Ebola Precautions and Considerations
Dear Program and Medical Directors
Due to recent global events, NAAMTA would like to address the following precautionary actions and considerations relating to the Ebola virus.
Ebola is not the first infectious communicable disease that healthcare workers and medical crews have had to deal with. Of recent history, first it was SARS, then it was MARS (or MEARS) and then it was H1N1. Now it is Ebola. While all of these diseases created significant concern, Ebola certainly has demanded that we stand up and pay more attention than usual.
With the worldwide concerns over Ebola, and as part of a comprehensive Infection Protection and Control Program, NAAMTA would like to take this opportunity to strongly recommend that each of our medical transport programs perform a detailed review and evaluation of infection control precautions utilized by your program.
There are endless recommendations, commentaries and editorials floating around the Internet and industry—some evidence-based and some not. This can make it difficult to effectively provide the necessary biohazard protection to our medical crews. The Centers for Disease Control in the U.S. (CDC) has published various guidelines for hospitals and healthcare workers caring for patients with known or suspected Ebola. There are further guidelines published to address the non-controlled environment of air transport and prehospital settings.
CDC guidelines are based on four Biosafety levels:
This the lowest level and usually microbes pose a minimal potential threat. BSL 1 agents do not consistently cause disease in healthy adults. There are various bacteria and virus that coexist with humans and are part of the normal body flora. BSL 1 environments usually do not require isolation from the general healthcare setting. Implementation of Standard Precautions and PPE is sufficient to control the spread of these agents.
Biosafety level 2 covers working with agents associated with human disease, (i.e., pathogenic or infectious organisms posing a moderate hazard. Bacteria and viruses that is indigenous to the local geographic community. Examples are C. difficile, Staph, Strep, most Chlamydiae, HIV, Hepatitis A, B, and C, influenza, Lyme disease, Salmonella, mumps, measles, MRSA, and VRSA.
Great care should be used to prevent percutaneous injury (needlesticks, cuts and other breaches of the skin), ingestion and mucous membrane exposures in addition to the standard practices of BSL 1. Contaminated sharps are handled with extreme caution. Decontamination of all non-disposable items is standard practice, (preferably, Class II biosafety containment and autoclaving decontamination.) BSL 2 PPE must also provide the next level of barriers, i.e., specialty safety equipment. Specific immunizations are required for personnel working with infected patients. More controlled access to these patients is required. Immunocompromised, immunosuppressed and other persons with increased risk for infection should only work with these patients at the discretion of the medical director.
Microbes at BSL 3 can be either indigenous or “exotic” (originating outside of general local community.) These agents can cause serious and potentially lethal disease through respiratory transmission. M. Tuberculosis, SARS, Rabies virus, Yellow fever virus, and West Nile virus are some examples of BSL 3 microbes.
Environmental precautions require double-door isolation, filtered and directional exhaust airflow from containment area, and restricted access to patient. All clothing, contaminated linens and clothing are to be decontaminated prior to disposal. Stringent and specific training and PPE are to be used with caring for patients with BSL 3 microbes.
Agents classified as BSL 4 are extremely dangerous and pose a high risk of life-threatening disease—Ebola, Marburg and other hemorrhagic fever diseases for example. The most stringent PPE and environmental containment precautions must be used to avoid aerosolized or direct contact transmission. Full-body isolation suits and N100 respiratory masks are required. Decontamination of all materials and clothing/gowns prior to leaving patient-care area are required.
Application to Medical Transport Environments
Clearly, it is impossible to isolate all patients that require such precautions in the medical transport environment. However, it is possible, and prudent, to take the necessary precautions to limit exposure, implement decontamination procedures and initiate surveillance monitoring to avoid any spread of infectious agents and communicable diseases.
NAAMTA encourages all transport programs to follow the current CDC recommendations regarding medical transport environment as follows:
- Guidance on Air Medical Transport for Patients with Ebola Virus Disease
- Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States
NAAMTA is asking all programs or medical to evaluate their Infection Prevention and Control Programs. Identify any areas in which changes need to be implemented in order to safely transport patients with known or suspected infectious disease at the time of transport, particularly Ebola. This includes evaluating all intake requests for transport for screening of potentially infectious scenarios.
Furthermore, all crewmembers that are involved in the loading, unloading and care of patients are to already have been fitted for an N95 mask. If this has not occurred, it should be considered an urgent priority. Additionally, since an N95 mask does not provide adequate protection against the Ebola virus, it is NAAMTA’s recommendation that programs consider the utilization of N100 masks for these patients.
Be safe. Be careful.
|Roylen GriffinExecutive Directorroylengriffin@naamta.com||Nancy PurcellMedical Administratornancypurcell@naamta.com|