In this rapid transportation era, a disease threat can move at lightning speed, and it’s possible for an ill patient to show up in any corner of the United States tomorrow. As we face the worldwide threat of Ebola, as well as a domestic challenge of serious pediatric respiratory infections due to an enterovirus, the U.S. Metropolitan Municipalities EMS and Federal Agency Medical Directors (aka the “Eagles”) have developed and collaborated on best practices for a broad range of EMS actions. The base of the Eagles is in Dallas, Texas, at the University of Texas Southwestern Department of Emergency Medicine, the metropolitan region that faced the first Ebola patient with onset of symptoms in America.
The diagnosis of Ebola and other serious infections takes some time, and the symptoms of the diseases overlap those of very minor illnesses. But Americans want—and expect—their emergency care system to be immediately responsive, accurate and safe. The responsibility of the EMS system is to be prepared to face serious diseases with a plan for public education, response, treatment, transportation, and protection of patients, families, bystanders and providers.
In the rapid evolution of these diseases, timeliness of information exchange requires a portal that processes intelligence in the course of hours and days, not weeks. With the current set of life-threatening diseases, EMS and ED providers must be aware of the symptoms that would give an early indication of the disease. Since Ebola has never occurred in America, emergency workers are all learning firsthand what the presenting complaints might be. As that knowledge comes out of Dallas, Atlanta and Omaha (Neb.), the providers in the rest of the country need a timely update on what to look for. In similar fashion, emergency leaders must exchange best practices in the choice and use of protective equipment; the use of decontamination; the safest methods of transport to the correct receiving hospital; the most effective treatment; and the most efficient ways to prevent others from getting the infection.
Each metropolitan region has different resources, but all have public safety personnel that are the first line of response, as well as EDs that must provide the initial diagnosis and treatment. With contributions from around the country, the Eagles have assembled a set of plans that provide staged responses to disease occurrence (stage 1—when the first cases of the disease are found; stage 2—when the disease is more prevalent, and so on); provide the most timely information on patient symptoms and travel exposures that would indicate a high risk; guide the emergency providers on the use of PPE and cleaning materials; and outline the elements needed for efficient destination and transportation.
Public safety responsibilities begin with a close alignment to public health, to provide community education on the dangerous diseases and how the health care system will respond. EMS system responsibilities begin at the 9-1-1 center. Timely interrogation of the 9-1-1 caller can find the symptoms of high-priority contagious diseases, and allow first responders to take protective actions before and as they arrive at the scene.
If Ebola becomes more common in certain communities, the 9-1-1 center may develop and utilize pre-arrival instructions to have the caller start the protective process, and initiate the response of public health resources.
Information, Tools and Resources
Dallas contributed their protocols for 9-1-1 interviews, plans for EMS response, and bulletins on the use of PPE, cleaning materials, communications, documentation and receiving hospitals (see article attachments below). Washington, D.C., has an action plan for rapid diagnostics and management. Many of the Eagles have pieces of the hospital plans that will provide the safest environment for diagnosis, treatment and information exchange that will improve patient outcomes now and into the future.
Sharing critical information is a mark of highly effective emergency systems. As we manage another health threat, it’s the responsibility of every EMS provider to find and share the information that makes the difference to our patients and providers. The Eagles have initiated that process, and will continue until we mitigate the risk.