EMS Guidance on Actions in Response to the Risk of Ebola Exposure

This document will focus on appropriate EMS response to individuals who have recently been to one of the three impacted countries or have come into close contact with individuals with Ebola.

 As of October 31, 2014, there are 30 travelers being monitored in Cuyahoga, Delaware, Franklin, Greene and Summit counties. These five counties are the only counties considered at increased risk at this time. All other counties in Ohio are considered low risk.

 As travelers come on and off the monitoring list, the counties involved will change. The level of a jurisdiction’s risk is dependent on whether there is an individual on the traveler list. If there is no one being monitored in a jurisdiction, the risk of Ebola exposure to EMS personnel is extremely low.

Monitoring protocol for travelers coming from Liberia, Guinea and Sierra Leone:

The State of Ohio and local health departments are currently monitoring travelers from the impacted counties of Liberia, Guinea, and Sierra Leone. Ohio receives an estimated two travelers from these countries per day, most of whom reside or stay within the Central Ohio area.

Every traveler entering the United States from one of the three impacted counties goes through four separate screens. Each screen requests contact information, potential exposure to Ebola, and signs/symptoms of illness.

• Screen 1 – West African countries exit assessment
• Screen 2 – Brussels, London, Paris airport screening (83% of all flights from West Africa)
• Screen 3 – Inbound International flights funneled to five airports (Newark, JFK, Dulles, O-Hare and Atlanta-Hartsfield-Jackson)
• Screen 4 – Local health department (LHD) follows up with individuals identified by CDC and ODH

When an individual is identified for further monitoring:

The local health officials will communicate with the appropriate local EMS agency and their respective emergency medical dispatch center.

• The LHD should be informing the EMS provider that an individual is being monitored in the jurisdiction, the period of time the individual will be monitored, and ensure the EMS provider has access to the necessary guidance on handling a person who may have been exposed to Ebola.

The LHD provides the individual with a written notice of their monitoring category and requirements, including the requirement to notify any first responder with whom they come into contact of their monitoring category and intervention.

• All individuals being monitored under these protocols are in close contact with their LHD and are checked for symptoms at least daily by the LHD or they are self-monitored, with daily verification to the LHD. Individuals being monitored are instructed to notify their LHD should they become symptomatic, so that the LHD can provide advance notice to the EMS provider, to ensure responders are properly equipped and prepared to handle a potentially Ebola exposed individual.

EMS Dispatch Protocol:

When risk of Ebola is elevated in a community, it is important for EMS dispatch centers to question callers about:

• Residence in, or travel to, a country where an Ebola outbreak is occurring (Liberia, Guinea, Sierra Leone);
• Signs and symptoms of Ebola (such as fever, vomiting, diarrhea); and
• Other risk factors, such as direct contact with someone who is sick with Ebola.

EMS dispatch centers should tell EMS personnel this information before they get to the location so they can put on the correct PPE following proper procedures as described in CDCs guidance.

ODH has requested that LHDswork with local EMS to identify EMS providers who would transport an individual should he/she become symptomatic during the 21 day monitoring period. A smaller number of EMS providers designated for potentially symptomatic individuals limits exposure of EMS providers and ensures PPE training and supplies are concentrated for efficiency and safety purposes. EMS providers are encouraged to limit the vehicles equipped and used to handle such a response.

EMS providers who are designated to handle an individual potentially exposed to the Ebola virus should utilize the CDC Guidance for EMS and Guidance for PPE for Health Care Workers in responding to events (attached). Also attached are documents identifying commercial providers of this equipment and instructions on requesting assets from the state cache, through the Ohio Emergency Operations Center, should market supply be limited.

EMS providers who have not been notified by their LHD of a monitoring case in the community should continue to use the CDC checklist to screen individuals who claim to have been exposed to or ill with Ebola symptoms, and should rely on universal precautions or droplet precautions in responding to these calls, much as they would for other types of infectious disease-related events.

EMS providers are encouraged to reach out to their local health department of jurisdiction to confirm these protocols and have dialogue around planning and response to this and other types of public health events.