H1N1

[Quakefire]

So far I swear H1N1 is tied to the full moon (very long night) but regardless of the tides flu season seems to be in full swing so I figured I would ask a few questions find out whats going on out there.

For your confirmed (or heavily suspected) cases

What seems to be our average time for onset of symptoms

What do you wear for BSI? Are gloves good enough, do you wear a mask from the second you get out of the unit? after initial assesments? N95 or Surgical? Mask your patient as well?

What similarities are you seeing

Did you get innoculated? Just H1N1 or both? were you required?

What are your disinfection policies regarding your unit after transporting these patients?

Anyone else have any questions?

[mhull]

So far I swear H1N1 is tied to the full moon (very long night) but regardless of the tides flu season seems to be in full swing so I figured I would ask a few questions find out whats going on out there.

Funny enough, my last two shifts did about 8 calls each day. Not ONE Flu call. The full moon seemed to bring about seizures!

For your confirmed (or heavily suspected) cases, what seems to be our average time for onset of symptoms?

Haven't seen an H1N1 case yet...good for me I suppose.

What do you wear for BSI? Are gloves good enough, do you wear a mask from the second you get out of the unit? after initial assesments? N95 or Surgical? Mask your patient as well?

Gloves - always. We get a FRI (Febrile Respiratory Infection) alert along with dispatch information - which is really quite useless as 80% of all callers meet some of the requirements. So generally I don't wear a mask till I get to the pt. and see what the story is. Twice in the last year have I put on a mask during the call. One of those (last year) was as we arrived at hospital as the pt. stated a friend of hers who was sick had JUST got back from Mexico.

What similarities are you seeing.

H1N1 looks like the flu to me.

Did you get innoculated? Just H1N1 or both? were you required?

Nope. and they can't make you.

What are your disinfection policies regarding your unit after transporting these patients?

Normal disinfection. Wipe down of external surfaces coming in contact with pt. with Virox or such. Stretcher, monitor cables, BP cuffs, etc. Deep clean not required for H1N1. Although some crews are trying to get taken out of service for such. Supervisors are putting a stop to that now.

Anyone else have any questions?

[rock_shoes]

So far our H1N1 precautions include wearing an N95, isolation gown, eye protection, and the usual gloves. Proper donn and doff procedures (initiated by our Chemical, Biological, Radiation, Nuclear specialists) are in full effect. Post potential H1N1 call every car is to be completely decontaminated (a 1.5 to 2 hour process). Also it's time for us to sharpen our memories as patient care forms are not to be touched until the attendant has been decontaminated (a measure to eliminate cross contamination via medical records).

As to receiving H1N1 and seasonal flu vaccinations this is where BCAS has truly dropped the ball. No measures have been put in place to ensure medics are vaccinated on a priority basis. I received both today by visiting one of the public clinics and identifying myself as a frontline care provider (I arrived at 0840 and was not able to leave until 1100 at a flu clinic commencing at 0900). Crews at my station yesterday where denied access to the vaccine when the local hospital was vaccinating its staff. Our station by the way is attached to said hospital.

[WolfmanHarris]

For your confirmed (or heavily suspected) cases

Have had one "suspected" case. 8y/o F c/o N/V, headache, fever and aches.

What seems to be our average time for onset of symptoms

One isn't anything you can really average and my ancedotal evidence wouldn't be of any particular use anyways in the face of much better data available from Health Canada, CDC, etc.

What do you wear for BSI? Are gloves good enough, do you wear a mask from the second you get out of the unit? after initial assesments? N95 or Surgical? Mask your patient as well?

Gloves, N95, glasses as required if coughing, vomiting etc. (these I tend to avoid as with the N95 they get fogged beyond usefulness so quickly that I end up bringing my hands to my eyes to clear them, which kinda defeats the purpose.) I mask my pt with a surgical if not on O2.

BSI comes initially from FRI precautions mentioned by CACC or pt. presentation. Once contact's been made if I no longer think the pt requires me to wear an N95 I'll doff it. Like mhull mentioned, FRI precautions have a really high instance of false positives.

What similarities are you seeing

None. See above. Once again, I'm not going to let my limited anecdotal exposure trump the science. Especially when ILI has such wide ranging, non-specific symptoms.

Did you get innoculated? Just H1N1 or both? were you required?

Yes for H1N1. Seasonal shot not currently available. Not required but encouraged and the hoops MOH makes you jump through are damned near coersion. To the point that when I considered taking a sick day following the shot, I was going to file it as a workplace injury on the grounds the service instructed me to. Instead I went to work. (Casuals get no sick days)

What are your disinfection policies regarding your unit after transporting these patients?

Unaware of anything specific. Wipe down equipment/surfaces with virox wipes as is done after all calls.

Anyone else have any questions?

Before this gets like "Trauma" can we maybe merge some of these H1N1 threads? On a long enough time line they'll probably end up being very similar.

Edited November 5, 2009 by docharris

[northernmedic]

I have had 40+ potential expossures and 8 confirmed cases including 2 severe. I had my seasonal flu shot as well as my H1N1 shot last week. It seems like many of the rural public health providers are not including EMS here in BC but so far I haven't seen this to be the case here in Vancouver. I would we have actually had a better immunization roll out than most of the hospitals for staff. Since last friday I would estimate we have vaccinated over 800 staff. There are some mobile vaccine vans starting up this week to hit more of the rural stations. The public health department response so far seems to be less than coordinated.

Rock Shoes,

You should be kicking up a fuss with your local public health since they are supposed to be including EMS with the rest of front line health care staff. I suspect this is a small town mentality as I haven't seen this at all in any of the urban areas to date.

[Quakefire]

We were innoculated as part of the hospital staff, because in Saskatchewan we are mostly private services, we were treated as health region employees. We so far have no specific instructions as to deep cleaning our units after these calls, we try and get a mask on the patient before getting into the unit, but we haven't done a full deep clean after, just the wipes on all surfaces.

Has anyone tried to avoid the use of nebulizer masks as i've heard that it actually puts the crew at higher risk?

[VentMedic]

Has anyone tried to avoid the use of nebulizer masks as i've heard that it actually puts the crew at higher risk?

Wear your N95 masks for patients on CPAP, nebulizeres, NRBMs, SM, etc. This may have to apply to anyone in the truck while these devices are on the patient.

Everyone (U.S.) should be monitoring the CDC website for updates. Hospitals are being held to these guidelines and they are expecting EMS providers to be up to date as well when it comes to protecting the patients and bystanders in the care areas and entry ways.

http://www.cdc.gov/h1n1flu/guidance_ems.htm

http://www.cdc.gov/h1n1flu/guidance/

Edited November 5, 2009 by VentMedic

[tniuqs]

docharris

Before this gets like "Trauma" can we maybe merge some of these H1N1 threads? On a long enough time line they'll probably end up being very similar.

Already so much EBM information ... heck I think EMT city should just merge VENTMEDICS post on the topic and go from there (well accept my poll) that is ....

AGREED !

Mind you if one used the most excellent search engine on this site that would not be a bad idea either EH dust?

cheers

[Arctickat]

Quakefire, you're gonna have to get Wally to give you guys up there some CME on H1N1. These questions of yours should have been answered back in June. Also, some of the well intentioned individuals here are giving you region specific, ie bad, information.

Take mhull's response for question regarding the requirement for innoculation. Sask Health has mandated that all employees of health services, including us, are not required to take the H1N1 innoculation, but, if an outbreak occurs, all employees who refused the innoculation will be prohibited from working because they pose a risk to patients.

Sask Health no longer tests for H1N1 because it is a community acquired illness. In essence, it is treated like any other influenza case. If symptoms are severe enough to require hospitalization the patient will be given antivirals, otherwise they are told to stay at home. I've been called to several Influenza Like Illness(ILI) cases and have transported very few because they didn't require hospitalization and were simply in panic mode. People are of the assumption that H1N1 is a death sentence and that every cough, sniffle, and fever requires a trip to the ED.

Even the use of an N95 is not required unless an activity is being conducted that will result in aerosolized vapours, such as a neb treatment. Otherwise a simple surgical mask on the patient or you will suffice. Proper hand washing techniques is most important. The virus can only survive on a hard surface for 2 - 8 hours, even less on a soft surface like a blanket or clothing.

You would be best served in going here for information rather than asking for help from individuals who have no idea what your specific local and provincial policies are.

Edited November 6, 2009 by Arctickat

[VentMedic]

Even the use of an N95 is not required unless an activity is being conducted that will result in aerosolized vapours, such as a neb treatment. Otherwise a simple face mask on the patient will suffice.

No oxygen mask will protect against any aerosolized particles. In fact, almost any O2 mask will aerosolize the particle to spread t/o the immediate area.

It was actually Canada and China that tracked the spread of SARS that came up with the O2 device guidelines which the U.S. CDC and RT association, AARC, have adopted.

Also, just this week the U.S. nurses, especially CA, have won a victory with the N95 masks and hospitals will now be held to the higher CDC standards for protection. Thus, everyone is now trying to hold onto a mask. Myself, I am now wearing a battery operated HEPA full hood mask in the ICUs. But, we do have quite a few confirmed cases on serious O2 and devices. All precautions are also being taken when doing IFT with the truck, RW and FW.

Edited November 6, 2009 by VentMedic