The U.S. Department of Health and Human Services (DHHS) Centers for Disease Control and Prevention (CDC) and Office of the Assistant Secretary for Preparedness and Response (ASPR), in addition to other federal, state, and local partners, aim to increase understanding of Ebola and encourage U.S.-based EMS agencies and systems to prepare for managing patients with Ebola and other infectious diseases. Every EMS agency and system, including those that provide non-emergency and/or inter-facility transport, should ensure that their personnel can detect a person under investigation (PUI) for Ebola, protect themselves so they can safely care for the patient, and respond in a coordinated fashion. Many of the signs and symptoms of Ebola are non-specific and similar to those of other common infectious diseases such as malaria, which is commonly seen in West Africa. Transmission of Ebola can be prevented by using appropriate infection control measures.
This checklist is intended to enhance collective preparedness and response by highlighting key areas for EMS personnel to review in preparation for encountering and providing medical care to a person with Ebola. The checklist provides practical and specific suggestions to ensure the agency is able to help its personnel detect possible Ebola cases, protect those personnel, and respond appropriately.
Now is the time to prepare, as it is possible that individuals infected with Ebola virus in West Africa may travel to the U.S., develop signs or symptoms of Ebola , and seek medical care from EMS personnel.
EMS agencies, in conjunction with their medical directors, should review infection control policies and procedures and incorporate plans for administrative, environmental, and communication measures.
The checklist format is not intended to set forth mandatory requirements or establish national standards. It is a list of activities that can help each agency prepare. Each agency is different and should adapt this document to meet its specific needs. In this checklist, EMS personnel refers to all persons, paid and volunteer who provide pre-hospital emergency medical services and have the potential for direct contact exposure (through broken skin or mucous membranes) with an Ebola patient’s blood or body fluids, contaminated medical supplies and equipment, or contaminated environmental surfaces.
This detailed checklist for EMS is part of a suite of HHS checklists. This guidance is only for EMS agencies and systems; the CDC’s Interim guidance for EMS includes information for individual providers and for 9-1-1 Public Safety Answering Points.
CDC is available 24/7 for consultation by calling the CDC Emergency Operations Center (EOC) at 770-488-7100 or via email at firstname.lastname@example.org
C=Completed; IP=In Progress; NS=Not Started PREPARE TO DETECT
Train all EMS personnel on how to identify signs and symptoms of Ebola infections and to avoid risk of exposure.
Review CDC Ebola case definition for guidance on who meets the criteria for a PUI for Ebola.
Ensure EMS personnel are aware of current guidance: Interim Guidance Emergency Medical Services Systems.
Review patient assessment and management procedures and ensure they include screening criteria (e.g. relevant questions: travel within 21 days from affectedWest African country, exposure to case) for use by EMS personnel to ask individuals during the triage process for patients presenting with compatible symptoms.
Post screening criteria in conspicuous locations in EMS units, at EMS stations, and in other locations frequented by EMS personnel (see suggested screening criteria).
Designate points of contact within their EMS organization/system responsible for communicating with state and local public health officials. Remember: Ebola must be reported to local, state, and federal public health authorities.
Ensure that all personnel are familiar with the protocols and procedures for notifying the designated points of contact regarding a PUI for Ebola.
Conduct spot checks and reviews for staff to ensure they are incorporating Ebola screening into their patient assessment and management procedures and are able to initiate notification, isolation, and PPE procedures.
PREPARE TO PROTECT
Consider travelers with fever, fatigue, vomiting and/or diarrhea and returning from affected West African countries as potential cases, and obtain additional history.
Conduct a detailed inventory of available supplies of PPE suitable for standard, contact, and droplet precautions. Ensure an adequate supply, for EMS personnel, of:
• Fluid resistant or impermeable gowns,
• Shoe covers, boots, and booties, and
• Appropriate combination of the following:
o Eye protection (face shield or goggles),
o Facemasks (goggles or face shield must be worn with facemasks),
o N95 respirators (for use during aerosol-generating procedures)
• Other infection control supplies (e.g. hand hygiene supplies).
Ensure that PPE meets nationally-recognized standards as defined by the Occupational Safety & Health Administration (OSHA), National Institute for Occupational Safety and Health (NIOSH), Food and Drug Administration (FDA), or Interagency Board for Equipment Standardization and Interoperability.
Review plans, protocols, and PPE purchasing with community/coalition partners that promote interoperability and inter-agency/facility coordination.
Ensure Ebola PPE supplies are maintained in all patient care areas (transport unit and in bags/kits).
Verify all EMS personnel:
• Meet all training requirements in PPE and infection control,