Download Ebola Exposure - Office Hours Telephone Triage Protocols

Ebola Exposure
Office Hours Telephone Triage Protocols | Adult | 2014
DEFINITION
Travel to or living in an area with recent local transmission of Ebola (i.e., countries in West Africa;
Guinea, Liberia, Sierra Leone)
Exposure to a person with suspected or proven Ebola
Questions about Ebola
EXPOSURE to Ebola is defined as:
Physical contact (touching) a person with suspected or proven Ebola. Examples include kissing,
hugging, holding hands, carrying someone, and sharing eating or drinking utensils. Other examples
are performing a physical examination (relevant to health care providers) and touching a dead body.
Contact with blood or body fluids of a person with suspected or proven Ebola. Body fluids
include breast milk, saliva, semen, stool, sweat, urine, and vomit. Examples are dirty clothes,
bedding, needles, and medical equipment.
Handling of bats or primates (e.g., apes, monkeys) in countries that have an Ebola outbreak.
TRIAGE ASSESSMENT QUESTIONS FOR EBOLA EXPOSURE
Call EMS 911 Now
Sounds like a life-threatening emergency to the triager
See More Appropriate Protocol
Fever occurs more than 21 days after last Ebola EXPOSURE
Go to Guideline: Fever (Adult)
Go to ED Now
Fever within 21 days of Ebola EXPOSURE
R/O: Ebola Virus Disease. Note: After Ebola Exposure, a person with any fever should be evaluated. An
oral temperature of 100.0° F ( 37.8° C) or higher is a fever. And, if person does not have a thermometer,
then fever is a (subjective) sense of feeling too warm.
Abdominal pain, diarrhea, or vomiting within 21 days of Ebola EXPOSURE
R/O: Ebola Virus Disease
Headache within 21 days of Ebola EXPOSURE
R/O: Ebola Virus Disease
Unexplained bleeding or bruising and within 21 days of Ebola EXPOSURE
R/O: Ebola Virus Disease
Any symptoms that are unexplained occur within 21 days of Ebola EXPOSURE
R/O: Ebola Virus Disease
Go to ED Now (or to Office with PCP Approval)
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Patient sounds very sick or weak to the triager
Reason: severe acute illness or serious complication suspected
Call Local Agency Today
Ebola EXPOSURE within past 21 days and NO fever or other symptoms such as abdominal pain,
diarrhea, fever, headache, vomiting or bleeding/bruising
Reason: No symptoms of Ebola infection; people exposed to Ebola but without symptoms need to be
followed closely by a health care provider.
Home Care
Ebola EXPOSURE more than 21 days ago
Reason: Asymptomatic. Symptoms appear 2 to 21 days after exposure to Ebola. The average is 8-10 days.
Ebola, questions about
CARE ADVICE
Ebola Exposure within 21 Days and Symptoms
1.
Note to Triager - Emergency Disposition is Recommended:
If the patient is located currently in a country where Emergency Departments (ED) are
available, then referral to the nearest ED is recommended.
Reason: The ED will be most prepared for taking care of such a patient. The ED has correct
infection control procedures and personal protective equipment (PPE).
2.
Note to Triager - Triage Nurse Should Notify Emergency Department (ED):
The triager must call ahead to the ED and inform them of patient's symptoms and suspected
diagnosis of Ebola. Obtain and document the patient / caller's mobile phone number. Either
keep the patient on hold or call the patient back with instructions.
Reason: So that ED can make arrangements to prevent Ebola transmission to others in the
hospital.
Transport: In some communities, the ED or PHD (Public Health Department) may have a
special ambulance for transporting suspected Ebola patients. Follow PHD directives.
3.
You should Go to the Emergency Department (ED):
You will need to go to a nearby ED.
Do not leave until I've called and talked with the ED. The ED may have special instructions on
how best to get you there. I will call you back (or place you on hold).
The ED is the best place to get testing and treatment.
The ED is most prepared to prevent the spread of this infection to others.
4.
Isolation Is Needed:
Do Not go to work or school
Do Not go to church, child care centers, shopping, or other public places.
Avoid close contact with others (hugging, kissing). Do Not shake hands.
5.
Protect Others from Your Body Fluids:
Protect others from your blood and other body fluids!
Body fluids include breast milk, saliva, semen, stool, sweat, urine, and vomit.
Cover any bleeding area with a towel or cloth.
Other people should avoid contact with your blood or body fluids. They should not touch you.
They should not handle your bedding materials or dirty clothes.
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Ebola Exposure within 21 Days and No Symptoms
1.
Note to Triager - Triage Nurse Should Notify the Local Public Health Department:
The triage nurse should notify the local public health department. Obtain and document
the patient / caller's mobile phone number.
The patient should also call the local public health department. The patient should stay at
home and avoid contact with others until he/she has talked with the public health department.
The patient should check his/her temperature two times a day.
Reason: People exposed to Ebola but without symptoms need to be followed closely by a
health care provider. Early detection of symptoms is the only way to prevent spread of the
disease.
2.
Reassurance:
Although you were exposed to Ebola, you do not have any symptoms.
The Ebola infection starts within 21 days following the last exposure.
Since it's been less than 21 days, you still are at risk for coming down with Ebola.
You will need to take to watch for symptoms until 21 days have passed.
3.
Stay at Home, Check Your Temperature:
Stay at home until you talk with the public health department or your doctor.
They will tell you how much isolation is needed during the 21 days.
Check your temperature two times a day. Report any fever or symptoms to the health care
person person monitoring you.
4.
Ebola - General Info:
Ebola virus disease (EVD or Ebola) is an infection caused by the Ebola virus. It is a rare but
deadly infection.
Previously it was called Ebola hemorrhagic fever.
There have been small outbreaks in Africa since 1976. In 2014, a major outbreak of Ebola
started in Guinea in West Africa.
On September 30, 2014, the CDC reported the first case of Ebola in the United States. The
patient got Ebola while in Liberia.
5.
Ebola - Symptoms:
Symptoms appear 2 to 21 days after the last exposure to Ebola. The average is 8-10 days.
Fever is a common and concerning symptom. After Ebola Exposure, if you have any fever you
need to be checked. An oral temperature of 100.0° F ( 37.8° C) or higher is a fever. If you do not
have a thermometer, then fever is a (subjective) sense of feeling too warm.
Other symptoms include: abdominal pain, diarrhea, severe headache, muscle pain (myalgia),
vomiting, and weakness. Bleeding and bruising are late symptoms.
6.
Ebola - How it is Spread:
Ebola can be spread to others.
People with Ebola do not spread the disease until they become sick and get a fever.
The Ebola virus can be spread by blood or body fluids (including breast milk, feces, saliva,
semen, sweat, urine, vomit) of a person who is sick with Ebola. It can be spread by
contaminated objects (like needles and syringes). It can be spread by handling and infected
animals such as bats and primates (apes, monkeys) in countries that have an Ebola outbreak.
Ebola is not spread by coughing or sneezing. It is not spread in the water nor in food. There
is no evidence that it is spread by mosquitoes or other insects. Ebola is not spread through body
fluid contact with intact skin. Blood or vomit on normal skin is safe if carefully washed off.
7.
Call Back If:
Fever occurs within 21 days of Ebola exposure
Abdominal pain, diarrhea, or vomiting occurs within 21 days of Ebola exposure
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Headache occurs within 21 days of Ebola exposure
Unexplained bruising or bleeding occurs within 21 days of Ebola exposure
You have more questions.
Ebola Exposure Over 21 Days Ago and No Symptoms
1.
Reassurance:
Symptoms appear 2 to 21 days after the last exposure to Ebola. The average is 8-10 days.
If you have not had any of the most common symptoms (fever, abdominal pain, headache,
unexplained bleeding) during the 21 days after an exposure, then you should be safe from
getting Ebola.
2.
Call Back If:
Fever develops
You become worse.
Questions About Ebola Virus Disease (EVD)
1.
Ebola - General Info:
Ebola Virus Disease (EVD or Ebola) is an infection caused by the Ebola virus. It is rare but
deadly.
In the past it was called Ebola hemorrhagic fever.
Ebola was first reported in 1976 near the Ebola river in the Democratic Republic of the Congo.
There have been sporadic outbreaks in Africa since then. In 2014 there was a major outbreak of
Ebola in Western Africa.
2.
Ebola - Symptoms:
Symptoms appear 2 to 21 days after the last exposure to Ebola. The average is 8-10 days.
Fever is a common and concerning symptom. After Ebola Exposure, if you have any fever you
need to be checked. An oral temperature of 100.0° F ( 37.8° C) or higher is a fever. If you do not
have a thermometer, then fever is a (subjective) sense of feeling too warm.
Other symptoms include: abdominal pain, diarrhea, severe headache, muscle pain (myalgia),
vomiting, and weakness. Bleeding and bruising are late symptoms.
3.
Ebola - How it is Spread:
Ebola can be spread to others.
People with Ebola do not spread the disease until they become sick and get a fever.
The Ebola virus can be spread by blood or body fluids (including breast milk, feces, saliva,
semen, sweat, urine, vomit) of a person who is sick with or died from Ebola. It can be spread by
contaminated objects (like needles and syringes). It can be spread by handling and infected
animals such as bats and primates (apes, monkeys) in countries that have an Ebola outbreak.
Ebola is usually not spread by coughing or sneezing. In general, coughing and sneezing are
not Ebola symptoms. Therefore, Ebola is usually not spread this way. But, a sick person's cough
or sneeze may contain the virus in the spray. If the spray gets into the eyes, nose or mouth, it
could transmit the disease.
Ebola is not spread in the water nor in food. There is no evidence that it is spread by
mosquitoes or other insects. Ebola is not spread through body fluid contact with intact skin.
Blood or vomit on normal skin is safe if carefully washed off.
5.
Ebola - Countries with Ebola Outbreaks:
Nearly all patients with Ebola have been linked to countries in West Africa. They have either
lived in or have traveled to one of these countries: Guinea, Liberia, Sierra Leone.
If you neither live nor have traveled to one of these countries, your risk of getting Ebola is very
low.
For the most up-to-date list of countries where Ebola is occurring, go to the CDC website
(www.cdc.gov).
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5.
Ebola - Internet Resources
Australia Department of Health:
http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-ebola-info-patients.htm
Centers for Disease Control, United States (CDC): http://www.cdc.gov/vhf/ebola/index.html
Health Canada: http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-eng.php
World Health Organization (WHO): http://www.who.int/mediacentre/factsheets/fs103/en/
7.
Call Back If:
You have other questions.
Treating Fever
1.
For All Fevers:
Drink cold fluids orally to prevent dehydration (Reason: good hydration replaces sweat and
improves heat loss via skin). Adults should drink 6-8 glasses of water daily.
Dress in one layer of lightweight clothing and sleep with one light blanket.
For fevers 100-101° F (37.8-38.3° C) this is the only treatment and fever medicine is
unnecessary.
2.
Fever Medicine:
For fever above 101° F (38.3° C) you may take acetaminophen (e.g., Regular or Extra
Strength Tylenol).
Regular Strength Tylenol: Take 650 mg (two 325 mg pills) by mouth. Each Regular Strength
Tylenol pill has 325 mg of acetaminophen.
Extra Strength Tylenol: Take 1,000 mg (two 500 mg pills) by mouth. Each Extra Strength
Tylenol pill has 500 mg of acetaminophen.
Do NOT take aspirin or ibuprofen (e.g., Advil, Motrin)
Read the package instructions thoroughly on all medications that you take.
FIRST AID
FIRST AID Advice for Someone Else's Body Fluid on the Skin:
Wash skin with soap and water.
FIRST AID Advice for Someone Else's Body Fluid in the Eye:
Flush the eye with tap water right away. Reason: to rinse out the body fluid. Do this for 2-3 minutes.
Wash skin of face with soap and water.
FIRST AID Advice for Someone Else's Body Fluid in the Mouth:
Rinse the mouth with water and spit it out. Do this repeatedly for 2-3 minutes.
Wash skin of face with soap and water.
FIRST AID Advice for Someone Else's Body Fluid in the Nose:
Rinse the nostrils with water and then blow your nose. You can do this by placing your face under a
faucet or by taking a shower. Another option is using a NETI pot or some type of squirt bottle or
syringe. Do this over and over for 2-3 minutes.
Wash skin of face with soap and water.
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BACKGROUND INFORMATION
Cause
Ebola virus disease (EVD or Ebola) is an infection caused by the Ebola virus. It is a rare but
deadly infection.
Previously it was called Ebola hemorrhagic fever.
There have been small outbreaks in Africa since 1976. In 2014, a major outbreak of Ebola started in
Guinea in West Africa.
On September 30, 2014, the CDC reported the first case of Ebola in the United States. The patient
got Ebola while in Liberia.
Symptoms
Symptoms appear 2 to 21 days after exposure to Ebola. The average is 8-10 days.
Symptoms include:
Fever over 101.5° F (38.6° C)
Abdominal pain
Diarrhea
Vomiting
Headache, severe
Muscle pain
Weakness
Bleeding and bruising
Transmission
Ebola can be spread to others. Ebola is spread through direct contact with:
Blood or body fluids of a person who is sick with Ebola. Body fluids include breast milk, saliva,
semen, stool, sweat, urine, and vomit.
Contact with the dead body of a person who died from Ebola.
Objects like dirty clothes, bedding, needles and syringes that have blood or body fluid on them.
How is the Ebola virus spread? Ebola can start when infected fluid gets into the eyes, nose or mouth.
This mainly happens if infected fluid gets on the hands. Then, the healthy person touches their face
with dirty hands. Thus, frequent hand washing is helpful. Rarely, the virus may pass through an open
cut on the skin.
People with Ebola do not spread the disease until they become sick and get a fever. Ebola is not
spread through body fluid contact with intact skin. Blood or vomit on normal skin is safe if carefully
washed off.
In general, coughing and sneezing are not Ebola symptoms. Therefore, Ebola is usually not spread
this way. But, a sick person's cough or sneeze may contain the virus in the spray. If the spray gets
into the eyes, nose or mouth, it could transmit the disease.
Ebola is not spread in the water nor in food. There is no evidence that it is spread by mosquitoes or
other insects.
One can also get Ebola from infected animals, such as bats and primates (apes, monkeys) in
countries where there has been an outbreak of Ebola.
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What Countries have Ebola Outbreaks?
All patients with Ebola Virus Disease have been linked to countries in and around the West Africa.
They have either lived in or have traveled recently to one of these countries.
Guinea
Liberia
Sierra Leone
These countries can change. The CDC website (www.cdc.gov) maintains an up-to-date list of
countries where an outbreak is occurring.
Prognosis
The World Health Organization (WHO) estimates mortality of the current (2014) outbreak in West
Africa to be approximately 55 - 75%.
Internet Resources
Australia Department of Health: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohpebola-info-patients.htm
Centers for Disease Control, United States (CDC): http://www.cdc.gov/vhf/ebola/index.html
Centers for Disease Control - Traveler Advisories and Traveler's Health:
http://wwwnc.cdc.gov/travel/diseases/ebola
Health Canada: http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-eng.php
World Health Organization (WHO): http://www.who.int/mediacentre/factsheets/fs103/en/
REFERENCES
1.
Adams DA, Jajosky RA, Ajani U, Kriseman J, Sharp P, Onwen DH, Schley AW, Anderson
WJ, Grigoryan A, Aranas AE, Wodajo MS, Abellera JP. Summary of notifiable diseases United States, 2012. MMWR Morb Mortal Wkly Rep. 2014 Sep 19;61(53):1-121.
2.
Centers for Disease Control and Prevention (CDC). Ebola Virus Disease (EVD). Available
at: http://www.cdc.gov/vhf/ebola/. Last accessed 10/17/2014.
3.
Centers for Disease Control and Prevention. Evaluating Patients for Possible Ebola Virus
Disease: Recommendations for Healthcare Personnel and Health Officials. CDC Health
Advisory. HAN00371. Available at: http://emergency.cdc.gov/han/han00371.asp. Last
access 10/4/2014.
4.
Kanapathipillai R. Ebola virus disease--current knowledge. N Engl J Med. 2014 Sep
25;371(13):e18.
5.
Meltzer MI, Atkins CY, Santibanez S, Knust B, Petersen BW, Ervin ED, Nichol ST, Damon
IK, Washington ML. Estimating the Future Number of Cases in the Ebola Epidemic --Liberia and Sierra Leone, 2014--2015. MMWR Surveill Summ. 2014 Sep 26;63:1-14.
6.
World Health Organization. Last accessed 10/20/2014. Clinical Management of Patients
with Viral Hemorrhagic Fever: A Pocket Guide for the Front-Line Health Worker. World
Health Organization. Available at
http://apps.who.int/iris/bitstream/10665/130883/2/WHO_HSE_PED_AIP_14.05.pdf.
Office Hours Telephone Triage Protocols | Adult | 2014
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AUTHOR AND COPYRIGHT
Author:
David A. Thompson, M.D.
Copyright:
2000-2014 David A. Thompson, MD. All rights reserved.
Company:
Schmitt-Thompson Clinical Content
Content Set:
Office Hours Telephone Triage Protocols | Adult
Version Year:
2014
Last Revised:
10/20/2014
Last Reviewed:
10/20/2014
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