UTSW/BioTel EMS Training Bulletin

October 2014 EMS TB 14-006 Ebola Virus Disease (EVD)

   

October 2014 EMS TB 14-006 Ebola Virus Disease (EVD)  PDF Here (includes CDC fact sheet)

CDC PPE Information PDF

 

Purpose:

  1. To inform & provide management recommendations to UTSW/BioTel EMS System EMS Providers about Ebola Virus Disease (EVD).

Background:

  1. A patient with EVD, also known as Ebola Hemorrhagic Fever, was recently evaluated & transported to Texas Health Presbyterian Hospital by Dallas Fire-Rescue paramedics.

EVD Transmission:

  1. Ebola virus can be transmitted ONLY via DIRECT contact with the bodily fluids (e.g. blood, saliva, emesis, feces, urine or semen) of a SYMPTOMATIC, INFECTED person.
  2. Ebola virus CANNOT be transmitted by casual contact, such as being in the same room with a patient. 
  3. Persons infected with Ebola virus are ONLY contagious when they are SYMPTOMATIC.  In other words, patients infected with Ebola virus are NOT contagious during the asymptomatic incubation period immediately following infection (which ranges from 2 to 21 days, with an average 8 to 10 days).

Patient Signs and Symptoms of EVD that suggest the possibility that a patient may be potentially contagious:

  1. Fever
  2. Headache
  3. Abdominal pain
  4. Body aches
  5. Fatigue or weakness
  6. Nausea
  7. Vomiting
  8. Diarrhea
  9. Bleeding or bruising of unknown cause

Patient Evaluation Procedures and Precautions:

  1. EMS Providers who evaluate ANY patient with fever AND flu-like symptoms listed above shall ALWAYS use STANDARD, DROPLET & CONTACT Precautions.
  2. OTHER HISTORY factors associated with risk of exposure for which STANDARD, DROPLET & CONTACT precautions are indicated during patient evaluation/transport:
    1. The ASYMPTOMATIC INCUBATION PERIOD after exposure to Ebola virus ranges from 2 to 21 days.  Therefore, even though the patient may not be symptomatic (or contagious) during this period, any patient who has had contact with a person with EVD should be considered to be at risk.
    2. TRAVEL HISTORY: Any patient who has recently traveled to the DFW Metroplex from West Africa should be considered to be at risk. 
  3. EMS Providers shall follow agency-specific guidelines for notification of EMS Chain of Command after evaluation and/or transport of a patient with the symptoms listed above.
  4. In addition, BioTel and/or the receiving hospital shall be notified before or during transport of such patients, so that the receiving hospital Emergency Department staff can be notified prior to arrival.
  5. Finally, any and all concerns regarding the possibility of EVD shall be communicated directly to the receiving hospital Emergency Department staff immediately upon arrival.

Disinfection and Decontamination Procedures and Precautions:

  1. Ebola virus is very fragile.  It cannot easily survive outside of body fluids.  Therefore, disinfection is relatively simple.
  2. Soap and water and standard disinfecting/cleaning solutions readily kill the virus. 
  3. Standard, Droplet and Contact precautions (including the use of standard personal protective equipment (PPE)), disposal of contaminated items, and equipment cleaning are sufficient to prevent exposure. EMS Providers should follow agency-specific procedures for routine decontamination of the vehicle and equipment.
  4. Procedures with high risk of aerosolization of body fluids (e.g. airway suctioning and advanced airway management) require use of an N95 respirator or higher.

Local, County, State and Federal Collaboration:

  1. UTSW/BioTel Fire/EMS agency command staff members are working collaboratively with all local, County, State and Federal colleagues, including local hospital partners, Parkland BioTel, City governments, Dallas County Health and Human Services, the Centers for Disease Control and Prevention (CDC), and the UTSW/BioTel EMS Medical Direction Team to provide timely, accurate information to all EMS Providers during this challenging period.

FINAL NOTES: