EMS Leaders & Providers Respond to Flu Outbreak

Nationwide epidemic prompts plan of action for the future



James J. Augustine, MD, FACEP | From the February 2013 Issue | Monday, March 25, 2013

A wise old fire chief once taught me, “Big challenging incidents are a gift, especially if they last a few days. Use them to obtain and apply the tools you will need over the next few years.”

With that in mind, I share some ideas about using the current major influenza outbreak to build a better response plan and durable programs for future outbreaks.

For the EMS leader, this is an important responsibility to your community. The community is relying on emergency services to be available for all emergencies, despite volumes of ill patients in the emergency departments (EDs), ambulances, or community clinics. Current efforts must include the cooperation of ED staff within the region’s EMS systems. Success in response to the current influenza outbreak also contributes to the community appreciation of the healthcare system, as we adapt to the recent healthcare changes.

As of mid-January, the Centers for Disease Control and Prevention (CDC) reported that 48  states reported widespread geographic influenza activity for the week of Jan. 6-12, 2013. This increased from 47 states in the previous week. Fortunately, the outbreak volume of illness hasn’t yet been accompanied by a large number of fatalities. The population affected has been largely the older members of the community, including some nursing home outbreaks. Few pediatric deaths have been reported. EMS systems across the country have been extraordinarily busy, as have EDs.

With an older population affected by the viruses, many of the presenting symptoms prompting EMS activation have been “shortness of breath,” “chest pain,” or “high fever.” Patients have generally been very ill, and required hospitalization. This has put pressure on the available inpatient beds, and some urban areas have had problems with hospital diversion.

Staying Well
A few immediate actions are available for EMS response. If EMS staff haven’t had the bug already, there’s still an opportunity to benefit from this season’s vaccine.

Several operating practices help staff avoid the contagious diseases: Don’t get within 6 feet of ill patients unless it’s needed; place a mask on coughing patients; wash hands and keep them away from the face; get appropriate rest and exercise. These good habits allow EMS providers to be confident because any form of contagious disease becomes concerning, and be able to reassure their family that they won’t bring any bugs home to them.

Additional opportunities to modify operating processes to improve the safety of staff and patients exist. Be sure to be stocked with enough masks, gloves and hand cleaning materials. They are the first lines of protection. EMS staff can limit exposures by safely reducing the number of personnel that are exposed to an ill patient who doesn’t need more than one staff member to provide care. Keep ventilation at high levels in the patient compartment and deliver patients to negative pressure or other protected areas of the ED. Reduce the amount of exposed materials in the back of the ambulance, and clean the exposed surfaces. If possible, reduce any time lingering on scene and in transport, and complete documentation and other duties away from the ill patient.

What opportunities can be built through the response to the current outbreak?
>> Conduct the meetings between EMS and hospital leaders, to eliminate EMS diversion, rerouting, or offload delays. Make the process changes durable, so that the behavior doesn’t return.
>> Establish a process for receiving, processing, and utilizing the strategies and documents that the CDC is producing and making available to EMS providers.
>> Develop an illness surveillance program with community public health officials, and use the information to report the level of illness publicly. Develop an approach that allows EMS leaders to assist in educating the community on how to avoid illness, treat it at home, and when to enter the emergency system because the illness has progressed to high acuity.
>> Develop an electronic learning management system that gets timely materials to your employees. This has become a critical tool for EMS agencies to deliver information of timely infection control and other teaching materials and bulletins across different shifts and roles.
>> Improve the use of personal protective equipment by EMS staff, and processes that reduce exposures.
>> After sequential issues involving widespread outbreaks of various viruses in recent years, EMS personnel deserve a wellness program that offers the best possible protection from contagious diseases, whether they come in blood or droplet form, or exist in other potentially infectious materials. EMS patients deserve the same.
>> Institute a non-threatening employee illness reporting system, so there is early warning about an illness affecting multiple staff members. Develop a vaccination plan for the staff. Let staff know you’re caring for their health and safety, or over time, they won’t come to work. These steps further prove that emergency leaders are concerned about the welfare of their staff members and will help protect them from flu and any other hazards that occur in the future.

Sign up for coca@cdc.gov for more updates. This site offers regular news briefs that highlight any critical information or programs that have become available across all areas of public health. Another daily source of information is available at

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Care, Special Patients, flu season, flu, Jems Priority Traffic

Author Thumb

James J. Augustine, MD, FACEPDr Augustine is a clinical Associate Professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio. He currently serves a Medical Director role with Departments in Florida and Georgia. He is the author of numerous EMS articles.


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