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April 30, 2009
To All BioTel Agencies -
American and World health officials on Sunday declared a public health emergency over increasing cases of swine flu in the United States and abroad. With at least 100 confirmed cases identified in the United States and many in the state of Texas, EMS Medical Direction – through Biotel our on-line medical control - has determined that an abundance of caution should be taken to keep our paramedics and personnel safe from potential swine flu exposure.
With the concern that more cases may appear in Texas, Biotel must assume that the paramedics in our system may encounter patients that have symptoms that may be compatible with influenza, and potentially the H1N1 swine flu variety. Until we have a better understanding of how this outbreak may affect our communities, the following guidelines should be implemented immediately for the following patients:
1. Any providers approaching a patient who appears febrile AND who has a cough OR difficulty breathing should first place a mask on themselves, including eye protection, and should wear gloves. The mask should preferably be one that offers protection on an N95 mask level or higher. All ambulances and response vehicles should be equipped with this level of protection at a minimum. The N95 mask should be fit-tested to maximize protection.
2. Following protecting themselves with the mask, eye protection, and gloves, providers should place a similar mask on the patient, if it can be tolerated. It is understandable that patients with shortness of breath may not tolerate such a mask, especially if oxygen is being administered or possibly CPAP.
3. Following transport of the patient to the emergency department and turning of the patient over to ED staff, EMS providers should IMMEDIATELY discard their masks, eye protection, and gloves and promptly wash their hands with soap and water. If your hands are not visibly dirty and soap/water is not readily available, then the waterless alcohol-based hand gels can be utilized. The gels should contain at least 60% alcohol.
4. If your patient meets the clinical criteria described above, the paramedic should notify Biotel for two reasons. First, BioTel must appropriately prepare the receiving ED staff with the knowledge that a febrile respiratory illness is inbound. Second, because of the evolving nature of a potential large epidemic or even a pandemic, all such cases will be tracked and monitored by Dr. Fowler. The importance of notifying Biotel is critical for the protection of the community and the paramedics-in-the-field so that we can make adjustments based on trends to keep everyone safe from potentially serious infection.
A useful website from the CDC on this topic is found here:
http://www.CDC.gov/swineflu/guidance_EMS.htm Thank you for your attention to this important matter. Please contact me any time with questions, comments, or suggestions.
Sincerely,
Ray Fowler, MD, FACEP
Chief of Operations
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