Jim Augustine, MD
Medical Director, Atlanta Fire Rescue
According to the CDC, an influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears of “emerges” in the human population, causes serious illness, and spreads easily from person to person worldwide. Past influenza pandemics have led to high levels of illness, death, social disruption, and economic loss. This same set of characteristics can occur with the outbreak of other diseases, including the recent emergence of SARS and resistant Staph Aureus.
Emergency Providers, fire/EMS agencies and personnel must have preparedness plans in place, and critical links established, to minimize the impact of serious contagious diseases on the community. The priority is to maintain the level of emergency services, reduce spread of disease in the community, and provide emergency medical services to those affected by the disease.
EMS CloseCalls will maintain a bulletin board linkage for Best Practices in preparedness programs for Pandemic Flu and serious contagious diseases. This link will allow exchange on the latest information related to Avian Flu, but the latest issues involving EMS and fire personnel safety. There will be interchange on items that have no precise answer, or where information will change frequently. A recent example is the controversy regarding CDC recommendations on particulate respirators needed as protection of health care personnel.
To post materials on the Link, send to Pandemic@emsclosecalls.com
Mission Statement of the Fire/EMS Exposure Control Plan
To minimize the risk to Fire/EMS personnel of occupational exposure to bloodborne and airborne pathogens. This will be accomplished through training, policy implementation, work practice controls, engineering controls, providing Personal Protective Equipment, and an effective post exposure plan.
Objectives:
The strategic objective is to provide a safe work environment and practice for our personnel, the people whose safety and health we believe are our most valuable resource.
The tactical objective of the fire/EMS exposure control program is to minimize or eliminate employee occupational exposures to respiratory droplets, blood or any other human body fluid, and potentially infectious airborne particulate.
The compliance objective is to perform service while satisfying regulations promulgated by federal and state agencies with oversight in the area, such as the Occupational Safety and Health Administration (OSHA). The plan, at a minimum, will demonstrate compliance with the OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030 and the OSHA Tuberculosis Exposure Standard 29 CFR 1910.1035.
Elements in the Plan
Establishing local syndrome surveillance
Working through the Local Emergency Planning Committee (LEPC)
Gathering appropriate constituents
Outlining cost-effective strategies
Implementing broad-based education
Recognition of an outbreak
Plans should always initiate at the local level. The local ED(s) undertake pattern recognition as part of everyday operations, and work with hospital Infection Control Practitioners to identify, report, and implement control plans for any outbreak of a serious contagious disease.
Develop methods of State or National communication
Public Health will assist in communications and local operations
Provide safe methods of Patient Access to the emergency system: when, where, how
Fire/EMS
Private Vehicle
Movement between other Health Care Facilities
Use of unconventional “Alternate Care” sites. Overlap with Special Needs Shelters
Participate in Developing Local Hospital Surge Capacity
Maintenance of day-to-day Emergency operations
Non-effected patient management
Lockdown, limited access and signage
Management of disease realities, fears and the unknown
Public Relation strategies: from planning through response
SARS lessons: real-time science and public education
Health Care Staff and their families
NFPA, JCAHO, OSHA and other regulatory bodies weigh in
Pandemic Flu and Emergency Services Organizations
What are the Planning Considerations?
Staff illness would necessitate change in personal behavior and station interaction
Staff family illness would have significant effect on Department capability
Patient illness would dramatically alter Department interaction in patient care
Community illness and deaths would alter social dynamics, and perhaps new order in funeral attendance
Societal changes would negatively effect economy, perhaps affecting community security and social order
Goals for Department Operations in a Pandemic Flu Outbreak
Provide for business continuity
Address staffing and personnel issues
Prevent illness in personnel
Personal life guidance
Station life guidance
Patient care changes to reduce contagious risks
Upgrade prevention programs
Institute changes in treatment of ill personnel
Altered Return to Work policies
Reassure operations and administrative personnel that “it is safe to come to work”
Prevent station outbreaks
Reduce station traffic
Establish and enforce appropriate quarantine and isolation procedures in operations
Service to Community
Develop and broadcast PSAs to reduce emergency workload
Change response patterns to alarms
Change exposures to patients
One staff member only in contact
Upgraded personnel protection
Ask patient to assist in protection
Educate Department personnel and enforce region’s quarantine and isolation procedures
Collaborate with Public Health in targeted positive and negative behaviors
Late Stage Critical Issues, when a Pandemic would be Widespread, and Deaths Frequest
Potential for breakdown in social order, riots and other behaviors
Ration services for public safety personnel
Agree on basic services to be provided
Forbid traffic into stations
Quarantine critical personnel
Employee education on targeted positive and negative behaviors for personnel and families
Mandatory prevention efforts
Increase prophylaxis behaviors
