This paper provides a concise overview of CDC guidelines for emergency medical services (EMS) personnel responding to patients under investigation (PUIs) for Ebola Virus Disease. Drawing primarily on CDC interim guidance, the paper explains the core "identify, isolate, and inform" framework, detailing the roles of public safety answering points (PSAPs), the proper use of personal protective equipment (PPE), adapted medical procedures, transport protocols, and post-exposure reporting requirements. The paper also highlights the importance of advance planning, interagency coordination, and non-punitive sick leave policies in ensuring an effective and safe EMS response to a potential Ebola case.
The Centers for Disease Control and Prevention (CDC) has been at the forefront of America's response to the Ebola outbreak in West Africa. When two medical workers returned to the United States with Ebola, weaknesses in the precautions hospitals had in place were revealed (CDC, 2015a). This event resulted in increased scrutiny concerning how well prepared first responders are should they be confronted by a patient suspected of having contracted the disease. Accordingly, the CDC has issued detailed guidelines for first responders.
According to the most recent press release from the CDC (2015b), it is difficult for anyone coming into contact with a symptomatic person suffering from Ebola to contract the disease unless they have direct contact with blood, urine, saliva, vomit, sweat, or diarrhea. Even then, unless the person is suffering from severe Ebola, the chances of contracting the disease are reduced. However, emergency medical services (EMS) personnel coming into contact with someone suspected of having Ebola need to take special precautions. What follows is a general overview of these precautions and how implementation should be accomplished at the local level. Should the Ebola outbreak ever achieve pandemic proportions in the United States, the same plans would be utilized.
The basic operational mantra is "identify, isolate, and inform" (CDC, 2015b). The identify step requires public safety answering points (PSAPs) to question callers about residing in or traveling to West Africa, or about coming into contact with someone who recently returned from West Africa. PSAPs should also question callers about the symptoms being experienced by the patient, such as fever, headaches, vomiting, muscle pain, diarrhea, and hemorrhage.
A positive response to these questions should trigger an already developed and implemented, coordinated plan to isolate the patient under investigation (PUI) by first responders. Activation of this plan depends on well-trained EMS personnel who are versed in Ebola response protocols, especially the correct use of personal protective equipment (PPE) appropriate to each first responder's role. Crucially, PSAPs must notify first responders as soon as they have identified a PUI, thereby giving EMS personnel time to don the appropriate PPE before coming into contact with the patient. Given the constraints that PPE often imposes on EMS personnel, some medical procedures will need to be adapted to PPE use as part of the Ebola response plan and training. Regular training in the application of these procedures while wearing PPE is therefore essential, as is demonstrable competency following training.
"Notifying EDs, disinfection, and medical waste disposal"
"Post-transport monitoring and sick leave policy"
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