Office of Emergency Medical Services & Trauma

Office of Emergency Medical Services & Trauma
Guidelines for Emergency Medical Service Personnel Regarding Care and Transport of
Patients with Suspected Ebola Virus Disease (EVD)
The CDC is continuing to monitor the outbreak of Ebola Virus Disease (EVD) in West
Africa. Early symptomatic recognition and reporting are critical to infection control.
EMS providers should determine the following upon arrival:
Does patient have fever (subjective or ≥ 101.5˚ F) OR compatible EVD symptoms such as
headache, weakness, muscle pain, vomiting, pain, diarrhea, abdominal pain or
hemorrhage?
AND within the 21 days before illness onset,
Has the patient traveled to an Ebola-affected area OR had contact with blood or other
body fluids of a patient known to have, or suspected to have, Ebola OR had direct
contact or direct handling of bats, rodents, or non-human primates from a diseaseendemic area?
Since Ebola is transmitted through direct contact with the blood or bodily fluids of an
infected symptomatic person, the presence of any of these criteria bring the following
recommendations:
•
•
•
•
Isolate the patient: Patients should be separated from other individuals as much
as possible (e.g., in the back of the ambulance with the door closed).
Wear appropriate personal protective equipment (PPE): Standard, contact and
droplet precautions should be implemented. Health care providers entering into
contact with the patient should wear gloves, gown (impermeable), eye
protection (goggles or face shield), and a facemask prior to coming into contact
with the patient. Additional PPE may be required in certain situations (e.g.,
copious amounts of blood, other body fluids, vomit, or feces present in the
environment). In these cases, double gloving, disposable shoe covers, and leg
coverings are recommended. After use, PPE should be carefully removed
without contaminating one’s eyes, mucous membranes, or clothing with
potentially infectious materials. Used PPE should be placed into a medical waste
container at the hospital or double bagged and held in a secure location.
Patient care equipment: Dedicated medical equipment (preferably disposable)
should be used for the provision of patient care. All non-dedicated, nondisposable medical equipment used for patient care should be cleaned and
disinfected according to manufacturer's instructions before subsequent use.
Patient care considerations: Use caution when approaching a patient with
Ebola. Illness can cause delirium with erratic behavior that can place EMS
personnel at risk of infection (e.g., flailing or staggering). Limit procedures to
OEMS Ebola Guidance 10-8-14
Page 1
•
•
•
•
•
only those that are absolutely necessary prior to arrival at the hospital (e.g., limit
the use of needles and minimize procedures as safely as possible). Hand hygiene
should be performed frequently, including before and after all patient contact,
contact with potentially infectious material and before putting on and upon
removal of PPE, including gloves.
Hospital Notification: EMS staff should notify the receiving healthcare facility in
advance when they are bringing a patient with suspected Ebola, so that proper
infection control precautions can be taken.
Patient transport into hospital: Movement of suspected Ebola patients into
hospital or healthcare facilities should be restricted to entrances away from
public waiting areas. Suspect cases should not be moved through or temporarily
left in waiting rooms.
Avoid aerosol-generating procedures: If performing these procedures, PPE
should include respiratory protection (N95 or higher filtering face piece
respirator). Examples of these procedures include airway management,
suctioning, inhaled nebulizer treatments, and cardiopulmonary resuscitation. If
necessary, these procedures should be performed in a stationary vehicle or in a
receiving hospital to minimize risk to the EMS provider from a moving vehicle.
Implement environmental infection control measures: Diligent environmental
cleaning and disinfection and safe handling of potentially contaminated
materials is of paramount importance, as blood, sweat, vomit, feces, urine and
other body secretions represent potentially infectious materials. All surfaces in
the patient care area must be cleaned and disinfected after transport. Persons
performing environmental cleaning and disinfection should wear recommended
PPE (described above). Follow standard procedures, per manufacturers'
instructions, for cleaning and/or disinfection of environmental surfaces and
equipment. EPA-registered hospital disinfectants with a label claim for one of
the non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) to
disinfect environmental surfaces may be used. Disinfectant should be available in
spray bottles or as commercially prepared wipes for use during transport
Alternately, a 1:50 dilution of household bleach that is prepared fresh daily can
be used to disinfect environmental surfaces. A 1:10 dilution of household bleach
that is prepared fresh daily can be used to treat spills before covering with an
absorbent material and wiping up. After bulk waste is wiped up, the surface
should be disinfected as described above.
Post-exposure guidance: EMS personnel who are exposed to blood, bodily
fluids, secretions, or excretions from a patient with suspected or confirmed
Ebola should immediately wash the affected skin surfaces with soap and water.
Mucous membranes should be irrigated with a large amount of water or
eyewash solution.
OEMS Ebola Guidance 10-8-14
Page 2
Reporting Reminder for EMS Providers:
As a reminder, confirmed or suspect cases of any viral hemorrhagic fever, including EVD,
must be reported immediately to the Alabama Department of Public Health (ADPH). .
Complete the ADPH Ebola Virus Disease Consultation Record and call ADPH at 1-800338-8374. If possible, submit the completed form via fax to 1-334-206-3734 or email to
cdfax@adph.state.al.us.
Additional Resources:
Alabama Department of Public Health: www.adph.org/ebola
Centers for Disease Control and Prevention: http://www.cdc.gov/vhf/ebola/index.html
Detailed Emergency Medical Services (EMS) Checklist for Ebola Preparedness:
http://www.cdc.gov/vhf/ebola/pdf/ems-checklist-ebola-preparedness.pdf
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: http://www.cdc.gov/vhf/ebola/hcp/interimguidance-emergency-medical-services-systems-911-public-safety-answering-pointsmanagement-patients-known-suspected-united-states.html
Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus:
http://www.cdc.gov/vhf/ebola/hcp/environmental-infection-control-in-hospitals.html
OEMS Ebola Guidance 10-8-14
Page 3