UPDATE: Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients Who Present With Possible Ebola Virus Disease in the United States
December 2, 2014
Special note: The likelihood of contracting Ebola in the United States is extremely low unless a person has direct contact with the blood or body fluids (like urine, saliva, vomit, sweat, and diarrhea) of a person who is infected with Ebola virus. The majority of patients with fever and other non-specific signs and symptoms* in the U.S. do not have Ebola Virus Disease (Ebola), and the transmission risk posed to those in direct contact by patients with Ebola and early symptoms is lower than the risk from a patient hospitalized with severe Ebola. Nevertheless, because early Ebola symptoms are similar to those seen with other febrile illnesses, providers should consider and assess patients for the possibility of Ebola. The guidance provided in this document reflects lessons learned from the recent experience caring for patients with Ebola in U.S. healthcare settings. Although inpatient hospital settings generally present a higher risk of Ebola virus transmission to healthcare personnel, transports by emergency medical services (EMS) present unique challenges because of the uncontrolled nature of the work, the potential for resuscitation procedures being needed, enclosed space during transport, and a varying range of patient acuity. Close coordination and frequent communications are important among 9-1-1 Public Safety Answering Points (PSAPs) (commonly known as “9-1-1 call centers”), the EMS system, healthcare facilities, and the public health system when preparing for and responding to patients with suspected Ebola.
*Signs and symptoms of Ebola include: Fever, severe headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal (stomach) pain, unexplained hemorrhage (bleeding or bruising). Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
What’s New: This version of the guidance has been updated to clarify the minimum PPE levels for EMS personnel and first responders. The updated information reflects the PPE guidance described in other CDC guidance documents such as “Identify, Isolate, Inform: Emergency Department Evaluation and Management for Patients Who Present with Possible Ebola Virus Disease” and “Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning) and Removing (Doffing)” to keep workers safe when responding to patients with suspected Ebola.
Who this is for: Emergency medical services providers (including emergency medical technicians (EMTs), paramedics, and medical first responders who could be providing patient care in the field-- such as law enforcement and fire service personnel) as well as managers of 9-1-1 PSAPS, EMS agencies, EMS systems, and agencies with medical first responders.
What this is for: Guidance to assure EMS and first responders are safe and patients are appropriately managed while handling inquiries and responding to patients with possible Ebola infection.
How to use: Employers and supervisors should use this information to understand and explain to staff how to respond and stay safe. Supervisors can use this information to prepare and train EMS personnel. Individual providers can use this information to respond to patients who are suspected to have Ebola and to stay safe.
BackgroundThe current Ebola outbreak in West Africa has increased the possibility of patients with Ebola traveling from the affected countries to the United States.1 The likelihood of contracting Ebola is extremely low unless a person has had direct unprotected contact with blood or body fluids (like urine, saliva, vomit, sweat, and diarrhea) of a person infected with Ebola virus. Initial signs and symptoms of Ebola include fever, chills, fatigue, weakness, and muscle aches, followed approximately 4-6 days after illness onset by diarrhea, nausea, vomiting, and abdominal pain. Other symptoms such as chest pain, shortness of breath, headache, or confusion, may also develop. Signs and symptoms may become increasingly severe and may include jaundice (yellow skin), severe weight loss, mental confusion, bleeding inside and outside the body, and complications such as shock, and multi-organ failure.2
Ebola virus infection can cause severe illness and extra care is needed when coming into direct contact with a recent traveler who has signs and symptoms of Ebola and has travelled from a country with an Ebola outbreak. The initial signs and symptoms of Ebola are similar to many other more common diseases found in West Africa (such as malaria and typhoid). Ebola should be considered in anyone with a fever who has traveled to, or lived in, an area where Ebola is present.3 In general, the majority of febrile patients presenting to first responders and EMS in the U.S. do not have Ebola, and the risk posed by patients with early, limited symptoms is lower than that from a patient hospitalized with severe Ebola.
The incubation period for Ebola, from exposure to when signs or symptoms appear, ranges from 2 to 21 days (most commonly 8-10 days). Any Ebola patient with signs or symptoms should be considered infectious.
Key safe work practices include avoiding:
Case Definition for EbolaCDC’s most current case definition for Ebola may be accessed here: Case Definition for Ebola Virus Disease (EVD)
Recommendations for 9-1-1 PSAPsState and local EMS authorities should coordinate with state and local public health, PSAPs, and other emergency call centers to use modified caller queries about Ebola, outlined below, when they consider the risk of Ebola to be higher in their community. This should be decided from information provided by local, state, and federal public health authorities, including the city or county health department(s), state health department(s), and CDC.
Modified Caller QueriesIt will be important for PSAPs to question callers and determine the possibility of anyone having Ebola. This information should be communicated immediately to EMS providers before arrival in order to assign the appropriate EMS resources. Local or state public health officials should also be notified. PSAPs should utilize medical dispatch procedures that are coordinated with their EMS medical director and with the local public health department.
When state and local EMS authorities determine there is an increased risk (based on information provided by local, state, and federal public health authorities, including the city or county health department(s), state health department(s), and the CDC), they may direct EMS providers to modify their practices as described below.
Infection ControlEMS providers can safely manage a patient with suspected Ebola by following the recommendations for appropriate PPE and following these CDC recommendations:
Follow-up and/or Reporting Measures by EMS Providers after Caring for a Suspected Ebola Patient