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High Risk Infectious Disease Response Team Patrick Auger BHSc, MEmgt, MEd(c) CCP Introduction & Background 2 Population & Call Volume • 13,678,740 • 38.5% of Canada’s Population • Approximately 21 000 calls for service per year page 3 Introduction & Background page 4 Scope of Practice Adult/Pediatric and Obstetrical Critical Care Transport. Example of skill set • Rapid Sequence Intubation • Difficult & Advanced Airway Management & Tools (Air-traq, Bougie, Needle Cric etc.) • Mechanical Ventilation • Needle thoracostomy • Intravenous, Intraosseous, umbilical vein catheterization • Gastric tubes and foley catheters • Gastroesphageal balloon monitoring • Chest Drainage Systems • X-ray, Lab, 12 interpretation • Arterial/central line maintenance & monitoring • Transcutaneous & Transvenous pacing • Blood product administration Emergency Medical Assistance Team & Paramedics page 6 CBRN Trained Paramedics page 7 EVD outbreak in West Africa • 1st cases notified in march 2014 8th WHO declared a Public Health Emergency of International concern. • August page 8 Ebola Virus Disease (EVD) • A severe, often fatal illness • Transmitted to people from wild animals and spreads through human to human transmission • Average EVD case fatality rate is around 50%. Varied from 25% to 90% in past outbreaks page 9 What were we asked to do…. • Transport confirmed EVD cases that required advanced or critical care. page 10 PPE Training Donning Requirements • Fit Tested N95 • Goggles • Face shield • Hood • Full body barrier protection • Double Gloves Challenges of fit page 11 PPE Training Doffing Requirements • Prevention of cross contamination • Safety Officer with Checklist Step by step process to remove PPE under the direction of a safety Officer page 12 Validating Training page 13 Challenges of PPE for Paramedics Heat Stress • Inside the suit is a microenvironment • • • • Inside Temperature Humidity Air currents Work Rest Cycles Donning Patient Care Rest Increased metabolic work Doffing • Reduction in speed, thought and alertness page 14 Modification of PPE for High Risk Infectious Disease Team page 15 Powered Air Purifying Respirator (PAPR) Positive Pressure System •APF 1000 Flow Pattern – Hood – Suit – outside Cooling effect page 16 Checklists 1. 2. 3. 4. 5. 6. 7. Issues Donning Doffing Engineering Controls Safety Officer Patient Preparation & Packaging Biocontainment Work Rest Cycles Visual Guides page 18 Visual Guide – Bio-Bag page 19 Personal Kit List Team Framework Modular & Scalable Team Leader Safety Officer Paramedic Crew 1 Paramedic Crew 2 Paramedic Crew 3 page 21 Patient Preparation & Packaging Patient Transport Patient Transfer of Care page 22 Donning Crew 1 Patient Preparation & Packaging Patient Transport Patient Transfer of Care page 23 Donning Crew 1 Patient Preparation & Packaging Donning Crew 2 Doffing Crew 1 Patient Transport Patient Transfer of Care page 24 Donning Crew 1 Patient Preparation & Packaging Donning Crew 2 Doffing Crew 1 Patient Transport Donning crew 3 Doffing crew 2 Patient Transfer of Care page 25 Donning Crew 1 Patient Preparation & Packaging Donning Crew 2 Doffing Crew 1 Patient Transport Donning crew 3 Doffing crew 2 Patient Transfer of Care Doffing Crew 3 page 26 Donning Crew 1 Patient Preparation & Packaging Donning Crew 2 Doffing Crew 1 Patient Transport Donning crew 3 Doffing crew 2 Patient Transfer of Care Doffing Crew 3 Decontamination and Bio Containment page 27 Call Organization – Major Issues Patient Information Equipment & Ambulance Preparation Duration of transport & estimated work/rest cycles Designated Driving Route Patient Care Plan Doffing areas & Bio-containment Designated Security Access & Ingress Donning Area/Location Identified Support Vehicles & Recovery area page 28 Donning Principles Safety Officer Check Time Documented page 29 Patient Preparation & Packaging Tubes & Lines Prepared All potential Infusion Medications anticipated page 30 Patient Preparation & Packaging Ingress & Egress Access page 31 Patient Preparation & Packaging page 32 Patient Transport Egress issues Patient Loading page 33 Two Ambulances Mitigate Logistical Challenges Support Primary Ambulance Vehicle/Secondary Ambulance page 34 Doffing Principles Checklists & Safety Officer Designated Marked Area page 35 Doffing Principles Rolling outer layer page 36 Doffing Priniciples Colour Coded Gloves Red Biohazard Bags & Container(s) page 37 Doffing Principles Reusable Equipment page 38 Doffing Principles Suit Size very important page 39 Bio-containment Everything Wiped Down Sealed Drums page 40 Recovery Phase After Action Report • Lessons Learned • Corrective Action Plan Decontamination • Vehicle Decontamination • Equipment Decontamination • Supply Replacement page 41 Questions? page 42
