Diseases of Public Health Threat Plan PDF

Procedure 309 Chesapeake Fire Department Fire Procedure Manual Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department Diseases of Public Health Threat Plan - 1 Diseases of Public Health Threat Plan 309.1 PURPOSE AND SCOPE Provide guidanc...

Procedure 309 Chesapeake Fire Department Fire Procedure Manual Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department Diseases of Public Health Threat Plan - 1 Diseases of Public Health Threat Plan 309.1 PURPOSE AND SCOPE Provide guidance to personnel responding to calls involving Diseases of Public Health Threat (DoPHT) as defined by the Centers for Disease Control (CDC) and the Virginia Department of Health (VDH). 309.2 GENERAL This policy is both a tool and a reasonable expectation for the management of Diseases of Public Health Threat. The guidance provided here will define the expectations for management of these patients, the use of personnel and equipment, and the roles of individual providers. It also seeks to bring greater consistency to these complicated events, producing better outcomes, with better communication. 309.2.1 EMERGENCY DISPATCH SCREENING With the risk of DoPHT constantly changing, the CDC recommends that the Emergency Communications Centers question the caller about: (a) Signs and symptoms of DoPHT (such as fever, vomiting, diarrhea). (b) Residence in or travel to/from an area where an outbreak is occurring. (c) Other risk factors, such as having physical contact with someone who is sick with a DoPHT. (d) The Emergency Communications Center (ECC) will tell CFD members this information before they arrive on scene so they can put on the correct personal protective equipment (PPE). The City of Chesapeake ECC will be using the International Academies of Emergency Dispatch Emerging Infectious Disease Surveillance Tool. This tool meets current CDC guidelines for Public Safety Answering Point (PSAP) triage of a suspected DoPHT, the ECC will alert members of a potential DoPHT patients by using the term “ENHANCED PRECAUTIONS” when giving the patient information over the radio. CFD members will check MDT’s for call updates prior to arriving on-scene. 309.2.2 SCENE SAFETY If the Emergency Communications Center (ECC) advises that a patient is suspected of having a DoPHT, or the patient assessment indicates the possibility of a DoPHT, EMS personnel should put on the appropriate PPE for that suspected disease before entering the scene. (a) Patients presenting with potential symptoms of a DoPHT at a CFD facility shall be assessed and treated in an appropriate area such as outside, apparatus bay, or in an ambulance. (b) Minimize the number of personnel providing care to the patient to reduce the risk of exposure. Chesapeake Fire Department Fire Procedure Manual Diseases of Public Health Threat Plan Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department Diseases of Public Health Threat Plan - 2 (c) Contact the Field Medical Officer (FMO) immediately. FMO will make required notification to CMO and Infection Control Officer (d) Keep the patient separated from other persons as much as possible. (e) Use caution when approaching a patient. Some illnesses can cause delirium, with erratic behavior that can place personnel at risk of infections, e.g., flailing or staggering. (f) During patient assessment and management,members should consider the symptoms and risk factors of the suspected DoPHT. (g) Based on the presence of symptoms and risk factors, put on or continue to wear appropriate PPE and follow the scene safety guidelines for a suspected case of a DoPHT. (h) If a patient meeting the risk factors is not transported, notify the FMO immediately. (i) If there are no risk factors, proceed with normal EMS care. 309.2.3 TRANSFER OF PATIENT CARE TO A HEALTHCARE FACILITY CFD members will notify the receiving healthcare facility prior to transport of a suspected DoPHT patient. (a) The transport unit will use the minimum number of members necessary for patient care. (b) All members on the transport unit shall utilize appropriate PPE, including the driver. In these instances, CFD will not transport family members, friends, or bystanders. (a) Any hospital that is following CDC infection control recommendations and can isolate a patient in a private room is capable of safely managing a patient with a DoPHT. (b) Unless instructed otherwise by the hospital, the patient should not be brought out of the transport unit and taken into the designated hospital area without first receiving permission from the receiving facility staff. 309.2.4 INFECTION CONTROL Early recognition or identification of patients with potential DoPHT is critical. CFD members can safely manage a patient with suspected or confirmed DoPHT by following recommended isolation and infection control procedures, including standard, contact, aerosol, and droplet precautions, where indicated. Particular attention should be paid to protecting the mucous membranes of the eyes, nose and mouth from splashes of infectious material, or self-inoculation from soiled gloves. Invasive procedures that are not necessary to treat life-threatening conditions should not be performed. When managing a suspected DoPHT patient CFD members should follow these CDC recommendations: • Pre-hospital treatment should be supportive in nature. Chesapeake Fire Department Fire Procedure Manual Diseases of Public Health Threat Plan Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department Diseases of Public Health Threat Plan - 3 • Limit activities that can increase the risk of exposure to infectious material (e.g., airway management, cardiopulmonary resuscitation, nebulizers, CPAP, use of needles). 309.2.5 USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE) Use of standard, contact and droplet precautions is sufficient for most situations when treating a patient with a suspected case of a DoPHT as defined above. CFD members should wear approved PPE recommended by the CDC which may include: (a) Gloves (b) Protective gown (c) Eye protection (goggles or face shield that fully covers the front and sides of the face) (d) Surgical Mask Additional PPE might be required in certain situations (e.g., large amount of blood and body fluids present in the environment), including but not limited to Tyvek-style suit, double gloves, disposable shoe covers, leg coverings, or a higher level of respiratory protection. Pre-hospital resuscitation procedures such as placement of airway adjuncts, open suctioning of airways, and cardiopulmonary resuscitation frequently result in large amount of body fluids, such as saliva and vomit. Performing these procedures in a less controlled environment (e.g., moving vehicle) increases risk of exposure for CFD members. If conducted, perform these procedures under safer circumstances (e.g., incident scene, stopped vehicle, hospital destination). If blood, body fluids, secretions, or excretions from patient with a suspected DoPHT come into direct contact with a provider’s skin or mucous membranes, then the provider should immediately stop working. They should wash the affected skin surfaces with soap and water or the alcohol based cleaner provided on units and report the exposure to the Designated Infection Control Officer for follow-up. Recommended PPE should be used by members as follows: (a) PPE will be worn upon entry into the scene and continued to be worn until members are no longer in contact with the patient or potentially infectious materials. (b) PPE will be carefully removed without creating secondary contamination. (c) PPE will be placed into an appropriate waste container at the hospital or double bagged and held in a secure location. (d) Re-usable PPE will be cleaned and disinfected per CDC recommendations, the manufacturer’s instructions and Department Infection Control policies. (e) Hand hygiene will be performed immediately after removal of PPE. 309.2.6 ENVIRONMENTAL INFECTION CONTROL CFD members shall contact the Hazardous Materials Team for guidance or support of the decontamination of occupancies or vehicles, or for the over pack and disposal of potentially contaminated material from a suspected DoPHT. Environmental cleaning and disinfections, and safe handling of potentially contaminated materials is essential to reduce the risk of contact with Chesapeake Fire Department Fire Procedure Manual Diseases of Public Health Threat Plan Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department Diseases of Public Health Threat Plan - 4 blood, saliva, feces, and other body fluids that can contaminate the patient care environment. CFD members should always practice standard environmental infection control procedures, including vehicle/equipment decontamination, hand hygiene, cough and respiratory hygiene, and proper use of U.S. Food and Drug Administration (FDA) cleared or authorized medical PPE. CFD members performing environmental cleaning and disinfection will: (a) Wear recommended PPE based on the DoPHT suspected. (b) Wear face protection (facemask with goggles or face shield or filter mask) when performing tasks such as decontamination that can generate splashes. (c) Use an EPA-registered hospital disinfectant, or an approved decontamination solution (bleach), with a label claim for one of the non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) to disinfect environmental surfaces. Disinfectant will be available in commercially prepared wipes for use during transport. (d) Spray and wipe clean any surface that becomes potentially contaminated during transport. These surfaces will be immediately sprayed and wiped clean (if using a commercially prepared disinfectant wipe) and the process repeated to limit environmental contamination. 309.2.7 DECONTAMINATION EMS TRANSPORT UNITS AFTER TRANSPORTING A PATIENT The following are general guidelines for cleaning or maintaining EMS transport units and equipment after transporting a patient with suspected or confirmed DoPHT: (a) CFD members performing cleaning and disinfection will wear recommended PPE (described above) and consider use of additional barriers (e.g., rubber boots or shoe and leg coverings) if needed. Face protection (facemask with goggles or face shield) shall be worn since tasks such as liquid waste disposal can generate splashes. (b) Patient -care surfaces (including, but not limited to, stretchers, railings, medical equipment control panels, and adjacent flooring, walls, computers, communications equipment, driver’s area and work surfaces) are likely to become contaminated and will be cleaned and disinfected after transport. (c) A blood spill or spill of other body fluid or substance (e.g., feces or vomit) should be managed through removal of bulk spill matter, cleaning the site, and then disinfecting the site. For large spills, a chemical disinfectant with sufficient potency is needed to overcome the tendency of proteins in blood and other body substances to neutralize the disinfectant’s active ingredient. (d) An EPA-registered hospital disinfectant with label claims for viruses (such as, norovirus, rotavirus, adenovirus, and poliovirus) and instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids will be used per those instructions. After the bulk waste is wiped up, the surface will be disinfected as described in the bullet above. (e) Contaminated reusable patient care equipment will be placed in biohazard bags and labeled for cleaning and disinfection per the CFD Infection Control Plan. Reusable equipment will be cleaned and disinfected per the manufacturer’s instructions by Chesapeake Fire Department Fire Procedure Manual Diseases of Public Health Threat Plan Copyright Lexipol, LLC 2023/03/25, All Rights Reserved.Published with permission by Chesapeake Fire Department Diseases of Public Health Threat Plan - 5 trained personnel wearing correct PPE. Avoid contamination of reusable porous surfaces that cannot be made single use. If reusable porous equipment is determined to be contaminated it shall be properly disposed of. (f) Any waste produced during patient care or decontamination from a DoPHT is a regulated bio-hazardous waste and shall be contained for appropriate disposal. These wastes will not be placed in the normal waste system.