EBOLA AND THE FIREFIGHTER

We are now all aware that Ebola has become a national topic of discussion especially when there were two infected Americans health care workers flown to Emory University Hospital for treatment; a facility built in collaboration with the CDC. They are apparently doing OK and have been released. We are also fully aware of the high mortality rate of these hemorrhagic fevers up to a 90% mortality rate in affected patients.There are a number of these viral hemorrhagic disease types with names such as Ebola, Marburg, Lassa and Crimean-Congo hemorrhagic fever viruses are a few examples. ^1.

Recently, the only Ebola death in the US was the result of a traveler from West Africa who lied on his exit health history questionnaire and was hospitalized in the US. We have a couple of nurses infected with the disease who treated our West African visitor and an uptick of other possible cases. This is a virus that can affect thousands of people; not unlike the Polio virus in the 50's; the AIDS virus in the 80's and the years of flu viruses that have killed thousands of Americans. Transmission of the virus occurs directly through close contact with infected people or their body fluids.

There is also a lot of social media hype (or hysteria) on this particular disease and the reasons we transported these two infected individuals to the United States instead of treating in place and why are we not closing our borders to travelers from those countries with Ebola. The American health care system believes they can treat those individuals infected with the virus adequately. As with the infected nurses, we are now discovering the possibility of breaches in protocol in doffing and donning of PPE and other preventive measures allowing the virus to spread to those health care workers caring for the West African visitor. There is a fear that these nurses may possibly infect others they come in contact through indirect contact and those two nurses are in quarantine and many others are being observed at home.

This country has the ability to adequately research this disease in a controlled environment, with top notch scientists, physicians and infectious disease specialists looking for a vaccine or some type of cure.  Previous experience with hemorrhagic viruses were successfully treated in the late 1960’s or early 1970’s when an infected American missionary became ill with the Lassa Hemorrhagic Fever. In this case she survived her infection providing additional research material for managing future infections.

The chances of a firefighter or EMT even seeing someone this sick is remote, but with the ability to traverse the earth via air travel in mere hours, the chances of an infected person arriving at your local airport, staying in a local hotel,at the travelers home or in a hospital increase every day. 

Also remember this is the beginning of the flu season and the initial symptoms between the two viruses are very similar.

The chance of exposure to Ebola being a remote possibility; firefighters and EMT’s come into contact with very sick people every day with viruses and bacteria that can also make you very sick. We must be trained to manage this new threat to our EMS and Firefighter providers with proper PPE, mask fit testing and hands on training. Programs your department should already have in place.

Every state’s Department of Public Health has information on this current hemorrhagic fever and other current or emerging viral or bacterial diseases. This information should make our firefighters aware of the simple infection control measures preventing the spread of disease to you, other patients and your families. One excellent site is found in Vermont Department of Health at http://healthvermont.gov/prevent/ViralHemorrhagicFevers.aspx and the other resource is found at the CDC website http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical...

Check your own state's Public Health Department's website for the most recent updates in this deadly disease.

Every Department must have a policy of how to manage Blood Borne Pathogens and other body fluids as required by OSHA. ((see OSHA Regulations (Standards - 29 CFR) Bloodborne pathogens. - 1910.1030)).

Some simple precautions are as follows and entitled as Universal Precautions ²:

• Hand Hygiene – frequent Hand washing with plain or anti-bacterial soap and water and to the use of alcohol gel to decontaminate hands.

• Personal Protective Equipment (PPE) includes items such as gloves, gowns, masks, respirators, and eyewear used to create barriers that protect skin, clothing, mucous membranes, and the respiratory tract from infectious agents.

• Gloves - Wear gloves when touching blood, body fluids, non-intact skin, mucous membranes, and contaminated items. Gloves must always be worn during activities involving vascular access, such as performing IV’s.

• Respiratory Protection - Wear a surgical mask and goggles or face shield if there is a reasonable chance that a splash or spray of blood or body fluids may occur to the eyes, mouth, or nose.

• Other skin Protection - Wear a gown if skin or clothing is likely to be exposed to blood or body fluids. ³

• Prevent needle stick and Sharps Injury safe handling of needles and other sharp devices are components of standard precautions that are implemented to prevent health care worker exposure to blood borne pathogens.

• Cleaning and Disinfection – back of the ambulance, gurney and other patient contact areas must be cleaned after every patient encounter. Some pathogens such as norovirus and Clostridium difficile are not inactivated by commercial disinfectants routinely used in local public health settings. In situations where contamination with these pathogens is suspected, a bleach solution (1:10) is recommended for disinfecting contaminated surfaces and items.

• Waste Disposal – Under the OSHA and state standards, there are regulations related to the management of medical waste. Your department will need an approved site for disposing of infectious waste.

Finally, here is a list of the immunizations that all firefighters should receive during their employment as firefighters, EMT’s or Paramedics. ⁴

• Hepatitis B Series

• Hepatitis A Series

• TDAP – Tetanus, Diphtheria, Pertussis

• TB Skin Test

• Measles Mumps and Rubella

• Shingles Injection (Over the age of 60)

• Influenza – the most current and recommendation by the Health Department. Usually annually

It is your responsibility to protect yourself, your patients, co-workers and your family by taking a few simple precautions; be educated and aware of your sick patient’s conditions; use proper PPE and wash your hands frequently.

Endnotes

1. http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm

2. https://www.osha.gov/SLTC/etools/hospital/hazards/univprec/univ.html

3. OSHA PPE Standards 1910.132 and 1910.133

4. http://wellamerica.net/health-alerts/2013-adult-immunization-schedule/

    

John K. Murphy JD, PA-C, MS, EFO, Deputy Fire Chief (Ret), has been a member of the career fire service since 1974, beginning his career as a firefighter & paramedic and retiring in 2007 as a deputy fire chief and chief training officer. He is a licensed attorney in Washington State since 2002 and in New York since 2012. Mr. Murphy is a licensed Physicians Assistant in Washington State with experience in Family Practice, Urgent and Emergency Care and Occupational Medicine

I updated this article today (10/16/14) with current information and provided this article based on my medical background as a Physicians Assistant - C., my interest in emerging infectious disease and their effect on the fire service.