Protocol 2-330 - Exposure: Biological / Infectious

CMH EMS & MIH Protocols

EMD:

• Situations where a biological or infectious agent may be present, ask the following questions and advise responding units of the responses:
  • Has anyone in the home had flu-like symptoms, breathing problems, coughing, headache, fever, or other illness in the last 14 days?
  • Has anyone in the home traveled outside of the state in the last 14 days?
  • Has anyone in the home been evaluated for the illness?
  • Is anyone in the home currently under a quarantine?

EMR:

• Limit contact to only essential personel.
• Situations where a biological or infectious agent may be present, re-evaluate persons at the scene with the questions listed in the EMD section above.
• Perform as many of the assessments and treatments in well ventilated areas as possible.
• Maintain minimum distance of six (6) feet from all possibly infected patients.
• If close contact is required, responders should wear appropriate PPE (in order of most important to least):
• Full-face respirator with N95 or equivalent cartridge,
• N95 (minimum of a surgical mask),
• Face shield (minimum of eye protection),
• Gloves, and
• Fluid-impermeable suit.
• Large outbreak or pandemic scenario:
• If you are within six (6) feet of another person, wear a surgical mask.
• If a patient is present, regardless of social distancing, place a sugical mask on the patient and all responders should wear surgical masks and eye protection.
• If the patient is possibly infected, symptomatic, or high-risk procedure is being preformed, all responders should wear N95 masks and eye protection (full-face respirators is preferred).
• If entering a facility with at-risk patients, limit responders to absolute minimum, and wear N95 and eye protection. Full-face respirators should not be worn due to exhalation valves are not filtered.
• Fever or respiratory distress:
• Place the patient on a NRB at 15 LPM Oxygen and
• Place a surgical mask over the exhaust ports of the mask.
• Unresponsive or respiratory arrest:
• If airway management and ventilation is mandatory, insert an OPA and place a NRB over it with Oxygen 15 LPM. Limit or eliminate (preferred to eliminate) BVM and strongly recommended to NOT use the facemask portion of the BVM.
• If CPR is needed, only provide chest compressions with the NRB and surgical mask described above.
• Before and after all patient contact, fully disinfect and clean equipment, uniform, PPE, and your hands.

EMT:

• Ensure completion of applicable items above.
• Unresponsive or respiratory arrest:
• If airway management and ventilation is mandatory, insert an NPA or supraglottic airway (NPA is preferred) with inline exhalation filter to bag. Limit or eliminate (preferred to eliminate) BVM and strongly recommended to NOT use the facemask portion of the BVM.
• Place high-volume Suction in or near the patient's mouth.
• Note: Ensure suction exhaust is not blowing contamination in the vacinity of responders by bystanders. CMH ambulance on-board suction exhaust is discharged under the vehicle.
• During transport:
• Driver should remove gown and gloves, but retain respiratory protection.
• Close pass-through between driver and passenger compartment.
• Keep all windows down in the ambulance.
• Limit occupants to minimum required.
• All personnel in the back should continue to wear full PPE.

AEMT:

• Ensure completion of applicable items above.
• Fever or respiratory distress:
• Nebulizer treatements are STRONGLY discouraged. Consider alternatives:
• Meter-dosed inhaler,
• Epinephrine 1:1,000 IM in severe patients under 50 yrs old and no cardiac history, OR

Adult	Pediatric
0.3 mg	0.01 mg/kg (max 0.25 mg) Click "calculate" to get dose.

• Epinephrine 1:100,000 (push-dose) IV every 10 min in severe patients under 50 yrs old and no cardiac history.

Adult	Pediatric
10 mcg	0.1 mcg/kg Click "calculate" to get dose.

RN:

• Ensure completion of all applicable items above.
• Fever or respiratory distress:
• Do NOT perform CPAP or BiPAP.
• Notify receiving hospital as soon as possible to allow for preparation for your arrival.

Medic:

• Ensure completion of all applicable items above.
• Unresponsive or respiratory arrest:
• Endotracheal intubation is STRONGLY discouraged. If required, use a cuffed tube, filtered exhalation, induce deep paralysis, avoid nasotracheal, and stop CPR during intubation attempt.

CP:

• Ensure completion of all applicable items above.

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Polk, Hickory, Cedar, & St Clair County EMS Protocols is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.