Swine Flu Guidelines

CDPHE releases interim guidelines for Swine Flu

Download the original announcement from EMTS

On April 17, 2009 the CDC and the California Department of Health identified two human cases of the swine influenza A (H1N1) virus in San Diego County in California. Since then 5 new cases have been identified near San Diego and Imperial counties, an additional 2 cases in San Antonio (Guadalupe County) Texas and 2 cases in (Dickinson County ) Kansas for a total of 11 laboratory confirmed cases of swine influenza in the U.S. as of April 26, 2009 (0000 hrs.). None of these cases have recent contact with swine and there has been no link established between the cases except for one father and daughter. In addition, the same strain of swine influenza A has been identified by CDC from patients who are part of an ongoing outbreak of acute respiratory illness in central Mexico. A number of deaths have been reported from this outbreak prompting Mexico to close its schools across its capital on Friday after at least 16 otherwise healthy people died and more than 900 others fell ill from what could be a new strain of swine flu. The World Health Organization is worried that these events may mark the start of a flu pandemic.

Scientists in the U.S. and Mexico are trying to determine if the deaths were due to the same new strain of swine flu that sickened 11 people in Texas, California and Kansas. The World Health Organization counted at least 57 deaths in Mexico, although it wasn’t yet clear if this larger number was due to swine flu. The situation is changing rapidly and the Centers for Disease Control swine flu website has the latest geographic information of confirmed cases.

“We are very, very concerned,” WHO spokesman Thomas Abraham said. “We have what appears to be a novel virus and it has spread from human to human….” If international spread is confirmed, that meets WHO’s criteria for raising the pandemic alert level. This alert came from JEMS. For those who may be unfamiliar with the Swine flu, these CDC links may be helpful:
At this time, although there are no documented cases in Colorado, we need to stay ahead of any disease spread by taking necessary precautions. Swine flu infected patients will present with typical or seasonal flu signs and symptoms. The suggested approach to patients with these signs and symptoms are consistent with universal and droplet precautions. NEMSMA (National EMS Management Association) is recommending that a number of strategies that EMS agencies should put in place to identify potential victims, protect their field providers, provide excellent patient care and participate in the public health process. The following practices should be implemented:

  • By EMS Agency Administrators/Chiefs:

    1. Notify staff of the emerging problem.
    2. Review and update local plans
    3. Communicate daily with hospitals and public health

  • By Dispatchers:

    • Medical History (questioning should begin at the dispatch level and should be reporte to field providers prior to their arrival on-scene. The questioning should be repeated by field providers once on-scene):
      • Does the patient have a febrile respiratory illness AND
      • Has the patient traveled in the 7 days preceding their illness to:
        1. San Diego area, OR
        2. San Antonio area, Texas, Kansas OR
        3. Mexico, OR,
      • Has the patient been in contact with persons with a febrile respiratory illness who were in these locations?

  • By Field Providers:

    1. Request additional information from dispatchers when sent to any respiratory illness, sick person or fever related calls if limited initial information is provided upon dispatch.
    2. Initial interrogation of the patient should be done from at least 2 meters (6.5 feet) away to determine if personal protective equipment precautions are necessary.
    3. Recommended PPE for taking care of ill/potentially infected patients includes: disposable gowns, gloves, goggles/face shields and N95 or better respirators. PPE should be donned and doffed according to published guidelines to prevent cross contamination, including eye and gown protection when splash or airborne contamination is possible.
    4. Placing a mask on all patients with suspected symptoms, using filtered oxygen masks when available, or non-rebreather masks when oxygen is required. Droplet producing procedures should be avoided whenever possible including nebulizers, bag-valve-mask, suctioning or intubation. If bag-valve-masks are needed, use those with HEPA filters whenever possible.
    5. Alert receiving hospital personnel of the possibility of an infectious patient as soon as possible and hold suspected infectious patients in the ambulance until their destination in the hospital is known, rather than immediately moving them into the emergency room.
    6. Perform a thorough cleaning of the stretcher and all equipment that has come in contact with or been within 2 meters (6.5 feet) with an approved disinfectant, upon completion of the call (back of ambulance).

As additional information regarding this important issue becomes available, the Colorado Department of Public Health and Environment will work to ensure that all ambulance services, rescue services, hospitals and clinics are advised. Questions regarding these procedures and additional information can be located at www.satool.org.