BIOTERRORISM GUIDE FOR PREHOSPITAL EMS RESPONDERS

Transcription

1 BIOTERRORISM GUIDE FOR PREHOSPITAL EMS RESPONDERS DISEASE AND METHOD OF INFECTION: Anthrax: Inhalation (Bacteria) Inhalation. 1 7 days of exposure Up to 42 days to appear. Botulinum Toxin Inhalation; food ingestion; 2 hours to 3 days Onset of symptoms commonly between hours. Mild, non-specific respiratory illnesses. Sore throat, fever, dyspnea, cough, mild chest discomfort, respiratory distress, fatigue, muscle aches and discomfort, abdominal pain, skin lesions. Possible short recovery phase then onset of dyspnea, respiratory failure, confusion, diaphoresis, stridor, cyanosis, shock. Fever, vomiting, diarrhea, dry mouth, dilated or unreactive pupils, drooping eyelids, weakened jaw, difficulty swallowing or speaking, double vision, slurred speech, generalized weakness, dizziness, descending flaccid paralysis and respiratory distress/ failure, intact mental state. Gastrointestinal symptoms accompany foodborne botulism. Inhalation botulism does not present with GI symptoms. No person-to-person Respiratory mask N95 or Eye protection/face shield.. No person-to-person Eye protection/face shield if potential for splashing. N95 respirators or greater until verification that no aerosol delivery occurred. PATIENT TREATMENT AND Supportive therapy. No transport restrictions. Urgent transport to prevent respiratory failure. If aerosol dispersed, patient decon with soap and water. Supportive therapy; respiratory support. EQUIPMENT, LINEN AND Decontaminate surface with 10% hypochloritic solution. with 10% hypochloritic solution. Update: May 13, 2004

2 Brucellosis (Bacteria) Contaminated food- Ingestion 5 days 2 months Plague: Pneumonic (Bacteria) Inhalation 1 6 days Fever (often intermittent) headache, chills, heavy sweating, joint pain. Most common findings are lymph node disease and enlargement of the spleen. Systemic illness may become chronic with fever and weight loss. May have pus-foaming lesions. Bone/joint pain common. Sudden onset of high fever, chest pain, cough chills, headache, muscle pain, vomiting. Weakness/prostration, swollen lymph nodes. Dyspnea, stridor, cyanosis. Gastrointestinal symptoms. Sputum initially watery, then bloody, rapidly developing pneumonia, cyanosis, shock, rapid death. Person-to-person transmission is rare. Ingestion Respiratory maskn95 or Person-toperson transmission via respiratory inhalation and infected flea bites. Respiratory mask N95 or greater Eye protection/face shield. Disposable full-length gown or jumpsuit. Disposable shoe covers. No transport restrictions. Supportive therapy. Place N95 respiratory mask on Limit movement as much as possible. Decontaminate surface

3 Q-Fever Inhalation and ingestion. 2 3 weeks Ricin (Biotoxin) Inhalation, ingestion and injection. Signs/symptoms occur hours after inhalation exposure; followed by severe respiratory distress and death from hypoxemia in hours. High fever, chills, severe headache, pain in the eye cavity, pain the chest cavity, cough, heavy sweating, pleuritic chest pain. Weight loss, muscle and joint pain, diarrhea, neck stiffness, bodily discomfort/fatigue. Inhalation: Chest tightness, weakness, fever, progressive cough, pulmonary edema, cyanosis, dyspnea, nausea and joint pain. Allergic/asthma like symptoms: congestion of nose/throat, itchiness of eyes, hives. Respiratory distress and death. Ingestion and Injection: Internal bleeding, vomiting and bloody diarrhea. Hallucinations, seizures, low blood pressure. Person-to-person transmission is rare. Respiratory mask N95 or Eye protection/face shield. No person-to-person Respiratory mask N95 or Goggles with respiratory protection or full face-piece respirator No transport restrictions. respirations No other transport restrictions Airway, Breathing and Circulation. 100% oxygen via nonrebreather. Soap and water or a 0.5% chlorine solution. Hypochlorite solution 10% sodium hypochlorite. Use dry clean up procedures (e.g., hepa vacuum).

4 Smallpox (Virus) Inhalation of droplets Contact with shedding virus. Direct contact of infected bodily fluids or contaminated objects. A. Range from 7 17 days Not contagious during this phase. B. First on-set of symptoms, sometimes contagious; symptoms last approximately 2-4 days. C. Rash emerges- most contagious. Person remains contagious until all of the scabs have fallen off. Disease On Set: acute onset of discomfort, extreme exhaustion, severe abdominal pain, fever, chills, cough, vomiting, muscle tremors, headache and backache. Eruptive Disease or Fever: appears as soon as 2-3 days. Discrete maculo-papular rash on face, hands, forearm, mouth and pharynx. Palm and soles is common. Rash spreads to legs and then centrally to trunk (Week 2) Person-toperson. If rash present, respiratory mask N95 or Disposable full-length gown or jumpsuit of Tyvek or equivalent material. Disposable shoe covers/head cover DOH minimum equipment list for transporting communicable diseased patients will limit contaminating unnecessary patient care Service must request (and receive) waiver from EMS Office, through regional EMS council, prior to equipment removal. Eye/splash protection if performing procedures that may cause splash. Use disposable linens. Place sheet or blanket over patient completely covering body from neck to feet. Place surgical mask on patient, if not administering oxygen via non-rebreather mask. Clean floors using a singlebucket procedure of wet mopping using solution. The contents of the bucket should be emptied into the toilet. Disposable mop head and cleaning cloths should be used. Mop head should be removed and disposed of by placing in red lined trash bag. Bag linen and place in a second red bag. Autoclave non-disposable linen before transporting to laundry. Autoclave waste before incinerating. Decontaminate surface

5 Staphylococcal Enterotoxin B (Toxin) Inhalation Tricothecene Mycotoxins (T-2) (Toxin) Inhalation Fever, chills, muscle pain, nausea, diarrhea and cough; Shortness of breath, chest pain. Skin burning pain, redness, tenderness, blistering. Nasal itching and pain, sneezing, nosebleeds. Dyspnea, wheezing and cough. Chest pain, blood stained sputum. Eyes pain, tearing, redness, foreign body sensation and blurred vision. No person-to person N95 respiratory mask (or greater). No person-to person Respiratory mask N95or greater Eye protection/face shield. Disposable full-length gown or jumpsuit of Tyvek or equivalent material. Disposable shoe covers. Supportive therapy. Patient decon: soap and water. Remove patients outer clothing. Decontaminate exposed skin with soap and water. Eye exposure: copious saline irrigation. Superactive charcoal if toxin has been ingested. with hypochlorite solution under alkaline conditions such as 1% sodium hypochlorite and 0.1 bleach.

6 Tularemia (Bacteria) Inhalation. 3 to 5 days Venezuelan Equine Encephalitis (VEE) (Virus) Inhalation and infected vectors (e.g., mosquito) Incubation period: 5-16 days Fever, chills, headache, discomfort, chest discomfort, anorexia, cough. Sore throat, shortness of breath, diarrhea, muscle pain, vomiting. Hemorrhage, weakness/ prostration, abdominal pain, swollen lymph nodes. Pneumonia in 30-80% of patients. Diffuse, varied skin rash. May be rapidly fatal. Sudden onset with generalized discomfort, spiking fever, chills, severe headache, intolerance of light, pain in the legs and lumbosacral area. Nausea, vomiting, cough, sore throat and diarrhea. No person-toperson Respiratory mask N95 or Eye protection/face shield Disposable full-length gown or jumpsuit of Tyvek or equivalent material. Disposable shoe covers. Person-to-person transmission is low. Respiratory mask. No other transport restrictions. No other transport restrictions.

7 Viral Hemorrhagic Fevers (Virus) Arenavirus Ebola Filoviruses Direct contact and inhalation. Fever, muscle pain, easy bleeding, red itchy eyes, vomiting, bleeding, hypotension, headache, and shock. Delirium, seizures and coma. Diarrhea, flaccid paralysis, weakness. Person-to-person Respiratory mask (N95or greater). Eye protection/face shield Disposable full-length gown or jumpsuit. Supportive therapy. Statewide and Regional with 10% bleach solution, hypochlorite or phenolic disinfectants.

8 PERSONAL PROTECTIVE EQUIPMENT: Employed in the care of patients: (clean non-sterile examination) used to prevent exposure to blood, body fluids, secretions, excretions and contaminated items. Full-length gowns or disposable jumpsuit used to prevent exposure to blood, body fluids, secretions, excretions and contaminated items. Material should be of Tyvek or equivalent material. Masks and eye protection or face shield should be used during procedures or activities that are likely to generate splashes or sprays of blood, body fluids, secretions or excretions. N95 (or greater) respiratory masks for most bio agents. Manage used patient care equipment and linen in a manner that prevents the transfer of microorganisms to people or Wash hands after each patient contact. Carry alcohol-based hand rub (when soap and water are not available.) HANDWASHING Wash hands after touching blood, body fluids, secretions, excretions and contaminated items, regardless of whether gloves are worn. Wash hands immediately after gloves are removed, between patient contacts and when other wise indicated to avoid transfer of microorganisms to other patients or environments. If soap and water are not available, use alcohol-based hand rub. Wash with soap (plain or antimicrobial) and water after contact with all patients and environmental surfaces in close proximity to the Do not touch the mucous membranes of the nose, eye or mouth with unwashed hands. MASKS Masks are single use. It is not recommended to be use with different patients. The mask should be dispose of especially if you are dealing with a contagious disease. ING SMALLPOX PATIENT WITH RASH Place a disposable sheet or disposable blanket on litter. Cocoon patient on bed with own sheet and place on top of litter. Cocoon patient with disposable sheet or blanket which was placed on the litter. Tape sheet/blanket or place using small strips of tape; or place another sheet/blanket on top of Place N95 mask or non-rebreather mask with 02 on

9 TREATMENT Supportive Care: Airway management Supplemental oxygen high flow via non-rebreather mask. Filters: Consider a reusable resuscitator equipped with inlet filtration system for filtering contaminated air. HOSPITAL NOTIFICATION: Ambulance crew must provide sufficient notification to the receiving hospital of a possible infectious patient and communicate specific signs and symptoms to allow hospitals the opportunity to prepare appropriately for the patient s arrival. Recognizing Bioterrorism-Related Illnesses Healthcare providers should be alert to illness patterns and signs/symptoms that might signal an act of bioterrorism (BT). The following clinical and epidemiological clues suggest a possible BT event: An unusual increase in the number of people seeking care, especially with fever, respiratory, or gastrointestinal symptoms. Any suspected or confirmed communicable disease that is NOT endemic in Pennsylvania (e.g., plague, anthrax, smallpox or viral hemorrhagic fever). Any unusual age distributions or clustering of disease (e.g., chickenpox or measles in adults.) Any unusual temporal and/or geographic clustering of illness (e.g., persons who attended the same public event). Any unusual illness or disease clusters should be reported immediately to the PA Department of Health: PA Health or DISINFECTION: To mix a.10% sodium hypochlorite solution: One part Bleach and 9 parts water. Apply via cloth or swab. DISCLAIMER In view of the possibility of human error or new information, the reader of this chart should contact medical command for further instructions. OTHER SOURCES OF INFORMATION: Department of Health Web Site: Center for Disease Control: Regional EMS Councils Poison Centers 1 (800)