Ebola Preparedness for Emergency Medical Services

[Dr. Gregg Margolis]
Hello and welcome to the webinar on Ebola Preparedness for Emergency Medical Services. (Unintelligible) Center for Disease Control,
in conjunction with the Federal Interagency Committee on Emergency Medical Services. Thank you very much for joining us today and
we are very excited to have the opportunity to present information that we have been working
on that we think will significantly enhance the ability of emergency medical services
to respond to the Ebola situation in the United States. It is my pleasure at this point to introduce
for opening remarks the Principle Deputy Assistant Secretary for Preparedness and Response, Mr.
Edward Gabriel. Mr. Gabriel has had an esteemed career in
EMS and emergency management in New York City and with the Walt Disney Corporation. He is a 26 year paramedic veteran of the New
York City Fire Department and emergency medical services, retiring as the assistant chief
and division commander. Without further ado, I’ll turn things over
to Mr. Gabriel for opening remarks. [Edward Gabriel]
Thank you Gregg. And to everyone on the phone it’s a pleasure
to talk to you all about this important issue. We have our partners on the phone from all
over government to provide you with the latest and best information. And I won’t take a lot of time. They’ll introduce themselves as they go along. But I know that on the phone and certainly
here at the Department of Health and Human Services and throughout the federal government,
we see each and every one of you EMS providers and first responders from all over the country
as an essential part of the response. And quite frankly, as a paramedic for many,
many years, we take it personal to make sure that the things we’re going to talk about
today give you guidance and direction that we think are important. We’re doing this webinar on Ebola working
with the Federal Interagency Committee on Emergency Medical Services and the DOT efforts
around that. And in addition to that, we want to talk to
you a little about – from the Assistant Secretary of Preparedness and Response’s role on that
committee. About a year ago I was the chair of that committee
and now the co-chair. And we have always had a long standing, continuing
interest in the emergency medical services and the people that support that, along with
our other partners on the phone, the Centers for Disease Control as well as the Department
of Transportation. The group here on the phone has been working
very hard to develop and share updated Ebola related guidance for all health care practitioners,
including all of you EMS providers. At some point we’re going to talk through
bigger picture issues and some of the work that one of our departments is doing on vaccinations
if we get to it. However, there’s a lot of time we want to
spend on just dealing with EMS agencies and providers managing this and potentially running
into patients like this in the field. I just want to close by saying all of us here
understand that the emergency medical services is a vital part of our health system, that
EMS agencies and all of you — the providers and the dispatchers, the police officers and
fire fighters that are on this call — know you’re ready to deal with any kinds of emergency. We’ve seen that over years; the heroic efforts
of first responders and we don’t take that lightly. And we want to make sure that everybody on
the phone here is ready to handle whatever comes along, because in the end, just because
there’s Ebola out there we all know — who have been providers for many, many years — that
people are not going to stop calling 911 or emergency lines for other – either critical
emergency events or simply to get support during an emergency. So understanding that this is one issue that
we wanted to bring to everyone’s attention, provide some information to you all. But understand that 99.9% of the work that
you’re going to do out there is going to continue and this will be an additional thing that
we would like everybody to focus on. So on behalf of the Health and Human Services
department, the rest of the government agencies on the phone, I’d like to thank you all for
participating in this important event. And let me turn it back over to Dr. Margolis. Gregg? [Dr. Gregg Margolis]
Thank you Mr. Gabriel and as Mr. Gabriel mentioned, EMS is an essential part of the United States
healthcare system and represents a unique intersection of healthcare, public health,
and emergency management. And like is the case with all public health
emergencies, EMS is going to play a critical role in our response to Ebola and in our nation’s
healthcare resilience. There are likely two main roles that EMS would
play in the evolving and dynamic situation that we have here in the United States. First is for the 911 providers, probably the
most likely scenario to encounter a potential Ebola patient would be somebody who is exposed
to Ebola in West Africa, travels to the United States, and is originally asymptomatic but
then develops symptoms while in the U.S. and dials 911 for assistance. We saw that happen with Mr. Duncan in Texas
and there clearly was an EMS component to that case. We do think that the likelihood of this happening
will decrease as the Centers for Disease Control and Department of Homeland Security are going
to be increasing the role of travel screening at airports in the very near future. But that will not eliminate this as a possibility
and all EMS agencies and providers need to be prepared for that possibility. There also is a very real possibility that
somebody would need to have an inter-facility transfer of either a confirmed or suspicious
case of Ebola Virus disease. We are learning as we have evolved that the
management of patients with Ebola does have to be done in specialized facilities that
have an awful lot of advanced critical care capabilities. And it very well may be that emergency medical
services are called to provide inter-facility transfers in the event that a patient presents
at a facility that is not able to provide that advanced level critical care. And then the final possible touch point for
emergency medical services is for the small number of people — the handful of people
— that are being medically evacuated from – American citizens that are medically evacuated
from West Africa back to the United States to receive care. And that has happened a number of times, as
you’re well aware in the media and may continue as the crisis in West Africa continues. I would like to point out that this webinar
was scheduled about three weeks ago and this is a dynamic and ever changing situation. The original intent was for us to spend the
majority of our time on a couple of resources that the federal government through a broad
inter-agency collaborative effort have worked on, in particular some EMS guidance and checklists
for preparedness. But it is clear — as the situation has evolved
in the last week and a half or so — that the biggest current event that – in regards
to this situation is the CDC’s change in personal protective equipment guidance. And we suspect that there’s going to be an
awful lot of questions about that, based on the coincidence of timing of this webinar
with that event. So with that, I’d like to turn things over
to our colleagues at the Centers for Disease Control to provide an overview of the Ebola
situation as it exists in the United States and West Africa today and to provide some
information about the PPE guidance and any other current events. [Jane Randolph]
Thank you very much, Gregg. This is Jane Randolph, I’m a consultant with
the Healthcare Preparedness Activity and I’ll introduce the people in the room and then
we’ll do the update. In the room I have Dr. Deborah Levy — who
is the chief of the Healthcare Preparedness Activity — Amy Veldrama — who is a nurse
officer in the activity — and Charlene Lee, who’s one of our epidemiologists. I also have Alison Laupher and Alice Gue,
both of whom are with the Domestic International Training Team and I have – I’m sorry, International
– I’m sorry, Domestic Infection Control Team. And on the phone is Chad Dowell, who is an
industrial hygienist in the – yeah, the National Institute for Occupational Safety and Health. I’m going to ask Alice to go ahead and do
the update for us. [Alice Gue]
Great, thank you Jane. So as many of you know, the outbreak of Ebola
in West Africa started several months ago and continues to be ongoing. Right now the affected countries in West Africa
include, Liberia, Sierra Leone, and Guinea with Liberia and Sierra Leone being the most
affected at this point. We have many, many staff from the CDC in country
in partnership with NGOs and other federal agencies to provide support to the Ministry
of Health in these respective countries, to provide infection control guidance, and training
of their healthcare personnel. As you can imagine, it’s a very difficult
and challenging situation in these countries and a lot of efforts have already been made
to try to bring both technical and financial support to those countries. In terms of the situation here in our country
— in the United States — to date there have been only two confirmed cases of Ebola in
healthcare workers. Both of these cases occurred in healthcare
workers who provided care to Mr. Duncan in Dallas, Texas – as many of you are aware. The good news is that none of family members
and community contacts who were exposed to Mr. Duncan developed Ebola. Their 21 day (unintelligible) period ended
this past Sunday and I also want to remind everyone that there were several other healthcare
workers who provided care to Mr. Duncan when he was hospitalized and none of them — to
date — have developed symptoms compatible with Ebola. [Jane Randolph]
Thank you, Alice. And now Gam, I’m going to toss it back to
you. [Gamunu Wijetunge]
My name is Gamunu Wijetunge or Gam. I’m a paramedic with the office of EMS and
the National Highway Traffic Safety Administration, or NHTSA. NHTSA’s an agency within the U.S. Department
of Transportation. I’m joined by my boss, Drew Dawson, director
of NHTSA’s office of EMS. And also on the line with us are Christina
Tackett and Ryan Paquet from the U.S. Department of Transportation’s Pipeline and Hazardous
Materials Safety Administration – or PHMSA. Drew, myself, and many of the other federal
staff on the phone today — including staff form ASPR, CDC, U.S. Fire Administration,
DHS Office of Health Affairs, and HRSA serve as staff members to the Federal Inter-agency
Committee on EMS – or FICEMS. And that’s a committee statutorily charged
with coordinating federal EMS activities. (Unintelligible) and representatives from
FICEMS collaborated with the CDC so provide technical input to the guidance that we’ll
be discussing and that many of you are probably already familiar with. And just for your information, FICEMS includes
representatives from NHTSA, the DHS Office of Health Affairs, the U.S. Fire Administration,
the Department of Defense, ASPR, the CDC, the Center for Medicare and Medicaid Services,
HRSA, the Indian Health Service, the FCC, and an appointed state EMS director, Joe Schmeter
from Texas, who is on the line today as well. Interim guidance for EMS systems and 911 public
safety answering points — or PSAPS — for management of patients with known or suspected
Ebola Virus disease in the United States — what I’ll be referring to as the EMS guidance — was
first posted on the CDC’s Ebola Web site on August 26th and widely distributed by FICEMS’
member agencies. It was subsequently revised on October 1st,
mainly to reflect updated information regarding the packaging and transport of hazardous materials. It’s currently undergoing revision to reference
new hospital PPE guidance released by the CDC on October 20th. This new CDC PPE guidance — titled Guidance
on Personal Protective Equipment to be Used by Healthcare Workers During Management of
Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting
On — Donning — and Removing — Doffing — is posted on the CDC’s Ebola Web site. It’s important to note that this PPE guidance
is intended for use inside the hospital. We have several CDC staff on the line to help
answer any questions concerning this PPE guidance. Again, this new CDC PPE guidance is for hospitals
but it is worth noting that it is centered on three principles. Number one, all healthcare workers undergo
rigorous training and are practiced and competent with PPE including putting it on and taking
it off in the systemic manner. Number two, no skin exposure when PPE is worn. And Number three, all PPE donning and doffing
activities are monitored by a trained observer. Again as I mentioned, EMS guidance is undergoing
revision to reference new recommendations in the CDC’s hospital PPE guidance. However it is important to be upfront and
to manage some expectations. While the CDC is working on revisions to the
current EMS guidance, they thought to recognize some of the unique circumstances faced by
EMS and to reference the new recommendations in the CDC’s hospital PPE guidance. At this time we do not anticipate a new set
of EMS specific PPE guidance and unfortunately we won’t be able to discuss those pending
revisions on today’s call. We and our fellow partners continue to provide
support to the CDC in revising guidance and we are pleased that CDC experts are available
on this call to discuss the new hospital PPE guidance. We appreciate the opportunity to have a dialog
with members of the EMS community on the line today. And we will certainly pay very close attention
to your thoughts and feedback and continue to keep you apprised as new information becomes
available. Now on that note I would like to give a brief
overview of some of the key points and recommendations in the EMS guidance. As folks on the call know, EMS personnel respond
to 911 calls that are typically dispatched by PSAPs and unlike patient care in a more
controlled environment of a hospital, care provided EMS patients in a more uncontrolled
environment. Care is often provided in a small and confined
area such as an ambulance and patient care decisions often have to be made with limited
information. Therefore as emphasized in the EMS guidance
coordination among PSAPs, the EMS system, healthcare facilities and the public health
system is important for coordinated response to Ebola. Each 911 in EMS system should seek the involvement
of an EMS physician medical director to provide appropriate medical oversight as well. The EMS guidance recommends that PSAPs consider
screen callers for symptoms and risk factors of Ebola and alerting the emergency responders
for the potential of Ebola so they can put on PPE before entering the scene. Similar to PSAP, EMS personnel should consider
the symptoms and risk factors of Ebola as part of their patient assessment. If they suspect that they have a patient with
Ebola then they should immediately put on PPE and notify the destination hospital. They should limit activities especially during
transport that can increase the risk of exposure such as airway management, CPR and the use
of needles and other sharps. EMS personnel should wear appropriate PPE
consistent with CDC recommendations. Procedures such as intubation, open suctioning
of airways, and CPR frequently result in a large amount of body fluids. Performing these procedures in a less controlled
environment such as in a moving vehicle increases the risk of exposure for EMS personnel. If conducted, these procedures should be performed
while stationary or at the hospital. And furthermore if performing these procedures,
EMS personnel should wear appropriate PPE. If body fluids from a patient come to direct
contact with the EMS providers’ skin or mucous membrane then the EMS provider should
immediately stop working, wash the affected skin surfaces with soap and water and report
the exposure. Additional detailed guidance is provided online
and we have the URL up on the screen and addresses environmental infection control, the cleaning
of EMS vehicles and follow up and reporting measures. I urge you to review this guidance carefully. Your state EMS office may be a useful point
of contact for state partners in interpreting this guidance and in providing appropriate
direction such as detailed protocols to local EMS agencies and personnel. Now we do understand there may be some concern
and uncertainty around this issue. We appreciate your patience and feedback as
we continue to learn from each other. I just want to thank you for joining us on
this call and we will be available for questions at an appropriate time. [Dr. Gregg Margolis]
Thank you Gam and all of our colleagues at the CDC. It is now my pleasure to introduce you to
my colleague Kevin Horahan who is a Senior Policy Analyst in the division of Health System
Policy in the Office of the Assistant Secretary for Preparedness and Response and also very
importantly an actively practicing paramedic. He was very much involved in the development
of many of these resources and will help us go through the EMS detailed checklist for
Ebola preparedness. I would like to just frame this a little bit
and let you know that this is part of a suite of checklists that ASPR and CDC developed
to help many sectors of the United States healthcare system be prepared for Ebola. They were created about three weeks or so
ago and we are committed to updating them regularly as the situation evolves. And clearly there have been a number of updates
this week that will be reflected in these checklists quickly. But very importantly this is all part of a
comprehensive approach to preparing all portions of the healthcare sector for Ebola. To include hospitals, coalitions, ambulatory
care and outpatient settings, et cetera. [Kevin Horahan]
Thanks Gregg and one thing as we get started here. I know Gam mentioned the URL being up on the
screen and I don’t know that that’s a clickable link for those of you that are watching
the Webinar. So I will just quickly say that all of the
materials that you will see today are available on the CDC’s Web site and we also have at
the ASPR Web site we have those linked. So we have established sort of an easier place
to go to. So it is phe.gov/ebola. P-H-E like Public Health Emergency.gov/ebola. And right on the screen when you go there
the top box is a link for EMS providers. And all of the materials, the guidance materials
that we are talking about are available there. So the way that this checklist works and what
we are talking about is framed in three ways. And you see on your screen it is detect, protect
and respond. And it is about knowing what to look for. Knowing what to do to protect yourself and
then knowing sort of the next step. What is the response? Who do you notify? What are the communications measures that
you have to take? [Dr. Gregg Margolis]
I would like to point out that this checklist does not set forth mandatory requirements
or establish national standards for Ebola response for emergency medical services. It was developed in conjunction with many
EMS leaders and reviewed extensively to provide a list of possible activities that emergency
medical services and agencies could go through and determine which of these steps apply to
them. So you need not get a check in all of the
columns in order to be prepared. But you should go through the checklist and
evaluate whether your service would benefit from each of these activities within this
framework. I will also point out that we take the broadest
possible definition of emergency medical services provider or professional and it is to include
everybody who is a potential medical responder to these sorts of incidences whether career
or volunteer, full-time, part-time and is without respect to level, et cetera. [Kevin Horahan]
So the first part of the checklist is the, prepare to detect section. And the key here is really to know what to
look for or to be thinking about what to look for. It is about the training that all EMS agencies
and systems should be thinking about providing to their individual providers. It is about reviewing things like the CDC
case definition. Making sure that there are some sort of no
notice drills or other ways that staff can be checked to make sure that they understand
what it is they are looking for. And it is – these are the most critical pieces
to put the next pieces into place. You have to know what you are looking for. And in fact what we did with this section
is we created a screening criteria document. I will bring that up on the screen now. And we have recently changed it so you will
notice if you went to the Web site right now you would pull up a slightly different version. This is a version that will be coming up very
soon. And you will notice that it removes the reference
to the temperature. The original temperature was 101.5. There was a lowering of that temperature with
regard to screening travelers. We have eliminated the temperature entirely. I know myself, my medic unit I am not super
confident that I have a thermometer that can give me a temperature reading that I would
trust. So I think as EMS providers recognizing fever
with these additional symptoms in combination with travel history are the things that should
raise our index of suspicion. So use this. This is a downloadable and a fillable pdf. You will see the boxes at the bottom that
talk about who to notify. Those can be completed with whichever contact
information is appropriate for your agency or system. The next section of the checklist is the,
prepare to protect. And again the image you see on the screen
is a slightly different image than you would see if you downloaded the guidance right now
from the CDC Web site. The image you see on the screen reflects the
updated PPE guidance that the CDC released on Monday I guess it was. This is again, critical to protecting EMS
providers and critical to making sure that your agency or system is prepared to protect
providers that are in the field. Knowing what the PPE requirements are or the
– what the necessary PPE are to protect folks. And then making sure that your system, your
agency, your units have the appropriate PPE on hand and that folks are trained in the
use of that PPE. We talk about – this image is still the old
version. You will see that top box references encouraging
the use of a buddy system. That now becomes an absolutely critical component. The buddy system along with the use of observers
to make sure that the PPE is donned and doffed appropriately. And again this checklist is not – this is
not the checklist that you want to pull out on the scene of an incident. This is the checklist that you want to be
using ahead of time. This is what you as EMS agency leader want
to be using to have conversations with your staff, the people who are staffing your units,
your EMTs and paramedics, firefighters, police officers. Whoever it is that provides that first line
patient care. You want to use this checklist to be ahead
of the situation so that when that 911 call comes in and someone reports that travel history
and those symptoms you have had this plan in place and you know what it is to do. [Dr. Gregg Margolis]
Well I want to point out that as I mentioned earlier there are a couple of scenarios in
which EMS professionals would encounter either confirmed or suspected Ebola patient. A few of them are situations in which there
would be considerable notice that you would be transporting a patient with confirmed Ebola. For example, the transportation from a medically
evacuated patient where they would need to be transported from the airport to a hospital. Or an inner facility transfer would provide
and afford the EMS agency with a fair amount of time certainly in the order of hours and
even possibly in the situation of a medical evacuation perhaps a day or so. Where they could prepare and really make sure
that the unit is fully prepared for infectious patient. To review policies and procedures and to really
go through a thoughtful and careful approach to just-in-time training and reviewing with
the crew exactly what to do. I think for many of us the other case of a
911 patient possibly having been exposed to Ebola is perhaps the more challenging. [Kevin Horahan]
And to that point, the prepare to protect section of the checklist does again talk about
these sort of no notice drills or spot checks in making sure that policies and procedures
are really not only in place but that people know them. People understand what PPE has recommended,
what PPE your agency or system stops and uses, how it is applied, who is going to be the
observer or what the different scenarios are for different types of calls. You know, no two calls are the same and so
there has to be advanced planning to understand how to apply the new PPE requirements. He prepare to protect section, it’s worth
noting it’s the longest section of our checklist and it’s because of the critical nature of
protecting providers as they deliver care. We’ve seen in the unfortunate case in Dallas,
the two cases in Dallas, this is where providers are most at risk. So this section continues on talking about
managing sharps, managing waste, hand hygiene, cleaning and disinfecting, and all of these
are critically important to make sure that agencies and systems, EMS agencies and systems
are prepared to manage patients that are either suspected or confirmed to have Ebola. The final section of the checklist is the
prepare to respond section and this is really about communication. This is about making the appropriate notifications,
having a communications plan, and again this is not the section of, you know, this is not
the checklist you want to pull out when you have a patient. This is the conversation you’ll want to have
ahead of time. What are the elements, the exercises that
you need to do? What are the plans and protocols? Who are the appropriate people to notify or
the person to notify? How will communications occur with the local
or state public health agency if that is the appropriate communication? What is the communication plan for the agency? Is there a public information officer? Are the agency leaders participating in things
like this webinar where we are getting situational updates from the CDC about the status of Ebola
here in the U.S. and in West Africa? So, again, this is about communication, understanding,
having an incoming line of communication and having an outgoing line of communication,
knowing in advance who those people are. [Gregg Margolis]
So, we hope that that checklist is helpful as you start to think about what are the kinds
of activities that you can do at the agency level to be prepared for the possibility of
encountering an Ebola patient. I will point out that we did receive some
feedback from a couple of national organizations and we are very pleased to hear that about
90% of the EMS medical directors were aware of the checklist and found it to be useful
and we hope that, we will continue to evolve this and are very much interested in your
feedback or ideas for other products that would be helpful as you handle your front
line responsibilities. It was our intent to make sure that we left
plenty of opportunity for questions. Before I open the lines for questions and
we are having people submit questions via the webinar interface so please feel free
to do that. I would like to introduce a couple of other
people that are in speaking roles and may help us address some of the questions as they
come up. You have already met our colleagues from ASPR
DHSP as myself, Gregg Margolis and Kevin Horahan, from the Department of Transportation, NHTSA’s
Office of EMS Drew Dawson and Gam, and from DOT’s PHMSA, which stands for the pipeline
hazardous material safety administration Ryan Paquet and Christina Tackett, from the Department
of Homeland Security, Office of Health Affairs Haley Hughes and from the United States Fire
Administration Mike Stern and last but certainly not least we are pleased to be joined by our
friend and colleague, the State EMS director from Texas and a member of the Federal Interagency
Committee on EMS Mr. Joe Schmeder. Along with our colleagues from CDC, we will
all be available for answering questions and we have a number of people that are here in
the room that are fielding questions as they come in on the web interface. So I will turn things over to Kevin who is
compiling these questions from our staff and we will do our best to make sure that we select
questions that are representative of a lot of questions that seem to be coming in. [Kevin Horahan] I’m going to take the first
question because I can answer it and it’s an easy one. The question is about accessing this, the
recording of this call. So, this webinar, this call is being recorded. The audio and the video will be posted on
phe.gov/ebola that, I believe there will also be a transcript of the call. We endeavor to get those up within 48 hours. I believe we have beat that mark every time
so that’s pretty good for government work. So phe.gov/ebola for this, please share that
with your colleagues. We’ve got a few, we’ve got well over 1,000
people on the main line and I know we have got several other lines for other time zones. So the substance of questions, I am going
to direct the – lots of questions about PPE, we’ve got some questions about the screening
criteria, so let me start with some of the questions about PPE and I’ll sort of look
to my friends in Atlanta to answer this. So, question #1 about PPE that we’ve gotten
is maybe give us a general overview of the shift to the new PPE guidance. We have questions about why the shift to no
bare skin, you know, so why don’t you guys spend a few minutes just talking in general
about the new PPE guidance and how you came to that, the new guidelines. [Woman]
Alison Laupher? [Alison Laupher]
Hello. So, in terms of our principals of PPE, what
we really want to (unintelligible) and what were discussed, first thing on the call included
we are making sure that everyone has training and demonstrated a competency through testing
and assessment, you know, what we’ve learned through limited experience is that taking
care of Ebola patients is difficult and it tends to be a high anxiety situation. So it needs to almost be so well practiced
and trained that it becomes almost a ritual that is carefully observed and monitored because
we want to make sure that we are ensuring PPE is put on properly and even more importantly
removed properly because we think that is when you have a high risk of self-contamination. In terms of skin, you know, this is something
that we are moving towards and I think in a way we’ve previously and also WHO has previously
allowed skin to be exposed but sometimes, you know, what we are thinking is that we
are trying to prevent self-contamination so if we’ve covered the skin it will protect
you if you are unconsciously touching your face or so we’re really trying to remove any
chance of self-contamination. [Kevin Horahan]
Okay great. Thanks for that answer. Let me ask maybe again to CDC, we’re getting
a bunch of questions about decontamination and I know that we’ve looked at a bunch of
the guidance and we’ve gotten questions about this. There are some questions about EPA registered
agents, the use of bleach, what are the right procedures for decontaminating an ambulance? Maybe the FIMSA folks could jump in and talk
a little bit about handling the wastes that might be generated from this. So, why don’t I start with CDC, maybe talk
a little bit about decontamination and then I will turn over to FIMSA just to see if you
have anything you might add about waste. [Woman]
Chad Dowell, do you want to handle that question? [Chad Dowell]
Yes CDC has a recommendation for disinfection that they use on EPA registered hospital grade
disinfectant that has label claims for viruses, for non-envelope viruses. So, you can go to the EPA website and search
many different products and check their label for registration against the non-envelope
viruses. (Crosstalk) [Woman]
And if you’re aware that that’s appendix D. [Woman]
I was just (unintelligible), this is adding a little bit of a safety factor because the
Ebola virus is an enveloped virus so it’s actually more susceptible to this disinfectant. So, applying a stronger disinfectant that’s
more appropriate for something like a Norovirus as adding that additional safety factor but
you still want to follow the contact times that are associated with the product that’s
selected. [Kevin Horahan]
Okay great and I think that is consistent with the EMS guide, the recommendations in
our draft, I’m sorry, the interim EMS guide. (Unintelligible) of folks, Ryan, Christina,
anything that you would like to add about the management of waste from decontamination
of an EMS unit? [Ryan Paquet]
Well, on our website, which is www.phmsa.dot.gov, we have guidance on how to properly package
and transport any suspected Ebola contaminated waste. That’s a good place to start and probably
the best place to start. Also, there is a special permit that we issued
last week and with five companies that have grantee status to it that can collect and
transport Ebola contaminated waste in the packaging that’s described or recommended
in the guidance document. And they have authority to transport that
for treatment and disposal so take a look at our website. We have a lot of great information up there
including that guidance document and the special permit that allows for the pickup and transport
of suspected Ebola contaminated waste anywhere in the country. [Kevin Horahan]
Okay Ryan, thanks for that. CBC, talk to us a little bit. The guidance, the new PPE guidance makes a
reference to coveralls as an option for the gowns and it says, I’m looking at the language
in my head here, I remember it says something about not having an integrated hood but don’t
I also recall that there was something that says that you could use an integrated hood
as an option? Talk to us a little bit about that. [Woman]
Alison? [Alison Laupher]
There is no option for an integrated hood in our guidance. We do allow for integrated socks, should you
choose to use a product, a coverall product that has integrated socks. [Woman]
So what is the concern that’s come up with the use of an integrated hood with the coverall
is that it might interfere as you are moving your head side to side with like a facial
that you are also wearing. Obviously the PPE, if you were wearing it
in ’95 would be worn underneath the hood but there were some concerns about that, which
is why we’ve gone – we really didn’t encourage the use of a hood that’s integrated. [Kevin Horahan]
Okay, great, I was going to follow up on that and I’m glad you corrected me on that. So, let me ask another question to my CDC
friends here. We are getting some questions about, and imagine
an EMS scenario where you enter a scene and discover maybe after the beginning of your
patient assessment that a patient meets the screening criteria of fever or some other
symptoms with recent travel, is there some sort of recommendation? Can you give us an idea of what should an
EMS provider do? Maybe give us a – what should they do at that
particular time and then what’s their kind of long-term strategy? [Woman]
Lisa Delaney or Chad do you want to handle that? [Lisa Delaney]
Are you talking about in terms of what PPE to wear? [Kevin Horahan]
So, have they had an exposure? I mean, what should they be thinking about? So, I’m a paramedic. I walk into someone’s house and I start assessing
a patient and they tell me after I’ve been within three feet of them for, you know, three
or four minutes, oh by the way I’ve just got back from West Africa from Liberia or somewhere
and I have a fever. So, should I then get, you know, should I
don PPE, should I remove myself from the scene, maybe call another unit. Give us an idea and then maybe talk a little
bit about what an exposure protocol might look like. Or what some recommendations are for exposure. [Lisa Delaney]
Yes, I think the guidance that we talk about if you – if that does occur that you should
step away and don the appropriate PPE. And, I know we really can’t talk too much
on the drop guidance. But, that would be my recommendation is to
then take a step back and reassess should you be in that situation. We hope that the checks and balances that
are written into the guidance that you would have more information up front to make that
assessment and determine your PPE needs. But, I do want to give some reassuring messages
that even with the scenario you’re describing were the person, has fever, you know, we really
still thinks it’s that very intimate contact with blood, and body fluids is what we’re
most concerned about. And, I think I stated earlier that the initial,
the family household contacts of the case, Mr. Duncan in Texas, as well as the initial
staff that treated him the first time he presented to the hospital, you know, none of them ultimately
contracted Ebola. So, you know, I know there’s still a lot
of fear and concern and we want to minimize exposures as much as possible. I think the scenario describing in my mind
would be a very, you know, a lower risk exposure compared to something where there is more
contact with body fluids. [Kevin Horahan]
Okay, great thank you. I’m going to throw one over here to my colleagues
from NHTSA’s office of EMS and the question is, What’s the role of dispatch agencies? Or what’s the role of our public safety
answering points? So, I’ll look over to Drew again. [Drew Dawson]
Hi, this is Drew Dawson. I think if you look at the draft or the interim
guidance that is posted that PSAPs Public Safety Answering Points are a critical part
of the community response to Ebola. And, it’s important that there be pre-planning
with emergency medical services, public health, and 911, and medical community, in that the
public safety answering part the EGAR response to that that they have the known questions
to ask in terms of screening. Practically when there’s an increased incidences
of suspicion in their community is determined locally in conjunction with public health
and the medical communities. That they do screening questions are outlined
specifically in the guidance, they’re also available though some of the emergency medical
dispatch venders. And, they also had the ability and need to
notify the emergency medical services providers if they suspect there is an Ebola and do so
confidentially. So, that the emergency medical services providers
have a high index of suspicion and can don their protective clothing prior to entering
the home. So, it’s a really keen effort of the DOD
and they public safely answering point is an integral part of that team. [Kevin Horahan]
Thanks, Drew. Let’s talk a little bit again about this
screening criteria. I mentioned earlier that we are revising our
screening criteria to drop the reference to temperature. I wonder if maybe if my colleague at CDC could
just talk a little bit about temperature and Ebola. And, you know, I think it makes sense for
us to eliminate that from our screening criteria. But, talk to us a little bit about what, you
know, why temperature is important. [Alice Gue]
This is Alice, I’m sorry right. This is Alice and, you know, in terms of temperature
our screening criteria includes, fever defined as a 100.4 or 38 degree Celsius, or subjected
fever reported by the patients. And, the reason why fever was mentioned is
because it usually is the first sign or symptom experienced by patients who may have Ebola. But, there are other symptoms that may also
be compatible to Ebola, with Ebola that EMS providers as well as 911 call takers need
to keep in mind. And that includes, severe headache, muscle
pain, diarrhea, vomiting, and unexplained bleeding. [Kevin Horahan]
Fantastic. Let’s go back to sort of a decon related
question. And, it’s a question about how long Ebola
can survive outside the body. So, give folks a sense of how robust the virus
is. [Woman]
So, I think you’re probably tossing that back to CDC aren’t you? All right. Allison and Alice anything you can give us
on that. [Woman]
So, I would say that our general – it’s important to remember that Ebola does not
replicate in the environment. So, it does not last very long in the environment. In terms, of cell mites object asking as possible
sources of transmission be. The only time that’s ever been observed
was once when there was actually blood and body fluid on a blanket. So, what’s really important to remember
is that this is transmitted by contact with blood and body fluids. [Kevin Horahan]
Okay, fantastic. I’m going to – as we’re continuing to
sort through the questions I’m going to grab one that I think again I can answer. Because it’s easy and it’s questions about
updating the check list and our guidance and the answers yes. The check list will be updated very soon,
it’ just in its final stage of clearance with regards to the new PPE guidance and the
interim EMS guidance is also in the process of being up dated. So, all of the guidance that we are developing
and have developed and will develop is constantly being reviewed and, you know, we work as quickly
as we humanly can to clear these through the process. And, you know, it often takes longer then
we’d like but we are continuing to do that. I’m going to – I think we have time for
one or two more. So, I’ve got one in my hand I think I’ll
ask this if CDC. And, it’s – I don’t know if there’s
a great answer to it but the question was. Could an EMS crew or an EMS provider put PPE
on a patient prior to transport, something like a gallon instead of coveralls? [Alice Gue]
This is Alice. At CDC what I can say is that, we do not have
recommendations at this point for PPE for the patient to wear. I will say that individual states and organizations
have had recommendations to that effect. For example, suggesting that if possible if
the patient could wear a face mask if they’re actively coughing. And, again that is only if the patient can
tolerate having a face mask on. As you know some patients are uncomfortable
with that and find it difficult to breathe with a face mask on. So, I think for us the focus as always been
on the protection of the healthcare worker and the PPE of the healthcare worker can wear
and safely provide care to the patient. [Kevin Horahan]
Okay, fantastic. I know that some jurisdiction that is one
of the included recommendations is a mask if the patient can tolerate it. All right, I think with that we are just about
at the top of the hour. We’re kind of looking to see if there are
one or two question. But, I think a lot of the questions will be
– we would point folks to the new PPE guidance. Some of the other questions I think we’ll
be able to answer once the interim EMS guidance is – that update is complete. So, I would adjust again encourage everyone
to visit the CDC’s Ebola page which is the home for all of this. And, you can get there easily again, phe.gov/Ebola
right on the front – or right as you click on that screen there is a big star light that
twill take to the EMS provider section for or EMS section for this guidance. And, I think with that I will – I think I
have one more question here. [Gregg Margolis]
No, I just wanted to take an opportunity to thank everybody for participating in this
Webinar. We hope that you found it to be interesting
and valuable. I’d also like to thank all of the Federal
partners that were able to join and field questions. I’ll point out or once again remind you
that we plan to post this on our Website at phe.gov as soon as possible for reference
for future reference or you can certainly feel free to refer colleagues to it in the
future. And once again would like to emphasize that
we are here to support you the EMS provider that are on the front line of our healthcare
system. We recognize that you’re an essential part
of our nation’s healthcare system and national health security. And, thank you for everything that you do
every day to insure the heath of the nation.

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