UTSW/BioTel EMS TRAINING BULLETIN

November 2014

EMS TB 14-014 Ebola Virus Disease (EVD) - November 2014 Update

Purpose:
To provide updated information and guidance to UTSW/BioTel EMS Providers regarding the evaluation, care and transport of patients at risk for Ebola Virus Disease (EVD).

Background:
As of 11/25/2014 in the Dallas-Ft. Worth area, there are no patients with Ebola Virus Disease.

EMS Providers must remain vigilant in screening all patients for infectious diseases, including EVD, who complain of fever and other systemic symptoms.  EMS Providers shall strictly adhere to the UTSW/BioTel EMS System Personal Protective Equipment (PPE) (TB 14-007 Revised), Disinfection & Decontamination (TB 14-008), and Destination Decision-Making (TB 14-009) Training Bulletins, Policies and Procedures. 

ESPECIALLY CRITICAL: Attention to detail when removing PPE – “Buddy System” advised.

• UTSW/BioTel Paramedics shall always address scene safety first, and use at least Standard Precautions for every patient encounter.

Patient Assessment:
There are no known patients with EVD in the Dallas-Fort Worth area as of this update (11/25/2014).  However, ALL patients shall undergo screening for possible risk factors for EVD:

1. Ask if the patient is complaining of fever, with any additional symptoms, such as:
• severe headache
• muscle pain
• weakness
• vomiting
• diarrhea
• abdominal pain
• unexplained hemorrhage

2. If the patient reports fever and ANY symptoms that are consistent with EVD, then the patient MUST be asked about the following risk factors, within the past 21 days:
1. Have you had contact with blood or body fluids of a patient known to have or suspected to have EVD?
2. Have you lived in or traveled to/from a West African country where EVD transmission has been reported? (Examples: Guinea, Liberia, Sierra Leone, Mali or Congo)
3. Have you directly handled or had contact with bats, nonhuman primates or other animals from EVD-endemic areas?

PPE Selection and Infection Control Measures:

1. If there is no pre-arrival notification from 911 Communication Dispatchers or other information to suggest that the patient may be at high risk for a potentially infectious disease, including EVD, EMS Providers shall perform hand hygiene and use Standard Precautions.
2. If 911 Communication Dispatchers advise, OR if initial patient screening suggests that a patient may have Ebola or other potentially infectious disease, EMS Providers shall perform hand hygiene and should don appropriate Personal Protection Equipment (PPE) for possible or suspected cases of EVD before entering the scene. This includes:
   • Gloves
   • Gown (fluid resistant or impermeable)
   • Eye Protection (goggles or full face shield or visor)
   • Respiratory protection (surgical mask or higher for both EMS Provider and patient)
   • Additional PPE may be required in certain, high-risk situations (e.g., large amounts of blood and body fluids (e.g. vomit or feces) present in the environment). These PPE items include, but are not limited to:
     • Double gloves (NOTE: donning more than 2 pairs of gloves does NOT confer increased protection and may complicate safe doffing procedures)
     • N-95 mask (respirator)
     • Disposable hair cover (bonnet)
     • Disposable boot covers
     • Disposable apron
     • Disposable hood

1. Use caution when approaching a patient who may have EVD, as the illness can cause delirium, with erratic behavior that can place EMS Providers at risk of infection (e.g. flailing or staggering.)
2. Keep the patient separated from other persons as much as possible. Minimize EMS personnel exposure.
3. PPE should be worn for the entire patient encounter, until patient care has been transferred to Emergency Department staff and until proper doffing can be performed.
4. If blood, body fluids, secretions, or excretions from a patient with suspected EVD come into direct contact with the EMS provider’s skin or mucous membranes, then the EMS provider shall stop working as soon as reasonably possible. They shall thoroughly wash the affected skin surfaces with soap and water and then report the exposure to their EMS Supervisor immediately.
5. If a patient’s body fluids come into contact with an EMS providers’ eyes, the EMS Provider shall irrigate their eyes with normal saline or water and then report the exposure to their EMS Supervisor.

Transport:
If a patient is suspected of being at risk of EVD, EMS Providers shall notify BioTel as soon as possible, to provide the receiving facility with adequate time for facility preparation.  The EMS Supervisor also should be notified as soon as possible.

There is currently NO specific receiving hospital designated for patients under investigation for EVD.  For transport destination decision-making, utilize the UTSW/BioTel Training Bulletin 14-009 and contact BioTel with any questions or for assistance.

If there are no risk factors for EVD or other potentially infectious disease, proceed with standard EMS care.

➢ EMS Providers are encouraged to contact BioTel or their EMS Supervisor immediately, with any questions or concerns.

Refer to the following documents and materials for additional information & guidance:

BioTel Resources

• TB 14-007 PPE – Revised November 2014
  
• DFR PPE Donning and Doffing Checklists
  
  
• DFR PPE Donning and Doffing Video
  
  
• DFR PPE and Hand Hygiene PowerPoint Presentation
  
  
• TB 14-008 Decontamination and Disinfection
  
  
• TB 14-009 Destination Decision-Making
  
  
• TB 14-010 EVD (October 2014)

• Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs)
  for Management of Patients with Known or Suspected Ebola Virus Disease in the United States    (Revised October 28, 2014; accessed November 16, 2014)
  
  
• Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing)  (Revised November 10, 2014; accessed November 16, 2014)