EMS staff not riding in the patient compartment.
• Before re-establishing contact with the patient, fresh PPE must be put on by all attendants participating in patient movement.
Patient Transport (Con’t)
• Before arrival at any receiving facility, the receiving staff must be advised that the ambulance is transporting a patient with ILI symptoms.
• On arrival the driver should contact the receiving staff to determine the destination of the patient within the facility. The shortest route to this destination should be employed. (The patient may remain in the ambulance with the attendant until a bed/room is available.)
Vehicle Decontamination
• All surfaces that have been in contact with a patient with ILI symptoms must be wiped down.
• ANY cleaning solution (soap and water, bleach solution, Virox wipes or commercial chemical wipes) will be effective in eliminating H1N1 and flu particles.
• Ensure that full PPE are worn during decontamination procedures.
Equipment Decontamination
• Hard surfaces may be decontaminated in the same manner as the vehicle interior.
• Soft equipment (i.e., bags and packaging) may be wiped down if not excessively contaminated.
• If a bag or equipment package has been in direct contact with contaminated particles (i.e., sneezed or spit upon), it will have to be emptied, removed from service and washed.
Clothing Decontamination• If a gown is worn, most particles will be prevented from contaminating clothing.• If the gown has become saturated, infected particles may penetrate to the clothing beneath. At the earliest opportunity, soiled clothing should be removed, the skin beneath cleaned, and a fresh uniform applied.• Machine washing or dry cleaning is effective against ILI/H1N1 contaminants.
Questions and Answers
1. Is it safe to launder my uniforms at home?2. How long will a N95 mask protect me?3. How do I know when to use an N95 versus a surgical mask?4. How does the 2 meter rule protect me?5. When should I wash my hands? How often?6. If I get the flu, how do I know when I can safely return to work?
Questions and Answers (Con’t)
7. What are the best cleaning solutions to use for cleaning at home? My workspace? My clothing?8. What are the questions I can use to screen for ILI? Whose job is it?9. What is the plan to ensure that there is enough PPE to protect our EMS responders and support staff during a flu outbreak?
Questions and Answers (Con’t)
10. I think I (or someone that I care for) has the flu. What should I do?
Resources:Council of Canadian Academics: www.scienceadvice.comPublic Health and Safety Canada: www.phac-aspc.gc.caYukon Health and Social Services: www.hss.gov.yk.ca
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