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Paramedic Care: Principles & Practice
Fourth Edition
Volume 4: Medicine
CHAPTER
10
Infectious
Diseases and
Sepsis
Multimedia Directory
Slide 89
AIDS Video
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Standard
• Medicine (Infectious Diseases)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Competency
• Integrates assessment findings with
principles of epidemiology and
pathophysiology to formulate a field
impression and implement a
comprehensive treatment/disposition
plan for a patient with a medical
complaint.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Infectious diseases: illnesses caused by
infestation of body by biological
organisms (bacteria, viruses, fungi,
protozoans, helminths).
• Most infectious disease states not life
threatening.
• Paramedics often first to encounter
patients with communicable diseases.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Public Health Principles
• Infectious agent: "hazardous material";
can affect large numbers of people.
• Epidemiologists: health professionals
who study how infectious diseases
affect populations.
• Characteristics of host, infectious
agent, environment yield clues to how
infectious agent transmitted.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Public Health Principles
• Demographics: characteristics of
certain population.
• Index case: individual who first
introduced infectious agent to
population.
• Paramedics must evaluate host
(patient), infectious agent,
environment.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Public Health Agencies
• Local agencies first line of defense in
disease surveillance and outbreak.
• At state level, an agency (health
department or board of health)
monitors infectious diseases.
• U.S. Department of Health and Human
Services (DHHS) Centers for Disease
Control and Prevention (CDC) most
visible federal agency.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Public Health Agencies
• CDC monitors national disease data;
disseminates information to all health
care providers.
• CDC researches infectious diseases.
• National Institute for Occupational
Safety and Health (NIOSH): standards
and guidelines to prevent infectious
diseases in workplace.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Public Health Agencies
• Federal Emergency Management
Agency (FEMA)
• National Fire Protection Association
(NFPA)
• U.S. Fire Protection Administration
(USFPA)
• International Association of Firefighters
(IAFF)
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Microorganisms
• Majority of disease-causing organisms
microscopic (visible only under
microscope).
• Normal flora help keep us disease free
by creating environmental conditions
not conducive to disease-producing
microorganisms (pathogens).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Opportunistic pathogens: nonharmful
bacteria that cause disease only under
unusual circumstances.
• Most opportunistic pathogens are
normal flora.
• Patients with weakened immune
system or unusual stress susceptible to
diseases caused by opportunistic
organisms.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Bacteria
– Microscopic single-celled organisms; 1
to 20 micrometers; prokaryotes.
– Reproduce independently; require host
to supply food and environment.
– Gram stain common method of
differentiating bacteria.
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Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Bacteria
– Cocci or spheres are round.
– Rods are elongated.
– Spirals are coiled.
– Specific tissues and organs infected
determine signs and symptoms.
– Heavy colonization may result in direct
damage to tissues as bacteria feed.
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Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Bacteria
– Indirect damage by releasing toxic
chemicals that have localized or
systemic effects.
– Exotoxins: poisonous proteins shed by
bacteria during bacterial growth.
– Endotoxins: proteins, polysaccharides
and lipids; released when bacterial cell
destroyed.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Bacteria
– Most bacterial infections respond to
antibiotics; bactericidal (kill bacteria) or
bacteriostatic (inhibit bacterial growth
or reproduction).
– Different antibiotics required to treat
different bacteria.
– Overuse of antibiotics has made some
ineffective against disease.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Viruses
– Much smaller than bacteria; only seen
with electron microscope.
– Cannot reproduce and carry on
metabolism by themselves.
– Obligate intracellular parasites: grow
and reproduce only within host cell.
– Resist antibiotic treatment.
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Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Viruses
– Enters host cell; becomes part of host
cell, making eradication of virus
impossible, as any treatment that kills
virus will kill host cell as well.
– 400 types of viruses; most viral
diseases mild and self-limiting.
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Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Prions: disease-producing agents
referred to as "slow viruses."
 Cause progressive, untreatable dementia
in Kuru, Creutzfeldt-Jakob disease, mad
cow disease, fatal familial insomnia.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Fungi: plantlike microorganisms, most
not pathogenic.
 Yeasts, molds, mushrooms are types of
fungi.
 Become pathogenic in patients with
compromised immune function.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Protozoa: single-celled parasitic
organisms with flexible membranes and
ability to move.
 Most live in soil; ingest decaying organic
matter.
 Opportunistic pathogens in patients with
compromised immune function.
 Enter body by fecal–oral route or through
mosquito bite.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Parasites: common causes of disease
where sanitation poor.
 Roundworms: live in intestinal mucosa;
may reach 30–50 cm in length.
 Symptoms: abdominal cramping, fever,
cough.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Pinworms: common in U.S. and civilized
countries.
 Tiny worms (3–10 mm long) live in
distal colon.
 Common cause of anal pruritus (itching)
and infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Hookworms: found in warm, moist
climates.
 Larvae passed in stool of infected
animals; contracted when barefoot
person walks in contaminated area.
 Epigastric pain and anemia.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Microorganisms
• Other Microorganisms
– Trichinosis: contracted by eating raw or
inadequately cooked pork products.
 Gastrointestinal disturbances, edema,
fever.
 If worms invade heart, lungs, brain in
large numbers, death may result.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Infectious agents exist in animals,
humans, insects, environment.
• While inhabiting animal or insect
reservoirs, they do not cause disease.
• When host and infectious agent come
together at right time and conditions,
disease transmission takes place.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Common direct transmission is from
person to person through cough,
sneeze, kiss, sexual contact.
• Indirect transmission spreads
organisms in number of ways.
• Microorganisms transmitted via food
products, water, soil.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Bloodborne diseases transmitted by
contact with blood or body fluids of
infected person.
– AIDS; hepatitis B, C, D; syphilis.
• Assume every patient has infectious
bloodborne disease; take precautions.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Some infectious diseases transmitted
through air on droplets expelled during
productive cough or sneeze.
– Tuberculosis, meningitis, mumps,
measles, rubella, chickenpox (varicella).
• Other diseases such as common cold,
influenza, respiratory syncytial virus
(RSV) transmitted by airborne route.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Some infectious diseases transmitted
orally (eating) or by fecal–oral route.
• Risk of disease transmission rises if:
– Open wounds.
– Increased secretions.
– Active coughing.
– Ongoing invasive treatment.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Many EMS patient care activities occur
in closed, poorly ventilated
environment (back of ambulance).
• Use protective clothing; barrier devices.
• Regular cleaning and sanitization of
ambulance and equipment will help
reduce exposure.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Not all infectious agents and diseases
communicable (transmitted to another
host).
• Penetration of host: infection occurred,
but never equated with disease.
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Contraction, Transmission, and
Stages of Disease
• Factors in becoming infected:
– Correct mode of entry.
– Virulence: organism's strength or ability
to overcome body's defenses.
– Number of organisms transmitted
(dose).
– Host resistance: host's ability to fight off
infection.
– Other host factors.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Contraction, Transmission, and
Stages of Disease
• Phases of the Infectious Process
– Latent period: once infected with
infectious agent, host cannot transmit
agent to someone else.
– Communicable period: host may exhibit
signs of clinical disease; can transmit
infectious agent to another host.
– Incubation period: time between
exposure and presentation.
©2013 Pearson Education, Inc.
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Contraction, Transmission, and
Stages of Disease
• Viruses and bacteria have surface
proteins (antigens); stimulate body to
produce antibodies.
– Antibodies in blood indicates exposure
to disease that they fight.
• Window phase: time between exposure
to disease and seroconversion.
• Disease period: duration from onset of
signs and symptoms until resolution.
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The Body's Defenses Against
Disease
• The Immune System
– Fights disease by protecting body from
foreign invaders.
– Must be able to differentiate "self" from
"nonself."
– Inflammatory response involves
selected leukocytes (white blood cells),
functional units of blood in immune
response.
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The Body's Defenses Against
Disease
• The Immune System
– Neutrophils and macrophages: attack
infectious agent by combination of
digestive enzymes and ingesting it
(phagocytosis).
– Cell-mediated immunity does not result
in formation of antibodies; humoral
immunity does.
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Phagocytosis occurs when cells engulf infectious agents.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• The Immune System
– Cell-mediated immunity generates
various T lymphocytes; react against
specific antigens.
– Humoral immunity: immune system's
properties of memory and specificity.
– Antibodies (immunoglobulins): protect
against most infectious agents to which
body repeatedly exposed.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• The Immune System
– Five classes of human antibodies:
 IgG: remembers antigen and recognizes
repeated invasions.
 IgM: formed early in most immune
responses.
 IgA: main immunoglobulin in exocrine
secretions.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• The Immune System
– Five classes of human antibodies:
 IgD: present on surface of B
lymphocytes; acts as antigen receptor.
 IgE: attaches to mast cells in respiratory
and intestinal tracts.
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The Body's Defenses Against
Disease
• The Complement System
– Provides alternate pathway to react
more quickly to foreign bodies.
– At least 20 proteins; works with
antibody formation and inflammatory
reaction to combat infection.
– Starts cascade of biochemical events
triggered by tissue injury.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• The Lymphatic System
– Secondary circulatory system.
 Spleen, thymus, lymph nodes, lymphatic
ducts.
– Set of small, thin-walled vessels;
collects overflow fluid from tissue
spaces and returns it to circulatory
system.
– Fluid (lymph): same composition as
normal interstitial fluid.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• The Lymphatic System
– Important in disease prevention.
– Lymph nodes filter lymph before
returning it to circulatory system.
– Spleen: generates antibodies and
produces B and T lymphocytes;
removes unwanted particulate matter.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• Individual Host Immunity
– Passive immunity: received antibodies
from maternal circulation via placenta or
from inoculation.
– Active immunity: develops antibodies in
response to inoculation by killed or
modified form of infectious agent in
attenuated vaccine.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• Individual Host Immunity
– Serotype: determined by exposing
microorganism to known antibody
solutions.
– Immunizing against tetanus common
practice in emergency medicine.
– Tetanus rare, but frequently fatal,
disease; results from wound infected
with bacterium.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The Body's Defenses Against
Disease
• Individual Host Immunity
– Generalized tetanus: pain and stiffness
in jaw muscles ("lock jaw"); stiffness in
trunk muscles.
– Progresses to reflex convulsive spasms
and tonic contractions of muscle groups.
– Passive immunity provided by injection
of tetanus immune globulin (TIG)
(Hypertet).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• EMS providers must protect themselves
from infectious exposures.
• Four phases of infection control in
prehospital care:
– Preparation for response
– Response
– Patient contact
– Recovery
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Paramedic Care: Principles & Practice, 4th Ed.
Interruption of infectious disease transmission is a role of prehospital personnel.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Preparation for Response
– Establish and maintain written standard
operating procedures (SOPs).
– Prepare infection control plan.
– Provide adequate original and ongoing
infection control training.
– Ensure all employees provided with
personal protective equipment (PPE).
©2013 Pearson Education, Inc.
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Infection Control in Prehospital
Care
• Preparation for Response
– Ensure all EMS personnel treat and
bandage all personal wounds before
emergency response.
– Use disposable supplies and equipment
when possible.
– Ensure all EMS personnel have access to
facilities and supplies needed to
maintain high level of personal hygiene.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Preparation for Response
– Do not allow EMS personnel to deliver
patient care if signs or symptoms of
infectious disease.
– Monitor EMS personnel for compliance
with vaccinations and diagnostic tests.
– Appoint designated infectious disease
control officer (IDCO).
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Infection Control in Prehospital
Care
• Preparation for Response
– Identify specific job classifications and
work processes in which possibility of
exposure exists.
– Provide hazmat (hazardous materials)
education for employees.
– Do not assume EMS agency can protect
you from exposure to all infectious
agents.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Response
– Obtain information from dispatch
regarding nature of patient's illness or
injury.
– Prepare for patient contact; put on
gloves and don eye and face protection
before patient contact.
– Prepare mentally for call; think infection
control.
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Infection Control in Prehospital
Care
• Patient Contact
– Isolate all body substances; avoid any
contact with them.
– Take Standard Precautions.
– Allow only necessary personnel to make
patient contact.
– Use airway adjuncts; disposable items
preferable.
– Properly dispose of biohazardous waste.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Always use the personal protection recommended for the degree of exposure anticipated.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Patient Contact
– Use extreme caution with sharp
instruments.
– Never smoke, eat, or drink in patient
compartment of ambulance.
– Do not apply cosmetics or lip balm, or
handle contact lenses.
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Paramedic Care: Principles & Practice, 4th Ed.
Dispose of needles and other sharp objects properly.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Standard Precautions
– All health care workers should use
appropriate barrier precautions to
prevent exposure of skin and mucous
membranes to any contact with blood,
or body fluids, from any patient.
– Wash hands/skin surfaces with soap and
warm water after removal of gloves.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Standard Precautions
– Prevent injuries caused by needles,
scalpels, sharp instruments or devices
when performing procedures and
cleaning or disposing of instruments.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Standard Precautions
– Although saliva not directly implicated in
HIV transmission, use mouthpieces with
one-way valves or filters, bag-valvemask devices, ventilation devices to
avoid mouth-to-mouth contact.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Standard Precautions
– Do not put gloved hands close to your
mouth; avoid wiping face with forearms
or backs of gloved hands.
– If exudative or weeping skin lesions,
refrain from direct patient care.
©2013 Pearson Education, Inc.
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Infection Control in Prehospital
Care
• Standard Precautions
– Pregnant health care workers familiar
with, and adhere to, precautions to
minimize risk of HIV transmission.
– Disinfection of diagnostic or therapeutic
equipment and supplies is mandatory.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Recovery
– Decontaminating ambulance and
equipment is essential.
– Wash hands immediately after patient
contact.
– If you sustain wound and are exposed
to body fluids of others, wash wound
with soap and warm water immediately,
before contacting employer or IDCO.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Hand washing is one of the most effective methods of preventing disease transmission.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Recovery
– Dispose of biohazardous wastes.
– Place potentially infectious wastes in
leakproof biohazard bags.
– Decontaminate all contaminated
clothing and reusable equipment.
– Handle uniforms in accordance with
agency's standard procedures.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Decontamination Methods/Procedures
– Decontaminate infected equipment
according to local protocol and SOPs
established by EMS agency.
– Low-level disinfection: destroys most
bacteria and some viruses and fungi.
– Intermediate-level disinfection: destroys
Mycobacterium tuberculosis and most
viruses and fungi.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Decontamination Methods/Procedures
– High-level disinfection: destroys all
forms of microorganisms except certain
bacterial spores.
– Sterilization: destroys all
microorganisms; required for all
contaminated invasive instruments.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Infectious Disease Exposures
– Immediately report exposures of EMS
personnel to designated IDCO,
according to local protocol.
– Report all exposures to blood, blood
products, potentially infectious material,
regardless of perceived severity.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Infection Control in Prehospital
Care
• Infectious Disease Exposures
– The Ryan White Act: federal law, passed
in 1990; outlines rights and
responsibilities of agencies and health
care workers when infectious disease
exposure occurs.
– 2009, Congress passed Ryan White
HIV/AIDS Treatment Extension Act.
©2013 Pearson Education, Inc.
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Infection Control in Prehospital
Care
• Infectious Disease Exposures
– Employers required to provide medical
evaluation and treatment for paramedic
or EMS provider exposed to infectious
disease.
– Treatment in line with U.S. Public Health
Service recommendations.
– IDCO maintains records of all
exposures; all are confidential.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Assessment of the Patient with
Infectious Disease
• Always maintain high index of suspicion
that infectious agent may be involved.
• Dispatch information, evaluate
environment, maintain Standard
Precautions.
• Look for general indicators of infection.
©2013 Pearson Education, Inc.
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Assessment of the Patient with
Infectious Disease
• Past Medical History
– Patients who have AIDS or are taking
immunosuppressant medications such
as steroids susceptible to infection.
 Chronic obstructive pulmonary disease
(COPD); autoimmune diseases
 Transplant recipients; diabetes
 Alcoholism; malnutrition
 IV drug abuse; splenectomy
 Cancer; artificial heart valves or joints
©2013 Pearson Education, Inc.
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Assessment of the Patient with
Infectious Disease
• The Physical Examination
– Determine level of consciousness and
vital signs early on; increased
temperature indicates infection.
– Hypotension with infectious disease may
result from dehydration, vasodilation, or
both.
– Dehydration common consequence of
infectious diseases.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Assessment of the Patient with
Infectious Disease
• The Physical Examination
– Dehydration: tachycardia and
hypotension; thirst, poor skin turgor,
shrunken and furrowed tongue.
– Skin for temperature, hydration, color,
or rash.
– Sclera (white of eye) for icterus
(jaundice).
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Assessment of the Patient with
Infectious Disease
• The Physical Examination
– Reaction to neck flexion.
– Lymph nodes for swelling or tenderness.
– Breath sounds.
– Hepatomegaly.
– Purulent (pus-filled) lesions.
©2013 Pearson Education, Inc.
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Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Collection of signs and symptoms; share
anatomical, physiological, biochemical
derangements in immune system.
 Like other viruses, HIV utilizes host cell's
reproductive apparatus to copy itself.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 HIV is retrovirus.
 Action of reverse transcriptase enables
genetic material from retrovirus to
become permanently incorporated into
DNA of infected cell.
 Two types: HIV-1 and HIV-2.
©2013 Pearson Education, Inc.
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Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Specifically targets T lymphocytes with
CD4 marker.
 Correlation between disease progression
and decrease in CD4 T lymphocyte count.
 Physicians can predict development of
specific clinical events as CD4 count
decreases.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Measurement of viral load best indicator
of response to therapy and long-term
clinical outcome.
 AIDS can now be treated.
 Numerous medications (antiretroviral
agents) have changed the face of AIDS.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Transmitted through contact with blood,
blood products, body fluids, semen,
vaginal secretions, breast milk.
 Commonly contracted through sexual
contact or sharing contaminated needles.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Persons at high risk:
– Men who have sex with men
– African Americans
– Urban dwellers
 Infection of health care workers from
HIV-positive patients exceedingly rare.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Blood most dangerous; followed by fluids
that may or may not contain blood.
 Other diseases: extrapulmonary and
pulmonary tuberculosis, recurrent
pneumonia, wasting syndrome, HIV
dementia, sensory neuropathy.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Kaposi's sarcoma: cancerous lesion quite
rare until HIV appeared.
 As AIDS progresses, involves central
nervous system (CNS); dementia,
psychosis, encephalopathy, peripheral
neurologic disorders.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 CD4 counts gives indication of how well
immune system functioning.
 Viral load is number of copies of HIV
virus in patient's blood.
 High viral load (>10,000 copies)
indicates virus reproducing; disease
progressing.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 No cure or vaccine for AIDS.
 Health care worker should immediately
seek evaluation; initiation of treatment.
 Postexposure therapy: regimen of
antiretroviral drugs.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Counseling by ICDO or trained
occupational infectious disease specialist.
 HIV-positive patients generally do not
present in life-threatening situations
to EMS.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Human immunodeficiency virus (HIV)
 Important that care be compassionate,
understanding, nonjudgmental.
 Take appropriate precautions to prevent
disease transmission.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
AIDS Video
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©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis
 Inflammation of liver caused by viruses,
bacteria, fungi, parasites, excessive
alcohol consumption, medications.
 Headache, fever, weakness, joint pain,
anorexia, nausea, vomiting, right upper
quadrant abdominal pain.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis
 Patient may become jaundiced.
 Hepatitis A, B, C, D, E greatest potential
for communicable disease.
 Hepatitis A (infectious or viral hepatitis):
transmitted by fecal–oral route; hepatitis
A virus.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis A
 Infections asymptomatic.
 Combination vaccine available for
children for hepatitis A and B.
 Incubation period: 3 to 5 weeks.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis B
 Hepatitis B (serum) virus transmitted
through direct contact with body fluids;
substantial risk to EMS providers.
 Much more contagious than HIV.
 Health care workers infected by hepatitis
B can develop acute hepatitis, cirrhosis,
liver cancer.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis B
 Effectiveness of immunizations: 90%.
 Transmission: sexual, transfusion,
dialysis, needle sharing, tattooing,
acupuncture, communally used razors
and toothbrushes.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis B
 Vaccination required before employment
as health care provider; safe and
effective.
 Incubation period: 8 to 24 weeks.
 Infections asymptomatic.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis C
 Transmitted by IV drug abuse; sexual
contact.
 Chronic condition; 85% of infected
people.
 Ineffectiveness of antibodies attributed to
virus's high mutation rate.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis C
 Causes liver fibrosis; progresses over
decades to cirrhosis.
 No effective vaccination.
 Treatment with alpha interferon has
limited success.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis D
 Depends on surface antigen of hepatitis B
virus (HBV) to produce structural protein
shell.
 Hepatitis D virus (HDV) infection exists
only with coexisting HBV infection.
 Immunization against HBV confers
immunity to HDV; no vaccine exists.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Hepatitis E
 Transmitted through fecal–oral route.
 Associated with contaminated drinking
water.
 Does not lead to chronic infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Most common preventable adult
infectious disease in world.
 Cause: bacteria known collectively as
Mycobacterium tuberculosis complex.
 Affects respiratory system.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Multiple-drug-resistant tuberculosis
(MDR-TB): drug-resistant bacteria
outgrow drug-susceptible bacteria.
 Transmission: airborne respiratory
droplets, through mucous membranes
and broken skin, drinking contaminated
milk.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Purified protein derivative (PPD) skin test
identifies candidates for prophylactic
drug therapy.
 Most EMS agencies skin test annually.
 Incubation period: 4–12 weeks.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Development of disease 6–12 months
after infection.
 Reactivation in extrapulmonary sites
(lymph nodes, pleura, pericardium) more
common in HIV-infected persons.
 Known to lead to subacute meningitis
and granulomas in brain.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Symptoms: chills, fever, fatigue,
productive or nonproductive chronic
cough, weight loss, night sweats.
 Hemoptysis (expectorating blood) very
suggestive of active TB.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Protecting yourself from M. tuberculosis
important step in preventing disease
transmission.
 Risk of transmission increases if close
and prolonged contact with patient.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Use appropriate respiratory precautions
while performing cardiopulmonary
respiration (CPR) and intubation.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Don protective respirator on contact with
patient.
 N95 masks: designed to prevent
contaminated air from reaching health
care workers wearing them.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
NIOSH/OSHA standards call for N95 masks when caring for patients with tuberculosis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Tuberculosis (TB)
 Ventilation systems in selected
ambulances recycle and filter air to
ensure expulsion of infected droplet.
 Early identification of exposure and drug
prophylaxis keys to preventing active TB
in health care workers.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Pneumonia
 Acute lung inflammation; not single
disease but family of diseases; result
from respiratory infection by viruses,
bacteria, fungi.
 Spread by droplet nuclei, direct contact,
linens soiled with respiratory secretions.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Pneumonia
 Always consider possibility of communityacquired pneumonia.
 Signs and symptoms: acute onset of
chills, high-grade fever, dyspnea,
pleuritic chest pain worsened by deep
inspiration, productive cough with
phlegm of various colors.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Pneumonia
 In children, fever, tachypnea, retractions
ominous signs; but not specific to
pneumonia.
 Triad of signs indicates respiratory
distress secondary to infectious process
in pediatric patients.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Pneumonia
 Support adequate ventilation and
oxygenation.
 Supplemental oxygen administered to
correct hypoxia.
 Consider TB possibility in patient with
pneumonia; place mask on yourself or
patient.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Pneumonia
 Vaccination exists against most serotypes
of S. pneumoniae.
 Highly recommended for children 2 years
and younger, adults over 65, those
without spleens; EMS workers not
necessary.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Severe acute respiratory syndrome
(SARS)
 Viral respiratory illness; SARS-associated
coronavirus (SARS-CoV).
 Spread by close person-to-person
contact via respiratory droplets; touching
contaminated object.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Severe acute respiratory syndrome
(SARS)
 Incubation period: 2 to 14 days.
 Considered contagious as long as he has
symptoms.
 Quarantined to home for 10 days after
fever abated and symptoms cleared.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Severe acute respiratory syndrome
(SARS)
 All personnel should use PPE on every
call or as directed by local health
authorities.
 Altered mental status, one- to two-word
speech dyspnea, cough, cyanosis,
hypoxia.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Severe acute respiratory syndrome (SARS) is a viral respiratory illness that first appeared in China in November
2002.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Severe acute respiratory syndrome
(SARS)
 Sore throat, rhinorrhea, chills, rigors,
myalgias, headache, diarrhea, cough,
sputum production, respiratory distress,
respiratory failure.
 Administer oxygen to correct hypoxia.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Severe acute respiratory syndrome
(SARS)
 Provide ventilatory assistance.
 Establish IV access; administer fluids.
 If wheezing, consider administering
nebulized bronchodilator.
 Notify hospital if you suspect SARS.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Chickenpox (Varicella)
 Caused by varicella zoster virus (VZV);
herpesvirus family.
 Much more lethal in adults.
 Infectious agent of shingles (herpes
zoster): painful condition; skin lesions
along course of peripheral nerves and
dermatome bands.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Chickenpox (Varicella)
 Respiratory symptoms, malaise, lowgrade fever; rash on face and trunk and
progresses to rest of body, including
mucous membranes.
 Rupture, forming small ulcers; scab over
within 1 week.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Chickenpox (Varicella)
 Transmission: inhalation of airborne
droplets; direct contact with weeping
lesions and tainted linen.
 Incubation period: 10 to 21 days.
 In adults, common complication is
varicella zoster virus (VZV) pneumonia.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Varicella (chickenpox). (Centers for Disease Control/Joe Miller)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Chickenpox (Varicella)
 Important for unexposed or unvaccinated
paramedics to be immunized.
 Most people develop immunity for life
after recovery from childhood chickenpox
infections.
 Chickenpox vaccine: Varivax.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Chickenpox (Varicella)
 Observe Standard Precautions.
 If patient only has chickenpox, remain
home until lesions crusted and dry.
 If susceptible paramedic exposed to
chickenpox, postexposure vaccination
may be warranted.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 Inflammation of meninges and
cerebrospinal fluid; caused by bacterial
and viral infections.
 Meningococcal meningitis (spinal
meningitis) disease variant of greatest
concern to EMS responders.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 Vaccines proven effective, especially in
children.
 Enteroviruses: 90% of patients with viral
(aseptic) meningitis.
 Transmitted by respiratory droplets;
peaks in midwinter months with low
temperature and humidity.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 For EMS responder, contact with
secretions during mouth-to-mask
ventilation, intubation, suctioning
increases probability of transmission.
 Incubation period: 2 to 10 days.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 Fever, chills, headache, nuchal rigidity
with flexion, arthralgia, lethargy,
malaise, altered mental status, vomiting,
seizures.
 Rash may appear; develop into
hemorrhagic spots, or petechiae.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 Fever in newborns evaluated with high
index of suspicion for meningococcemia.
 Brudzinski's sign: flexion of hips or knees
when neck flexed considered positive;
finding suggestive of meningitis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 Kernig's sign: inability to fully extend
knee due to meningeal irritation; positive
sign.
 Effective vaccine developed against A, C,
Y, W-135 serotypes.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of Immediate Concern to EMS
Providers
– Meningitis
 Observe Standard Precautions.
 Use masks on yourself and/or patients;
adequately protect yourself against all
infectious agents of meningitis.
 Postexposure prophylaxis primary means
of preventing meningococcal disease in
patients with significant exposures.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Influenza and colds, rubella, measles,
mumps, respiratory syncytial virus
(RSV): viral infections.
– Pertussis: highly contagious bacterial
disease; poses risk.
– Transmitted by direct inhalation of
infected droplets or exposed mucosal
surfaces.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Influenza
 Caused by viruses types A, B, C.
 Identified on basis of where they were
isolated, culture number, year of
isolation.
 Leading cause of respiratory disease
worldwide; various strains cause
epidemics.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Influenza
 Easily transmittable in crowded spaces.
 High potential for transmission by
autoinoculation.
 Sudden onset of fever, chills, malaise,
muscle aches, nasal discharge, cough.
 More serious in very young, very old, and
those with underlying disease.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Influenza
 Incubation period:1 to 3 days.
 Fever: 3 to 5 days.
 Severe cases: pneumonia, hemorrhagic
bronchitis, death.
 Determine hydration status early; begin
fluid replacement if indicated.
 Everyone susceptible to influenza.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Influenza
 Influenza viruses mutate so rapidly that
protection effective only against
particular strain or variant.
 CDC recommends vaccination for EMS
personnel.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Common cold (viral rhinitis)
 Caused by rhinoviruses; more than 100
serotypes.
 Transmission: direct contact, airborne
droplets, hands and linen soiled with
discharges from infected individuals.
 Course mild, often without fever and
muscle aching.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Avian influenza
 Some avian viruses mutate or merge
with human influenza virus to form virus
that can infect humans.
 Most human infections in those who
worked with poultry or lived around
domestic birds.
 H5N1 virus called "bird flu"; particularly
pathogenic.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Avian influenza
 Tends to affect younger people; high
mortality rate.
 Vaccine available.
 Influenza-like symptoms, pneumonia,
acute respiratory distress, viral
pneumonia, severe and life-threatening
complications.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Measles (rubeola, hard measles)
 Systemic disease caused by measles
virus; highly communicable.
 Immunity following disease is lifelong.
 Transmitted by inhalation of infective
droplets and direct contact.
 Incubation period: 7 to 14 days.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Measles (rubeola, hard measles)
 Fever, conjunctivitis, swelling of eyelids,
photophobia, malaise, cough,
nasopharyngeal congestion.
 Fever increases, rising to as high as
◦
◦
104 –106 F, when rash reaches its
maximum.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Measles (rubeola, hard measles)
 Before rash develops, Koplik's spots
appear on oral mucosa.
 Everyone should be immunized.
 Immunization 99% effective in children;
vaccination mandatory.
 Postexposure hand washing is critical.
 Life-threatening sequela: encephalitis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Mumps
 Virus; transmitted through respiratory
droplets and direct contact with saliva of
infected patients.
 Characterized by painful enlargement of
salivary glands.
 Most cases occur in 5- to 15-year age
group; 12- to 25-day incubation period.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Mumps
 Occurs in epidemics; lifelong immunity
conferred after infection.
 Generally benign and self-limiting.
 Mumps live-virus vaccine available;
administered with measles and rubella
vaccines to children over 1 year of age.
 Mumps easily transmitted.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Rubella (German measles)
 Systemic viral disease caused by rubella
virus transmitted by inhalation of
infective droplets.
 Sore throat and low-grade fever,
accompanied by fine pink rash on face,
trunk, extremities; lasts about 3 days.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Rubella (German measles)
 Incubation period: 12–19 days.
 Natural infection conferring lifelong
immunity, as does immunization.
 No specific treatment.
 Devastating to developing fetus; mothers
infected during first trimester at risk for
abnormal fetal development.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Rubella (German measles)
 All females should be immunized against
rubella before becoming pregnant.
 Vaccines for measles, mumps, rubella
(MMR vaccination); given safely with
varicella vaccine.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Rubella (German measles)
 Immunization 98–99% effective.
 Not recommended for pregnant women.
 EMS providers required to receive MMR
vaccination before being allowed to work.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Respiratory syncytial virus (RSV)
 Cause of pneumonia and bronchiolitis in
infants and young children.
 In this age group, RSV may be fatal.
 Associated with outbreaks of lower
respiratory infections.
 If patient with pneumonia or bronchitis
simultaneously contracts virus, disease
becomes more severe.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Respiratory syncytial virus (RSV)
 Wheezing, tachypnea, respiratory
distress.
 Diagnosed by rapid assay using nasal
washings.
 High-risk children can be treated with
antiviral agent ribavirin (Virazole).
 Treatment expensive; poses risk to
unborn babies.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Pertussis (whooping cough)
 Caused by bacterium; affects oropharynx
in three phases; incubation 6 to 20 days.
 Develops mild cough; quickly becomes
severe and violent.
 Rapid consecutive coughs followed by
deep, high-pitched inspiration ("whoop").
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Pertussis (whooping cough)
 Large amounts of thick mucus; sustained
coughing may lead to increased
intracranial pressure and intracerebral
hemorrhage.
 Vaccination of children; diphtheriatetanus-pertussis (DTP).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Pertussis (whooping cough)
 Disease likely to confer immunity.
 Previously immunized and exposed
adolescents/adults may be at risk of
infection.
 Anticipate intubation for patients with
respiratory failure.
 Highly contagious.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Job-Related Airborne Diseases
– Pertussis (whooping cough)
 Transmission: respiratory secretions or
aerosolized form.
 Mask patient; observe Standard
Precautions; postexposure hand washing.
 Everyone susceptible to B. pertussis
infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Viral Diseases Transmitted by Contact
– Mononucleosis
 Caused by Epstein-Barr virus (EBV).
 Affects oropharynx, tonsils,
reticuloendothelial system.
 4- to 6-week incubation period; begins
with fatigue.
 Fever, severe sore throat, oral
discharges, enlarged and tender lymph
nodes, splenomegaly.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Viral Diseases Transmitted by Contact
– Mononucleosis
 Generally confers immunity for life.
 Transmission: oropharyngeal contact
involving exchange of saliva.
 Common in 15 and 25 years of age.
 Full recuperation may take several
months; no specific treatment.
 Immunization unavailable.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Viral Diseases Transmitted by Contact
– Herpes simplex virus type 1
 Transmitted in saliva of carriers; infects
oropharynx, face, lips, skin, fingers, toes.
 Everyone susceptible.
 Infections of health care workers' hands
and fingers can result in herpetic
whitlow, weeping inflammations at distal
fingers and toes.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Viral Diseases Transmitted by Contact
– Herpes simplex virus type 1
 Incubation period: 2 to 12 days.
 In oral cavity, fluid-filled vesicles develop
into cold sores or fever blisters;
deteriorate into small ulcers.
 Disappear in 2 to 3 weeks.
 May recur spontaneously, especially
following periods of stress or illness.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Viral Diseases Transmitted by Contact
– Herpes simplex virus type 1
 Can cause meningoencephalitis in
newborns; aseptic meningitis in adults.
 Treatment with antiviral agents.
 Standard Precautions, primarily gloves,
absolutely essential.
 Immunization not available.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Herpes virus. Causative agent of herpes infections. (Centers for Disease Control/Dr. Fred Murphy; Sylvia
Whitfield)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Epiglottitis
 Inflammation of epiglottis; may involve
areas just above and below it.
 In children it is true emergency.
 Four "Ds": dysphonia, drooling,
dysphagia, distress.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Croup (laryngotracheobronchitis)
 Cause of acute upper airway obstruction
in children under 3.
 Viral illness; inspiratory and expiratory
stridor; seal-bark-like cough.
 Generally not life threatening.
 Total airway obstruction rare.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Pharyngitis
 Infection of pharynx and tonsils.
 Caused by virus or bacteria; sudden
onset of sore throat and fever.
 Most cases in 5- to 11-year-olds.
 Group A streptococcus (strep throat)
causes particularly serious pharyngitis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Pharyngitis
 Can progress to rheumatic fever or
scarlet fever (scarletina).
 Strep throat very contagious; wear
mask when assessing and managing
these patients.
 Antibiotics effectively treat strep throat.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Sinusitis
 Inflammation of paranasal sinuses.
 Mucus and pus cannot drain; become
trapped in sinus.
 Preceded by viral upper respiratory
infection or exposure to allergens.
 Nasal congestion; blocked sinus
passages.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Sinusitis
 If untreated, can cause abscess or
spread into cranium and attack brain.
 Antibiotics, decongestants.
 Apply heat pack directly over affected
sinus to help relieve pain and facilitate
drainage.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Hantavirus
 Family of viruses carried by rodents such
as deer mouse.
 Transmission: inhalation of aerosols
stirring up dried urine, saliva, fecal
droppings of rodents, contamination of
food.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Other Infectious Conditions of the
Respiratory System
– Hantavirus
 Causes hantavirus pulmonary syndrome
(HPS); anyone susceptible.
 4 to 10 days, symptoms of pulmonary
edema occur.
 No immunization available.
 EMS responders should wear face masks.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• GI System Infections
– Gastroenteritis
 Gastrointestinal disorder; nausea,
vomiting, gastrointestinal cramping or
discomfort, anorexia, diarrhea.
 Causative agents: viruses and parasites.
 Highly contagious via fecal–oral route,
including ingestion of contaminated food
and water.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• GI System Infections
– Gastroenteritis
 In very young, very old, those with
preexisting disease, can be serious and
fatal.
 Prolonged vomiting and/or diarrhea may
result in dehydration and electrolyte
disturbances.
 Start IV with isotonic saline.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• GI System Infections
– Gastroenteritis
 If shock, management objectives no
different than for hemorrhagic shock.
 If prolonged vomiting or retching,
administer antiemetic.
 Standard Precautions; postexposure
hand washing critical to avoid infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• GI System Infections
– Food poisoning
 Nonspecific term: gastroenteritis.
 Occurs suddenly; caused by eating,
bacteria and their toxic products.
 Diarrhea, vomiting, gastrointestinal
discomfort.
 Botulism or Escherichia coli O157:H7 can
cause debilitating illness or death.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• GI System Infections
– Food poisoning
 Other bacteria in food poisoning:
Campylobacter, Salmonella, Shigella,
Vibrio cholerae.
 Most transmitted by uncooked or
undercooked meat, poultry, or fish.
 Stool cultures required to confirm
bacterial cause of gastroenteritis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• GI System Infections
– Food poisoning
 Initiate standard advanced life support
(ALS) protocols, assessment of airway
and ventilatory status, oxygenation,
initiation of IV, cardiac monitoring, fluid
resuscitation with isotonic crystalloids.
 No immunization against these agents or
their toxins exists.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Encephalitis
 Inflammation caused by infection of brain
and its structures by viruses.
 Encephalitis similar to meningitis, as they
often coexist.
 Neurologic signs: uncoordinated and
involuntary movements; weakness of
arms, legs, other portions of body;
unusual sensitivity of skin to stimuli.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Rabies
 Transmitted by rabies virus.
 Urban: unimmunized domestic dogs
and cats.
 Sylvatic: skunks, foxes, raccoons,
mongooses, coyotes, wolves, bats.
 Humans susceptible when bitten by
infected animals.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Rabies
 Creates encephalomyelitis; almost
always fatal.
 Excessive motor activity, excitation,
agitation, confusion, hallucinations,
combativeness, bizarre aberrations of
thought, muscle twitches and tetany,
seizures, focal paralysis.
 Untreated: death 2 to 6 days.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Rabies
 Inspect wound for bite pattern; presence
of saliva.
 Rinse with copious amounts of normal
saline to remove saliva and blood.
 Do not bandage or dress wound; allow to
drain freely during transport.
 Ensure suspect animal secured and
contained.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– If you believe you are rabid:
 Vigorously wash wound with soap and
warm water.
 Debride and irrigate wound; allow it to
drain freely.
 Discuss postexposure prophylaxis with
physician.
 Consider need for tetanus and other
antibiotic therapy.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Tetanus
 Acute bacterial infection of CNS.
 Musculoskeletal signs and symptoms.
 Shorter incubation period leads to more
severe illness.
 General population susceptible.
 Pain and stiffness in jaw muscles;
muscle spasm and rigidity of entire body.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Tetanus
 EMS responders will rarely encounter this
disease.
 Use Standard Precautions.
 Postexposure prophylaxis with tetanus
immune globulin (TIG), diphtheriatetanus toxoid (Td), diphtheria-tetanuspertussis (DTP).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Lyme disease
 Recurrent inflammatory disorder
accompanied by skin lesions,
polyarthritis, involvement of heart and
nervous system.
 Caused by tick-borne spirochete Borrelia
burgdorferi.
 Northeast, upper Midwest, Pacific Coast.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Lyme disease
 Most infections in spring and summer.
 Everyone susceptible; natural infection
does not confer immunity.
 Incubation period: 3 to 21 days.
 Painless, flat, red lesion at bite site.
 Rash ("bull's eye") disappears in time.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Characteristic target rash of Lyme disease. (Centers for Disease Control/James Gathany)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nervous System Infections
– Lyme disease
 CNS sequelae: meningitis, seventhcranial-nerve Bell's palsy, peripheral
neuropathy; cardiac abnormalities.
 Late stage (persistent infection) can
occur months or years after initial
exposure.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Gonorrhea
 Gram-negative bacterium; 1 million
cases treated annually.
 Everyone susceptible to infection.
 Males in early 20s; painful urination and
purulent urethral discharge.
 Women: no pain; minimal discharge.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Gonorrhea
 Affected females: increased risk for
sterility, ectopic pregnancy, abscesses
within reproductive structures,
peritonitis.
 No immunization available.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Syphilis
 Disease caused by spirochete.
 Transmitted: direct contact with
exudates from syphilitic lesions of skin
and mucous membranes, semen, blood,
saliva, vaginal discharges.
 Congenital syphilis: infants contract
disease before birth from infected
mother.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Syphilis
 Everyone susceptible to infection.
 Lesions (may involve virtually any organ
or tissue); skin rash; loss of hair and/or
eyebrows.
 Period when symptoms improve or
disappear completely.
 Tertiary syphilis: justifies reputation as
"great imitator."
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Syphilis
 Avoid frequent contact with lesions.
 Hand washing after patient contact.
 Treatment: benzathine penicillin.
 No immunization available.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Genital warts (condyloma acuminatum)
 Caused by human papillomavirus (HPV),
a DNA virus.
 70 HPV types; some associated with
cervical cancer.
 Contagious and easily spread.
 In males, cauliflower-like, fleshy growths
on penis, anus, mucosa of anal canal.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Genital warts (condyloma) on female labial surfaces caused by human papillomavirus. (Centers for Disease
Control/Joyce Ayers)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Genital warts (condyloma acuminatum)
 In females, appear on labial surfaces.
 Vaccine available for HPV; serves as
cervical cancer prevention agent.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Herpes simplex virus type 2 (HSV-2)
 HSV-2 causes 70–90% of all genital
herpes cases.
 Transmission by sexual contact.
 Everyone susceptible.
 Vesicular lesions on penis, anus, rectum,
mouth of male.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Herpes simplex virus type 2 (HSV-2)
 Females: asymptomatic; can display
lesions of vagina, vulva, perineum,
rectum, mouth, cervix.
 Painful lesions may recur periodically
during patient's lifetime.
 Immunization not available.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Chlamydia
 Genus of intracellular parasites most like
gram-negative bacteria.
 Most clinically significant species; affects
genital area, eyes, respiratory system.
 Everyone susceptible.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Chlamydia
 Transmitted by sexual activity; hand-tohand transfer of eye secretions, causing
conjunctivitis.
 Leading cause of preventable blindness.
 Symptoms similar to gonorrhea's, less
severe.
 No immunization available.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Trichomoniasis
 Trichomonas vaginalis, protozoan
parasite, common cause of vaginitis.
 In women, greenish-yellow vaginal
discharge, irritation of perineum and
thighs, dysuria.
 Frequently present with gonorrhea.
 Men asymptomatic carriers of disease.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Chancroid
 Highly contagious ulcer caused by gramnegative bacterium.
 Uncircumcised men at higher risk.
 Spread by direct contact, mostly sexual,
with open lesions and pus.
 Painful, inflamed pustule or ulcer;
appears on penis, anus, urethra, vulva.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Chancroid. (Centers for Disease Control/ Joe Miller)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Sexually Transmitted Diseases (STDs)
– Chancroid
 Linked with increased risk of HIV
infection.
 Health care workers have contracted
disease by contacting patients' ulcers.
 Immunization not available; infection
does not appear to confer immunity.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of the Skin
– Impetigo
 Very contagious infection caused by
staphylococci or streptococci.
 Single vesicle; ruptures and forms thick,
honey-colored crust with yellowish-red
center.
 Lesions occur on extremities and joints.
 Easily transmitted by direct skin-to-skin
contact; use Standard Precautions.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of the Skin
– Lice (pediculosis)
 Parasitic infestation of scalp, trunk,
pubic area.
 Infest hosts rather than infect them
because they do not break skin.
 Head lice, body lice, pubic lice.
 Head lice diagnosed by presence of
small, white, oval-shaped eggs (nits).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of the Skin
– Lice (pediculosis)
 Three-stage life cycle: eggs, nymphs,
adults; anyone can be infested.
 Body lice: infest clothing close to skin
surfaces; attach to skin only to feed.
 Pubic lice: infest through sexual contact
by attaching to hair in genital and anal
regions.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of the Skin
– Lice (pediculosis)
 Treated with one of several
nonprescription agents.
 Isolating infested linen and clothing
advisable.
 Clean and wipe all sprayed areas to
remove insecticide residues.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of the Skin
– Scabies
 Caused by infestation of mite barely
visible without magnification.
 Close personal contact, from hand
holding to sexual relations.
 Female tunnels into skin; lays eggs in
epidermis.
 Intense itching.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Diseases of the Skin
– Scabies
 Remains communicable until all mites
and eggs destroyed.
 All household members and/or close
contacts of infested EMS responders
treated simultaneously.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Bed Bugs (Cimex lectularius)
– Small, flat, parasitic insects that feed
solely on blood of people and animals
while they sleep.
– Reddish-brown in color, wingless, range
from 1 mm to 7 mm; can live several
months without blood meal.
– Generally do not transmit disease.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Infectious Diseases
• Nosocomial Infections
– Hospital-acquired diseases.
– Bacteria that resist antibiotics of
particular concern.
– These organisms cause severe host
damage; difficult to treat.
– May also contract resistant strains of
tuberculosis; spread easily from patient
to patient.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Patient Education
• Prevention is without question the most
effective intervention in preventing
transmission of infectious diseases.
• Key to effective prevention: education.
• CPR and first-aid classes offer platform
to introduce and discuss issues related
to disease transmission.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Patient Education
• Taking active part in public diseaseprevention education will be among
your most important roles as
paramedic.
• Infectious diseases' serious personal
and public health implications require
you to be knowledgeable in this area
and take lead in educating others.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Preventing Disease Transmission
• Do not go to work if you:
– Have diarrhea.
– Have draining wound or any type of wet
lesions; allow them to dry and crust over.
– Are jaundiced.
– Have mononucleosis.
– Have been exposed to lice or scabies and
have not yet been treated.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Preventing Disease Transmission
• Do not go to work if you:
– Have strep throat; have not been taking
antibiotics for at least 24 hours.
– Have a cold.
– Have not kept immunizations current.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Preventing Disease Transmission
• Approach scene cautiously with high
index of suspicion.
• Control scene to decrease body fluid
exposure for everyone present.
• Use Standard Precautions.
• With experience, you will develop
intuition and associate symptoms with
infectious patients you have treated.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Preventing Disease Transmission
• After call, wash your hands first.
• Decontaminate and disinfect equipment
and interior of ambulance.
• Spray gurney and interior of ambulance
with appropriate insecticide; wipe or
mop up any residue.
• Report any infectious exposure to
IDCO, human resources director,
appropriate designated official.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Preventing Disease Transmission
• Topics mandated by OSHA/NIOSH for
compliance with standards reflect
paramedic's minimum needed
knowledge of infectious diseases.
• Proactive EMS agencies offer continuing
education.
• Always consider interaction of three
major factors: infectious agent, host,
environment.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Preventing Disease Transmission
• Be a role model.
• Paramedics cannot allow their personal
prejudices to interfere with providing
optimum care for patients.
• Standard Precautions, which are EMS
practice standards, are predicated on
possibility that all body fluids, in any
situation, are infectious.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Sepsis/Systemic Inflammatory
Response Syndrome (SIRS)
• Sepsis (septicemia): most common
cause of death in debilitated patients in
hospital intensive care units.
• Life-threatening medical condition
caused by whole-body inflammatory
state called systemic inflammatory
response syndrome (SIRS).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Sepsis/Systemic Inflammatory
Response Syndrome (SIRS)
• Original site of infection can be
anywhere in body; infection spreads to
vascular system or other sterile areas.
• Sepsis can result from medical
interventions and devices.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Sepsis/Systemic Inflammatory
Response Syndrome (SIRS)
• At risk of developing sepsis:
– People with immunosuppression
– Patients who are hospitalized
– People with pre-existing infections or
medical conditions
– People with severe trauma
– People with genetic tendency for sepsis
– The very old or very young
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Sepsis/Systemic Inflammatory
Response Syndrome (SIRS)
• Sepsis Signs and Symptoms
– Heart rate > 90 beats per minute.
– Abnormal body temperature.
– Tachypnea.
– Abnormal white blood cell count on a
complete blood count (CBC).
– Severe sepsis: presence of sepsis and
evidence of hypoperfusion.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Sepsis/Systemic Inflammatory
Response Syndrome (SIRS)
• Septic Shock
– Mean systemic blood pressure below
60 mmHg.
– Maintenance of mean arterial pressure
above 60 mmHg requires vasopressor
therapy.
– Early recognition and aggressive
treatment necessary for best outcome.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Sepsis/Systemic Inflammatory
Response Syndrome (SIRS)
• Early Goal-Directed Therapy (EGDT)
– Supplemental oxygen with or without
intubation and mechanical ventilation.
– Central venous line placement.
– Fluid resuscitation.
– Maintenance of blood pressure > 90
mmHg with vasopressors.
– Administration of broad-spectrum
antibiotics.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• In past 30 years, medical science has
made tremendous progress in
diagnosing and treating infectious
diseases.
• New vaccines and antibiotics are
continually being developed.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Advances in laboratory technology,
notably polymerase chain reaction
(PCR), have made detection and
identification of microorganisms easier,
quicker, more accurate.
• Despite advances, many infectious
diseases cannot be effectively treated.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Specific treatments for most viral
diseases remain elusive.
• Each year countless people die from
AIDS, hepatitis, pneumonia, sexually
transmitted diseases, other infectious
diseases.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• EMS can have significant impact on
incidence of infectious disease if:
– Providers remain knowledgeable.
– Are leaders in public education.
– Are consistently alert in protecting
themselves and their patients.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Title of the International Association of
Fire Fighters (IAFF) hepatitis B
curriculum, The Silent War, provides
metaphor for dilemma of infectious
diseases in EMS.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• EMS personnel deal with few infectious
disease emergencies; when we do
respond to such emergencies, we often
are unaware of disease's presence until
after call.
• Constant vigilance and personal
accountability are the keys to reducing
risks.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.