After an autumn filled with headlines of Ebola, with about a dozen patients treated in the United States, the winter began with a major outbreak of influenza, and thousands have been affected.
Beginning in December, the flu spread from the Midwest to the coasts. Early pediatric deaths made headlines, but the public’s attention wasn’t focused on influenza until the Centers for Disease Control and Prevention (CDC) declared an epidemic on Dec. 30, 2014.
The CDC distributed the 2014–2015 influenza vaccine at the start of September 2014, but the vaccine elements weren’t a good match for the major villain in this year’s outbreak, which was an H3N2 strain of influenza A. EMS and public health officials noted the rapid increase in patient volumes in December, and hospitals saw a large increase within weeks.
Each year, the influenza season has certain elements that are predictable, and many that aren’t. How should EMS leaders develop programs for preparedness that can get traction with their own personnel, as well as the communities they serve? Here are three recommendations:
- EMS providers need to get annual influenza vaccines to improve short-term and lifelong disease resistance;
- EMS providers will have high rates of illness and may not be confident to come to work when infection risks are very high unless a rigorous program of infection control is in place; and
- Take advantage of the opportunity to improve the health and education of your EMS staff, especially the field providers, and take part in healthcare and community education on flu, Ebola, and other contagious diseases, to improve long-term EMS operations.
Viruses have been an unpredictable element of public health preparedness for centuries, and will continue to challenge the best that science can respond with. Viruses like Ebola have very high fatality rates. Influenza viruses are associated with severe illness and some deaths, have clear seasonal patterns and, over time, circulate through cycles of A and B types. This cycle allows parts of the human population to develop immunity, especially if they supplement their immune system with influenza vaccines. This development of immunity is very important to healthcare providers, including EMS personnel, and the community’s immune system is stronger when EMTs and paramedics get vaccinated annually.
Beyond vaccines, there are three ongoing protection strategies for the community and for EMS providers, who have an even higher risk of exposure to the disease. This process of supplying and reinforcing infection control is a major element of day-to-day prevention of illness in EMS providers. They’re also the building blocks necessary for EMTs and paramedics to function when at risk for dangerous infections.
There are at least three elements of an EMS infection control program.
- Maintain vaccines for all diseases EMTs are at risk for.
- Barrier protections are needed for bloodborne and airborne diseases. Gloves, gowns, masks and, sometimes, more complete barriers are needed.
- Ill providers should stay at home and rest to avoid spreading the infection to patients and co-workers.
- Wash hands well and often. Use soap and water to make a lather, scrubbing for 30 seconds.
- Use hand sanitizer to supplement washes with water and soap. Diseases like C. diff are transmissible unless hand washing is used. Sanitizers alone won’t work.
- Have the patient wear a mask. Stay six feet away from the ill patient until proper PPE can be donned.
- Ask the patient to cover coughs and sneezes with a tissue or their upper arm. Throw tissues away and wash hands or use hand sanitizer.
EMS systems have a very important and ongoing role in educating the public on infection control. Look for opportunities to work with public health agencies on any messages relating to emergency care, and allow them to use an EMS system as a backdrop for media releases on general community health issues. Take every opportunity to work with the local media and hospital communication staff. Where appropriate, set up a seasonal and annual EMS public education program, using EMS Week and other markers.
It’s appropriate for EMS leaders to access and utilize CDC documents and releases. Develop a reputation for helping the local media get the correct and accurate details on outbreaks. Infection control stories are very complex, and require the best communicators to convey a clear message to the community. Develop releases and find speakers whose message is consistent with releases from the CDC and state and local health agencies.
In communities with multiple EDs, work collaboratively with the regional ED and other EMS system leaders to develop an infection control response that’s consistent, as well as timely and effective. Release consistent statements, appear at joint press conferences and underscore how each agency is sharing information and applying the same management principles.
The widespread and dangerous nature of the influenza outbreak this year has given everyone cause for concern. On top of Ebola coverage, these are ideal times for EMS agency planning. The EMS system plays a critical role in surveillance, care and dissemination of information about all contagious diseases.