Editor's note: With the first U.S. death from swine flu confirmed today, it’s clear this issue isn’t going away soon. Our colleagues at JEMS (Journal of Emergency Medical Services) put together the following information. Take a look so you’re prepared on your next EMS run.

Protect Yourself and Your Patients from Swine Flu
By Jennifer Berry, Senior Editor, JEMS/jems.com

With the number of confirmed swine flu cases growing in North America, and cases now being confirmed in Europe and New Zealand, world health officials are expressing concern that the illness has "pandemic potential."

"The current situation regarding the outbreak of swine influenza A(H1N1) is evolving rapidly," the World Health Organization said on Monday in a prepared statement. The majority of the confirmed cases are in North America, with 26 being in Mexico, seven in Canada and 64 U.S. cases of swine flu virus were confirmed as of Tuesday afternoon.

According to the Centers for Disease Control and Prevention (CDC), those are in the following communities
• 45 in New York City,
• 10 in San Diego and Imperial counties in California,
• two in Dickinson County, Kansas,
• six in Texas, and
• one in Ohio.

The CDC offers interim guidelines for health professionals dealing with swine flu but warns the situation is constantly evolving. The CDC recommends using the appropriate personal protective equipment (PPE) with people who have been within about 6 feet of a person with a confirmed or suspected case of swine flu, a person with acute respiratory illness who has been in an area with confirmed cases of swine flu, and a person with acute respiratory illness who recently came in contact with an animal suspected of having swine flu. The CDC defines relevant acute respiratory illness as recent onset of at least two of the following flu-like symptoms: rhinorrhea or nasal congestion, sore throat and a cough with or without a fever.

"Do not jump on interim guidelines: They're interim; they will change," warns JEMS Editorial Board Member Katherine West, BSN, Med, CIC. Scroll down to read West's top 10 swine-flu recommendations for EMS providers.

However, general guidelines similar to those for other types of influenza, such as washing your hands, using a tissue when coughing or sneezing, not touching eyes, nose or mouth, avoiding close contact with sick people and staying home from work when sick, are being recommended in San Diego County, where several cases have been confirmed.

Across the country, the New York City Department of Health and Mental Hygiene recommends that field providers do the following:

• Request additional information from dispatch when sent to respiratory, sick person and fever related calls.
• If limited initial dispatch information is provided, perform initial interview from at least 6.5 feet away to determine if PPE precautions are necessary.
• Ask the patient to place a mask over their mouth and nose before approaching them if they have suspected influenza symptoms. Use a surgical mask or non-rebreather mask (when oxygen is required).
• Avoid droplet-producing procedures whenever possible, including use of nebulizers and bag-valve masks, as well as suctioning or intubation. If bag-valve masks are needed, use BVMs with HEPA filters whenever possible.
• Recommended PPE for taking care of ill/potentially infected patients includes: gloves, N-95 or better respirators, eye protection and gowns. PPE should be donned and doffed according to published guidelines to prevent cross contamination, including faceshield/eye and gown protection when splash or airborne contamination is possible.
• Alert the receiving hospital personnel of the possibility of an infectious patient and hold suspected infectious patients in the ambulance until their destination in the hospital is known.
• At the end of the call, place all PPE in a biohazard bag for appropriate disposal.
• Maintain strict adherence to hand hygiene by washing with soap and water or using hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions.
• Perform a thorough cleaning of the stretcher and all equipment that has come in contact with or been within 6.5 feet of a potentially infected patient with an approved disinfectant.
• Upon completion of the call, follow CDC interim guidelines for cleaning EMS transport vehicles.

For further information, Harvard Health Publications (HHP), a Division of Harvard Medical School, has published "Swine Flu: How to understand your risk and protect your health," which is a report that explains what the illness is, how it's diagnosed and treated, and how families and businesses can protect themselves against it. Click here for more information , and to purchase and download it as a PDF. In addition to these guidelines, the International Association of EMS Chiefs has created guidelines for assessing existing response protocols and making command decisions on actions. These resources are available below.

Swine Flu Top 10: Information points for EMS providers
By Katherine West, BSN, MSEd, CIC

As with any new viruses, there is confusion and sometimes fear generated by well meaning people, such as the media. This list will assist in clarifying some issues for EMS providers about swine flu.

1. We're in preparation mode -- not emergency mode -- on this illness.
2. This is a new virus that is a combination of swine, human and bird genetic components.
3. The virus is spread the same way as seasonal flu: via respiratory droplets expelled when a person coughs and sneezes.
4. This is a large-particle virus and requires close contact for transmission. Droplets do not remain suspended in the air and travel only a short distance in the air (less than or equal to 1 meter or 6 feet).
5. As with any respiratory illness, place a surgical mask on the patient to contain secretions.
6. It's unusual that this virus has appeared at the end of the normal flu season. It may spike and then drop off, because influenza is seasonal (the influenza virus does not like summer temperatures.) This version may appear in greater numbers in the fall, but we could have a vaccine by then.
7. This virus is susceptible to Tamiflu and Relenza, which are the antivirals in our national stockpile program. The Food & Drug Administration released these on April 27, 2009 for use if needed.
8. EMS personnel should be familiar with state pandemic plans. The CDC only issues broad guidelines and refers EMS to state and local plans, per National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, M.D.
9. Screen all persons with respiratory symptoms for a travel history, such as recent travel to Mexico. Stay home if you're ill. Work restrictions guidelines should be in place in your department for general influenza illness.
10. Interim guidelines are not cast in stone; they will change.

Keep this all in a proper perspective. Each year, there are at least 26,000 deaths in the U.S. from seasonal flu.

Katherine West, BSN, MSEd, CIC, is an infection control consultant with Infection Control/Emerging Concepts Inc. and a JEMS editorial board member.

Resources
• IAFC Guidance on Swine Flu
• Official swine flu updates from the CDC
• Official swine flu updates from the WHO
• JEMS Connect discussion on swine flu
• Harvard Health Publications. "Swine Flu: How to understand your ris...
• IAEMSC Recommended Planning for Pandemic Influenza Readiness
• IAEMSC Pandemic Flu Reference Sheet
• EMS Pandemic Influenza Guidelines for Statewide Adoption and Prepari...