OLD DOMINION
ALLIANCE
Regional Ebola Update
&
PPE Training
October 2014
www.odemsa.vaems.org
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Presented by:
ODEMSA Staff:
Adam Alford, ODEMSA Education Coordinator
Holly Sturdevant, ODEMSA Special Project Coordinator
Rachel Dillon, ODEMSA Program Coordinator
Damien Coy, ODEMSA Field Coordinator
Heidi Hooker, ODEMSA Executive Director
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Purpose
To provide:
• Ebola facts
• ODEMSA Ebola Virus Disease “EVD” Guidelines
for EMS Providers
• Donning/Doffing and disposal of Personal
Protective Equipment (PPE)
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Ebola Facts
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ODEMSA 2014 Regional Ebola Update
&
PPE Training
Facts Regarding Ebola…
• Commonly referred to as “EVD,” or Ebola Virus
Disease
• On August 6, 2014 members of the World Health
Organization (WHO) officially declared Ebola a
public health emergency of international
concern.
• Currently, the US has seen 4 cases with one
death
*This number may change daily*
ODEMSA 2014 Regional Ebola Update
&
PPE Training
• Signs and Symptoms:
– Fever
– Severe Headache
– Muscle Pain
– Weakness
– Diarrhea/Vomiting/Abdominal Pain
– Unexplained Hemorrhage (Bleeding or
Bruising)
Symptoms may appear anywhere from 2-21
days after exposure to active EVD.
ODEMSA 2014 Regional Ebola Update
&
PPE Training
• EVD Transmission
– Animal-to-person
• It is believed that the first case of human
contracted EVD was transmitted from an infected
animal to a susceptible host
– Person-to-person
• Once EVD is contracted in a human, the host can
easily spread the virus through direct contact
ODEMSA 2014 Regional Ebola Update
&
PPE Training
The human body produces many body fluids, secretions
and excretions that may contain pathogens - avoid direct
contact with:
• Blood or body fluids
– Potentially infectious body fluids include: blood, vomit,
feces, urine, sputum, saliva, and sweat, as well as
amniotic, spinal, vaginal, pleural, pericardial, peritoneal,
synovial fluids and semen
***To prevent exposure, ANY body fluid from any patient must
be treated as potentially infectious!***
• Objects like needles & syringes that have been contaminated
with EVD
• Infected fruit bats or primates
ODEMSA 2014 Regional Ebola Update
&
PPE Training
During outbreaks of Ebola, the disease can
spread quickly within healthcare settings.
Healthcare workers should use the following
precautions when treating EVD patients:
• Standard Precautions (ALL patients)
• Contact Precautions (“blood/body fluid”)
• Droplet Precautions (think “flu”)
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Standard Precautions
• All patients, all the time, any setting
• Minimum PPE required:
– Disposable Gloves
• Hand Hygiene
• Additional PPE, as needed, to protect against blood,
body fluids, secretions & excretions:
– Eye protection (goggles or face shield)
– Respiratory protection (surgical face mask)
– Impermeable or fluid-resistant gown
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Contact Precautions
• Protection against viruses (such as Ebola), Influenza,
HIV, Hepatitis; plague, MRSA, VRE, Strep; patients with
diarrhea, vomiting, or generalized rash
• Minimum PPE Required
– Disposable Gloves (change if visibly soiled)
– Gown
• Hand Hygiene
• Disinfection of all equipment/surfaces
– Examples: monitor, glucometer, BP cuff, etc.
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Droplet Precautions
• Large particles created by coughing, sneezing,
suctioning or intubation
• Disease examples: Influenza, meningitis, pertussis,
plague, Ebola, mumps, rubella, and most viruses
(including Enterovirus D68)
• Any patient with fever, respiratory symptoms, rash,
and/or flu-like signs/symptoms, such as weakness,
vomiting, diarrhea, severe headache, abdominal
pain, or muscle and body aches
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Droplet Precautions
• Hand Hygiene
• Minimum PPE required:
– Gloves
– Gown
– Eye Protection
– Bonnet
– Leggings/Boot Covers (or Shoe Covers)
– Respiratory Protection….
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Droplet Precautions
• What level of respiratory protection?
• Healthcare Providers (with eye protection):
– At least standard surgical face mask
– N95 mask for “Aerosol-Generating Procedures” or
other high-risk procedures (e.g. CPR)
• See UTSW/BioTel TB 14-007 PPE
• Patient (especially if coughing or sneezing):
– Standard surgical face mask or N95, if tolerated
– Add Nasal Cannula O2, if supplemental oxygen
needed
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ODEMSA 2014 Regional Ebola Update
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PPE Training
ODEMSA Ebola Virus
Disease “EVD” Guidelines for
EMS Providers
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ODEMSA 2014 Regional Ebola Update
&
PPE Training
Compiled by a Regional
Team of Experts:
• EMS Professionals
• Fire Service
Professionals
• Hospital Administrators
• Epidemiologist
• Hazardous Materials
Specialists
• Educators
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Agencies MUST work with
their local health department
and Operational Medical
Director to develop patient
care plans.
This is a fluid situation –
be flexible as there may
be frequent changes
Changes made to this
document will be posted to
our website
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Dispatch Centers – PSAP’s
should screen calls for
potential Ebola patientsPRIOR to YOUR Arrival
“EVD ALERT” has been
designated as the regional
alert to be used by prehospital
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Each agency should inventory
available supplies and ensure
an adequate supply
ODEMSA is conducting a
regional needs assessment.
You WILL be contacted by
ODEMSA staff
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Ensure an adequate supply, for EMS
personnel, of:
• Fluid resistant or impermeable gowns
Double layer of gloves
• Shoe covers, boots, and booties
• All of the following:
• N95 respirators or greater (i.e.
APR, PAPR, SCBA)
• Eye protection
• Fluid/splash shield (in addition to
eye protection and N95 mask)
• Other infection control supplies (e.g.
hand hygiene supplies)
We will always use the current CDC
recommendations
ODEMSA 2014 Regional Ebola Update
&
PPE Training
• Don full PPE
• Limit exposed personnel
• Only allow the patient and
protected providers in
patient compartment
• Cab of ambulance MUST
remain clean
• Seal cab compartment
• Driver should not
participate in patient
care
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Information to Convey to Hospital
• Notify hospital as soon as you
identify a potential case
• Use “EVD ALERT” trigger
• Describe Patient
• Low Acuity – Delay transport
• High Acuity – Transport
• Hospital personnel may
provide care until they are
ready to receive the
patient
• EMS might be asked to
assist hospital personnel
ODEMSA 2014 Regional Ebola Update
&
PPE Training
When arriving at the hospital:
• You may be directed to park in
an area away from other traffic
• Remain in the ambulance and
await direction from the
hospital staff.
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Patient Refusal or
Pronouncement:
• Report to your local Health
Department by calling
866-531-3068
• Ask for the Epidemiology
Investigator on call
• They will give instruction
• Connect you with local
team
ODEMSA 2014 Regional Ebola Update
&
PPE Training
If a Patient Reports to Your
Facility:
• Do NOT allow them inside
• Resources should be
dispatched like any other
medical emergency
• Wear appropriate PPE before
patient contact
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Doffing – PPE Removal:
• MOST Exposures Occur
during PPE Removal
• Use a “Buddy System”
• EMS Providers – Await
Decontamination
Assistance from Hospital
Personnel.
• Hospital Will Provide a
Change of Clothing
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Equipment/Ambulance
Decontamination and Disinfection:
• Plans should be made in advance
• Suggest
• Local HazMat response
• 3rd Party Decontamination
Company
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Post-Exposure:
• Follow Instructions from
your OMD and VA
Department of Health
• Self-Monitor for Fever
• If your patient is Ebola
positive, monitor for EVD
symptoms for 21 days in
conjunction with VDH and
CDC
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Donning/Doffing PPE
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ODEMSA 2014 Regional Ebola Update
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PPE Training
ODEMSA 2014 Regional Ebola Update
&
PPE Training
PPE = Gloves and….
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Oct 2014
ODEMSA 2014 Regional Ebola Update
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PPE Training
PPE Components
• Disposable Gloves
• Disposable Gown (Impermeable or Fluid Resistant)
• Eye Protection
– Wraparound Goggles, Safety Glasses or Face Shield
• Respiratory Protection (must be worn with eye protection)
– Lowest: Standard surgical face mask
– Higher: N95 filter mask (respirator)
– Highest: Air-Purifying Respirator (“APR”) – powered or not;
half-face, full-face or hood
• Other components for high volume fluid environments:
– Disposable Boot Covers (or Shoe Covers)
– Disposable Bonnets
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Oct 2014
ODEMSA 2014 Regional Ebola Update
&
PPE Training
“Buddy System”
• A trained observer shall monitor donning/doffing
procedures
• “Buddy” (in PPE) watches to prevent compromises or
other procedural breaches
• Any compromise/breach must be reported to your EMS
Field Supervisor immediately
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ODEMSA 2014 Regional Ebola Update
&
PPE Training
Donning
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Donning Sequence
Using Buddy System:
1.Remove all personal items (jewelry, watches, phones, pens, etc.)
2. Hand Hygiene, put on inner gloves
•
Inner Pair MUST be under cuff of the sleeve of gown/coverall
3.Leggings/Boot Covers (or Shoe Covers), if used
4.Gown or coverall suit (tie at waist and neck)
5.Eye Protection
6.Mask or Respirator (ensure proper fit)
7.Bonnet, if indicated. Must tape all visible gaps in suit
8.Outer Gloves
•
Outer pair must be over cuff of the sleeve of gown/coverall leaving NO SKIN
exposed
Remember: Do NOT touch your eyes, nose or mouth
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ODEMSA 2014 Regional Ebola Update
&
PPE Training
Decontamination
ODEMSA 2014 Regional Ebola Update
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PPE Training
Doffing
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Doffing (Removal) = Critical Process
Most Provider
exposures occur during
PPE Removal (doffing)!
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Doffing (Removal) = Critical Process
• PPE must be removed in the proper sequence & with
extreme care/caution, to prevent inadvertent exposure
• Basic Principle:
– Touch ONLY “clean to clean” and “dirty to dirty”
• Perform hand hygiene & replace gloves if hands become
contaminated during removal AND immediately after
PPE removal
• PPE must be removed immediately after patient care is
transferred to hospital staff
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ODEMSA 2014 Regional Ebola Update
&
PPE Training
Doffing Sequence
• Needed BEFORE beginning:
– Fresh disposable gloves
– BioHazard bags/receptacles (“Triple bagged”)
– Hand Hygiene supplies
• Sequence - “Touch ONLY clean to clean AND dirty to dirty”:
1. Outer Gloves: Touching ONLY inside, remove  Biohazard
disposal
2. Gown: Touching ONLY inside, Roll away from wearer, down to
wrists, remove  Biohazard disposal
3. Leggings/Boot Covers (or Shoe Covers): Touching ONLY
inside, roll down and away from wearer, remove  Biohazard
disposal
4. Inner Gloves: Touching ONLY inside, remove  Biohazard
disposal
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Oct 2014
– Continued….
ODEMSA 2014 Regional Ebola Update
&
PPE Training
Doffing Sequence
5. Hand Hygiene (dry hands as much as possible)
6. Don a fresh pair of gloves
7. Bonnet (grasp as far to the rear as possible)  Biohazard
disposal
8. Goggles (grasp as far to the rear as possible)  Biohazard
disposal
9. Respirator/Mask (grasp from as far to the rear as possible)
 Biohazard disposal
10. Last Pair of Gloves: Touching ONLY inside, remove 
Biohazard disposal
11. HAND HYGIENE, including wrists and fingernails
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Disposal of Contaminated PPE
• Once the contaminated PPE is placed in the Biohazard
bag and bag is triple-sealed, follow directions of facility
staff for proper disposal and decontamination.
**Remember, the ODEMSA hospitals have committed to
decontaminate EMS personnel (not vehicles) after contact
with a potentially infectious EVD patient. Follow the
direction of the hospital staff.**
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ODEMSA 2014 Regional Ebola Update
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PPE Training
Summary
• Hand hygiene is the single most important way to prevent
infection spread
• Proper selection of appropriate PPE is vital
• Standard: ALL Patients
• Contact + Droplet: Sick Patients at risk for infectious
diseases
• Doffing (removal) = greatest risk to Providers
• A “Buddy System” – especially during doffing – will reduce the
risk of compromise/breach
• PPE must be disposed of properly after removal
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ODEMSA 2014 Regional Ebola Update
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PPE Training
If you have questions…
Virginia Department of Health – Ebola Hotline
1-877-ASK VDH3 (1-877-275-8343)
ODEMSA
Office Number:
(804) 560-3300
Website: www.odemsa.vaems.org
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