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Stop EMS Providers from Spreading the Flu

1Wk-Wesley

Review of:

Rueckmann E, Shah MN, Humiston SG: Influenza vaccination among emergency medical services and emergency department personnel. Prehospital Emergency Care. Jan-Mar;13(1):1-5, 2009.

The Science

This rather simple but very enlightening survey study was performed in Rochester, N.Y. during July/August of 2006. In it, 128 EMT/Medics and 128 emergency department (ED) personnel were asked whether they had received the influenza vaccine for the previous (2005-2006) flu season. Only 26 of 128 (21%) EMS providers compared to 83 of 128 (65%) ED personnel had done so.

When asked what interventions would have led to an increase likelihood of them getting the vaccine, the most commonly chosen answer by EMS providers and ED personnel was "no waiting" vaccination delivery at work (71% and 62%, respectively) and free vaccination (59% and 50%, respectively). When asked about important factors in the decision whether to get an influenza shot the following season, the most common response was frequency of exposure (71%, 69%) and concern about secondarily exposing family members (62%, 60%).

It should be noted that the EMS service in this study didn't provide free, on-site vaccination to their providers. They had to pay for it themselves and obtain it elsewhere. The hospital did provide the service free to its ED personnel.

The researchers concluded, "EMS providers reported low influenza vaccination levels in 2005 2006, even as compared with ED personnel. This failure to receive vaccination poses potential risk to the workers themselves and their patients. Resolution of reported barriers could lead to higher vaccination rates."

The Street

I find this article at odds with our obsession with "BSI." We begin every skill station with the donning of the magical gloves, which we never remove for the remainder of the patient experience, spreading germs from our patients to the radio, to the pen we use to complete the run report. But I digress. We continue to be concerned about contracting HIV, hepatitis and TB, yet every year we re exposed to influenza and do little to prevent it.

OK. It's just the flu, right? We may miss a couple of days of work. But the issue is that before we get the spiking fever and chills that result in our sick call, we're shedding the virus and during that time we're in contact with some very immuno-compromised patients. The Centers for Disease Control and Prevention(CDC) doesn't provide hard numbers on how many deaths occur from influenza, but the 122 surveillance cities during the 2005-2006 flu season reported 8% to 10% of their hospitalized deaths were caused by influenza or the complications of influenza.

The CDC's 2005 target for citizen immunization was 45%, and vaccinated EMS in this study amounted to less than half that. How can we be good stewards of our patients' care when we can't protect them from catching our cold? Perhaps I'm being too harsh, and I hope that this service is not the norm. However, this is the first published study of EMS vaccination rates.

Perhaps things have changed since 2005 and your service enjoys the same benefits of free, on-site immunization as hospital personnel. If so, then publish it. If not, you should demand it. I'm proud to state that HealthEast Medical Transportation in St. Paul, Minn. provides free, on-site vaccination of their employees. And for the 2008/2009 flu season, 75% of employees took the online education program, and 55% received the flu shot.

The authors of this study were so bold as to suggest the Joint Commission on Accreditation of Hospitals require EMS providers be provided free immunizations. Perhaps the Departments of Public Health should do the same. Hopefully, the "cover your cough" and other vaccination programs have increased awareness of the importance of vaccination, but this study is concerning, and it's incumbent on us to set the facts straight they're if indeed better than this.

The retail cost of the 2005 flu shot was only $11. The cost of complicating the admission of an elderly diabetic patients admission with influenza? Incalculable.

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