Dr. Robin McFee sees the Swine-Origin Influenza A (H1N1) Infection virus as a wake-up call. While swine flu is considered to have pandemic potential, McFee reminds us that between 5 and 20% of Americans come down with seasonal flu every year, and more than 36,000 people die from flu-related illnesses annually. (1)
"To me, this is a good opportunity to drive home the greater need for vigilance against pathogens and infections. We tend to worry more about blood precautions than respiratory ones," says McFee, a JEMS editorial board member, and a toxicologist and the professional education coordinator of the Long Island Regional Poison Information Center. "I think we need to be far more proactive and start looking at respiratory illnesses."
Swine flu has pandemic potential because it's a novel strain for which humans have little to no immunity, is transmittable through person-to-person contact and doesn't have a currently available vaccine. Swine flu is susceptible to Tamiflu, but McFee reminds us that seasonal flu strains this year have had Tamiflu resistance. And EMS is exposed all the time.
McFee suggests personal protective equipment (PPE) should be the standard of care for any case that could be a respiratory illness, that systems should have a plan for operations not just during a pandemic flu outbreak but also the annual flu season -- including stockpiles of N-95 masks. The Centers for Disease Control and Prevention (CDC) guidelines only recommend healthcare providers wear masks if they're closer than 6.5 feet away from a patient with a suspected flu-like illness, but often 6.5 feet is tough to maintain because of the nature of EMS.
"I have read the CDC guidelines and overall they provide good recommendations. But during a flu season or outbreak of respiratory illness, erring on the side of caution should be considered. Even if a patient doesn't present with flu like symptoms, EMS potentially treats many patients who might have a respiratory illness. Moreover, an ill EMS responder could transmit a respiratory infection to patients presenting with injuries or other illnesses," she says.
An important step to reduce EMS responder risk is to get the annual flu vaccine.She also recommends EMS take a detailed occupational and travel history, because international travel is becoming more common and international travellers may return with respiratory or other illnesses. Clearly working in close quarters with patients sets the stage for easier transmission of illness.
"It shouldn't take a novel strain to make us more vigilant and be prepared for flu. The same precautions we are dusting off today should be used throughout influenza season," she says."I think the concern swine flu has raised has done us a tremendous favor by putting this in the news and reminding us about the threats of infectious diseases, and the need for greater infection precautions."
1. National Institutes of Health National Institute of Allergy and Infectious Diseases.http://www3.niaid.nih.gov/topics/Flu/
- "Protect Yourself and Your Patients from Swine Flu"
- "Swine Flu Top 10"
- Official swine flu updates from the CDC
- Official swine flu updates from the WHO
- JEMS Connect discussion on swine flu