Download Infectious Disease Ambulance Response Team (Draft)

Contra Costa Emergency Medical Services
Infectious Disease Ambulance Response Team (IDART)
Conceptual Model
Background: Recent developments associated with emerging diseases have demonstrated the
challenges and difficulties of assuring all health care providers are trained, equipped and
competent in protocols that rarely needed but have the potential for tremendous harm if not
managed effectively. Organizations1 expert in the management of emerging highly infectious
disease understand that high risk, low frequency patient(s) require specialized, highly
competent medical transportation teams to effectively protect patients, workforce and the
community at large. The recent events associated with Ebola patients in the United States
require the Contra Costa EMS System to respond by working with 9-1-1 emergency ambulance
providers to create a new strategic asset. This new strategic asset will be called the Infectious
Disease Ambulance Response Team (IDART) and will be capable of managing a potential or
confirmed infectious scene much like a HazMat team would respond and manage the scene of
toxic spill.
Goal: Provide a strategic ambulance asset supported by appropriate medical oversight to the
medical health community facing the challenges of managing emerging infectious diseases.
Objectives:
1. To provide reliable specialized emergency medical transportation resource for patients
with suspected and confirmed cases of known and emerging infectious diseases.
2. Assure the highest level of competency in EMS personnel responsible for the medical
transportation of suspect or confirmed disease that warrants activation of IDART.
3. Reduce risk by reducing the number of first responders and non-IDART ambulance
personnel needed to respond and manage a suspect or confirmed patient with
infectious disease.
4. The IDART would be periodically evaluated and could be stood up or down during
periods of high or low threat much as ambulance strike teams are used in the present
system
5. IDART personnel would be recruited to serve on a dedicated elite team of prehospital
professionals qualified to effectively manage high risk infectious disease medical
transportation.
1
Emory University Center, University of Nebraska Medical Center
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Concept of Operations: Efforts to support increase awareness and appropriate use of PPE as
part of the normal EMS System workflow. However these measures may not be sufficient.
Lessons learned from recent experience with Ebola have demonstrated that it is difficult to
expect that expert PPE use among health care providers. The is especially true in the settings
EMS personnel are force to work in which are unpredictable unlike the hospital setting that is
more controlled.
The expectation that all providers in all medical settings can achieve a uniform level of technical
expertise in the management of patients with a potentially highly infectious disease is
unrealistic. Given that these diseases may have prolonged incubation periods complicate and
confuse providers as to what level of PPE is really necessary during patient contact. In addition
emerging disease are known to “evolve” and “change” and it is difficult to assure timely up to
date education and training when there is minimal infrastructure in many EMS systems to
support that function. The fact that EMS may come in contact patients at any point of the
disease process requires a more strategic approach.
The ambulance strike team rapid response model provides an appropriate concept of
operations. This approach would provide a small but highly trained team of EMS providers
(paramedics and EMTs) skilled in PPE, isolation and safe medical transport of at risk patients
creates an important and effective asset for the community while reducing risk within the
emergency medical and med/health system. The asset would accessible 24/7 365 to respond
to all settings for patients with suspect or confirmed conditions known to be highly infectious.
An IDART unit could be activated in the following ways:
1. If during a 911 call the dispatcher learns of a possible suspect case e.g. caller reports risk
factors of Ebola the unit would be deployed. Fire First responders would not be
deployed to reduce potential for exposure and risk.
2. If during a 911 call the dispatcher learns from an ambulatory health care setting of a
suspect case the unit will be deployed. Fire First responders would not be deployed to
reduce potential for exposure and risk.
3. If on scene either first responders or first on scene emergency ambulance learn of a
possible suspect case on initial screening the IDART unit will be deployed. Fire First
responders would not be deployed to reduce potential for exposure and risk.
4. Response to landing zone for air to ground transfer of suspect patient to a receiving
facility
5. Response to a hospital facility for planned or urgent intrafacility transfer of patients to
receiving center.
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6. IDART response times may be greater in some cases however control of the
environment to reduce spread of the disease and protection of the workforce in are the
highest priorities when responding to these events.
Participation: All 911 emergency ambulance providers in Contra Costa will be invited to
participate in this voluntary program with an ideal minimum configuration of 3 AMR units (1 for
East, West and Central County), 1 for Moraga Orinda Fire Protection District and 1 for San
Ramon Fire Protection District
Plan: CCEMS in coordination with CCHS Public Health and the emergency ambulance providers
will develop the program. The program oversight will be the responsibility of CCEMS Medical
Director in close coordination with CCHS Public Health. Each ambulance provider will
determine how best to integrate the units during down time into their normal 911 workflow.
Competency Based Training:
1. Overview of Emerging Infectious Disease, Mechanisms of transmission and principles for
exposure risk.
2. Appropriate medical management of the patient during transport including mechanisms
to limit patient contact to reduce exposure and potential for inoculation.
3. Instruction and competency testing in all levels of PPE both standard and extensive PPE
including PAPR’s and respirators
4. Extensive competency in (donning and doffing with buddy) at all times
5. Isolation procedures including draping of the inside of the ambulance
6. Hospital early alert and notification procedures
7. Procedures for patient handoff for each receiving in county receiving facility
8. Procedures for decontamination of ambulance, equipment and personnel post
transportation
9. Procedures for disposal, sterilization and cleaning of contaminated materials and
provider clothing.
10. Protocols for reporting of accidental breach of PPE, exposure or inoculation
Next Steps:
1. Do not reinvent the wheel. Use lessons learned from experienced entities.
2. Develop timeline for implementation.
3. Task AMR for National Protocols and Technical Expertise (AMR is one of the ambulance
providers in Texas dealing with these events and has transported these patients via IFT).
4. Contract Nebraska for their PPE transport protocols including equipment, draping of
ambulances prior to patient transport and decontamination.
5. Establish competency based training curriculum with periodic refreshers (quarterly).
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6. Establish activation protocols and educate EMS System to processes
7. Address and resolve any and all administrative issues to support the sustainability of the
program.
8. Develop a plan for appropriate medical oversight with Public Health and participating
ambulance providers.
9. Educate the first responders and non-IDART on the resource.
10. Identify equipment gaps and processes and effectively address in cooperation with
Public Health and participating transport providers.
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