Download Any personnel that are at increased risk for influenza complications

CLEMC Standard Operating Guidelines
Document/Subject: Pandemic Influenza
Policy: 178
Document Type: SOG
Last Review: April 2009
Created: April 2009
Next Review: April 2010
1. Background:
As a component of the Nation’s critical infrastructure, emergency medical services
(along with other emergency services) play a vital role in responding to requests for
assistance, triaging patients, and providing emergency treatment to influenza patients.
However, unlike patient care in the controlled environment of a fixed medical facility,
pre-hospital EMS patient care is provided in an uncontrolled environment, often
confined to a very small space, and frequently requires rapid medical decisionmaking, and interventions with limited information. EMS personnel are frequently
unable to determine the patient history before having to administer emergency care.
2. Recommendation:
A. Patient assessment:
Interim recommendations:
CLEMC providers should assess all patients as follows:

Step 1: CLEMC personnel should stay more than 6 feet away from patients and
bystanders with symptoms and exercise appropriate routine respiratory droplet
precautions while assessing all patients for suspected cases of influenza.

Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or
cough).
o
o
If no acute febrile respiratory illness, proceed with normal EMS care.
If symptoms of acute febrile respiratory illness, then assess all patients for
travel to a geographic area with confirmed cases of influenza within the
last 7 days or close contact with someone with travel to these areas.


If travel exposure, don appropriate PPE for suspected case of
swine-origin influenza.
If no travel exposure, place a standard surgical mask on the patient
(if tolerated) and use appropriate PPE for cases of acute febrile
respiratory illness without suspicion of influenza (as described in
PPE section).
If the CDC confirmed influenza in the geographic area

Step 1: Address scene safety:
o
o

If Dispatch advises potential for acute febrile respiratory illness symptoms
on scene, CLEMC personnel should don PPE for suspected cases of
influenza prior to entering scene.
If Dispatch has not identified individuals with symptoms of acute febrile
respiratory illness on scene, CLEMC personnel should stay more than 6
feet away from patient and bystanders with symptoms and exercise
appropriate routine respiratory droplet precautions while assessing all
patients for suspected cases of influenza.
Step 2: Assess all patients for symptoms of acute febrile respiratory illness (fever
plus one or more of the following: nasal congestion/ rhinorrhea, sore throat, or
cough).
o
o
If no symptoms of acute febrile respiratory illness, provide routine EMS
care.
If symptoms of acute febrile respiratory illness, don appropriate PPE for
suspected case of influenza if not already on.
B. Personal protective equipment (PPE):
Interim recommendations:

When treating a patient with a suspected case of influenza as defined above, the
following PPE should be worn:
o

Disposable N95 respirator and eye protection (e.g., goggles; eye shield),
disposable non-sterile gloves, and gown, when coming into close contact
with the patient.
When treating a patient that is not a suspected case of influenza but who has
symptoms of acute febrile respiratory illness, the following precautions should be
taken:
o
o
Place a standard surgical mask on the patient, if tolerated. If not tolerated,
EMS personnel may wear a standard surgical mask.
Use good respiratory hygiene – use non-sterile gloves for contact with
patient, patient secretions, or surfaces that may have been contaminated.
Follow hand hygiene including hand washing or cleansing with alcohol
based hand disinfectant after contact.

Encourage good patient compartment vehicle airflow/ ventilation to reduce the
concentration of aerosol accumulation when possible.
C. Infection Control:
CLEMC Members should always practice basic infection control procedures including
vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and
proper use of FDA cleared or authorized medical personal protective equipment
(PPE).
Interim recommendations:



Pending clarification of transmission patterns for a pandemic outbreak, Clemc
Members who are in close contact with patients with suspected or confirmed
cases should wear a disposable N95 respirator, disposable non-sterile gloves, eye
protection (e.g., goggles; eye shields), and gown, when coming into close contact
with the patient.
All CLEMC Members engaged in aerosol generating activities (e.g. endotracheal
intubation, nebulizer treatment, and resuscitation involving emergency intubation
or cardiac pulmonary resuscitation) should wear a disposable N95 respirator,
disposable non-sterile gloves, eye protection (e.g., goggles; eye shields), and
gown, unless CLEMC personnel are able to rule out acute febrile respiratory
illness or travel to an endemic area in the patient being treated.
All patients with acute febrile respiratory illness should wear a surgical mask, if
tolerated by the patient.
D. Transport
CLEMC personnel involved in the transfer of patients with suspected or confirmed
influenza should use standard, droplet and contact precautions for all patient care
activities. This should include wearing a fit-tested disposable N95 respirator, wearing
disposable non-sterile gloves, eye protection (e.g., goggles, eyeshield), and gown, to
prevent conjunctival exposure. If the transported patient can tolerate a facemask (e.g.,
a surgical mask), its use can help to minimize the spread of infectious droplets in the
patient care compartment. Encourage good patient compartment vehicle airflow/
ventilation to reduce the concentration of aerosol accumulation when possible.
E. Interim Guidance for Cleaning EMS Transport Vehicles After Transporting
a Suspected or Confirmed Influenza Patient
The following are general guidelines for cleaning or maintaining EMS transport
vehicles and equipment after transporting a suspected or confirmed influenza patient.
This guidance may be modified or additional procedures may be recommended by the
Centers for Disease Control and Prevention (CDC) as new information becomes
available.
Routine cleaning with soap or detergent and water to remove soil and organic matter,
followed by the proper use of disinfectants, are the basic components of effective
environmental management of influenza. Reducing the number of influenza virus
particles on a surface through these steps can reduce the chances of hand transfer of
virus. Influenza viruses are susceptible to inactivation by a number of chemical
disinfectants readily available from consumer and commercial sources.
After the patient has been removed and prior to cleaning, the air within the vehicle
may be exhausted by opening the doors and windows of the vehicle while the
ventilation system is running. This should be done outdoors and away from pedestrian
traffic. Routine cleaning methods should be employed throughout the vehicle and on
non-disposable equipment.
F. EMS Transfer of Patient Care to a Healthcare Facility
When transporting a patient with symptoms of acute febrile respiratory illness,
CLEMC personnel should notify the receiving healthcare facility so that appropriate
infection control precautions may be taken prior to patient arrival. Patients with acute
febrile respiratory illness should wear a surgical mask, if tolerated. Small facemasks
are available that can be worn by children, but it may be problematic for children to
wear them correctly and consistently. Moreover, no facemasks (or respirators) have
been cleared by the FDA specifically for use by children.
3. Occupational Health
A. Sick Leave Policy
During the outbreak of a Pandemic Flu the Chief of Operations in conjunction with
the Medical Director will be making several changes to the Sick Leave Policies. A
liberal/non-punitive sick leave policy will be placed in effect. If a member test
positive for a pandemic flu, the will not be allowed to return to work for a minimum
of 7 (seven) days. Any member who develops a fever greater than 100.0 degrees will
not be allowed to work until they are fever free for a minimum of 24 hours. Any
personnel who need to care for sick family members will need to contact the on-duty
supervisor immediately. The supervisor will consult with the Chief of Operations and
the Medical Director whom will decide on a course of action for the personnel.
B. Personnel at increased rick for influenza complications
Any personnel that are at increased risk for influenza complications (i.e. pregnant
women, immunocompromised personnel, etc.) will be placed on administrative leave
or have their work locations altered at the direction of the Chief of Operations in
conjunction with the Medical Director.
C. Faith based resources
If any CLEMC member is in need of Faith based resources, a MOU has been set up
with Fire & EMS Chaplaincy to offer theses services. The can be accessed at
[email protected]
4. Chemoprophylaxis:
Antiviral chemoprophylaxis (pre-exposure or post-exposure) is recommended for close
contacts of a confirmed or highly suspected case of influenza virus infection.
Chemoprophylaxis is recommended for health care workers caring for patients ill with
confirmed or highly suspected influenza.
If you are exposed to the pandemic flu virus, you should notify the On-duty supervisor
immediately. The On-duty supervisor will authorize you to obtain testing at Clear Lake
Regional Medical Center ED. Clear Lake Emergency ED will perform nasal swabs as
needed for testing and start antiviral chemoprophylaxis as needed.
5. Influenza Vaccinations
The Clear Lake Emergency Medical Corps will offer its members free influenza
vaccination on an annual basis. The vaccination is voluntary and will not be made
mandatory by any CLEMC member.
6. Surge capacity
CLEMC will keep a minimum of 2 (two) weeks supply of consumables resources (i.e.
masks, gloves, hand hygiene products) on hand at all times. If at anytime a member
notes a decrease in the amount of consumable resources in supply, they are to contact the
On-duty supervisor immediately. The On-duty supervisor will contact the Chief of
Operations and the Supply Officer and further consumable resources will be procured.
CLEMC will rely on its normal channels to procure supplies, but if these channels are
exhausted, the Supply Officer or the Chief of Operations will make contact with the
Governor’s Office of Emergency Management to assist in locating other sources of
supplies. If CLEMC develops a large surge in call volume, the Chief of Operations in
conjunction with the Medical Director will place CLEMC Disaster Plan (Encl 01) into
effect. At that time, CLEMC will not be responding to any request for mutual aid out of
its own territory without approval from the Chief of Operations.
7. Staffing
If CLEMC develops a staffing shortage, it will start by placing its Mandatory Overtime
Standard Operating Guideline, SOG # 167 (Encl 02) into effect. If needed due to
continued staff shortage, CLEMC will drop down to 2 (two) districts and run both
districts out of CLEMC Station 1 at the discretion of the Chief of Operations in
conjunction with the Medical Director.
From: R.L. Hunter
Chief, Clear Lake Emergency Medical Corps (CLEMC)
To:
Texas Department of State Health Service
Ref:
CLEMC DISASTER PLAN IMPLAMENATION
CLEMC is activating its Disaster Plan with Verbal Orders from Dr. Abel Longoria
(CLEMC Medical Director). This has been precipitated due to the outbreak of a
Pandemic Flu in the local area. As part of our disaster plan, CLEMC will be triaging all
patients in the field. Minor injuries will be treated and not transported. Only life
threatening conditions, (chest pain, strokes, open fractures, etc.) will be transported.
When working a cardiac arrest, two rounds of ACLS medications will be administered.
If there is no change in the patient condition, we will attempt to contact Clear Lake
Hospital ED for termination orders. If we are unable to make contact with Clear Lake
Hospital ED, a CLEMC supervisor or the Chief of Operations will be contacted for
termination orders. If you need any further information please feel free to contact me at
281-488-3078.
Sincerely,
Roy L. Hunter,
Chief, CLEMC
Encl (01)
CLEMC Standard Operating Guidelines
Document/Subject: Mandatory Overtime
Policy: 167
Document Type: SOG
Last Review: March 2009
Created: January 2007
Next Review: March 2010
1. Purpose:
● To define how shifts will be filled if needed under mandatory overtime.
2. Commentary:
● To ensure that all on duty units are staffed, the following SOG will be used if
CLEMC needs to go into a mandatory overtime.
3. Procedure:
● The full time person with the least seniority at the needed certification level for
the shift will be the person held over for mandatory overtime. This will rotate
through during the next mandatory period to the next person with the least
seniority. This will continue in this fashion until all persons in the needed
certification level have been held on mandatory overtime and will start over with
the person with the least seniority.
● During disaster declaration, this policy will be modified as needed by the Chief
of Operations or the Shift Supervisor.
.
(Encl 02)