EMS Update on
H1N1 Influenza A and Pan Flu
Kathy Robinson
NASEMSO Program Manager
September 23, 2009

EMS & 9-1-1
Critical Components of the National
Strategy
9/23/2009
EMS and 9-1-1 documents are available for download at www.ems.gov
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9/23/2009
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9/23/2009
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Results 1 - 10 of about 38,400,000 for Swine Flu [ definition ]. (0.21 seconds)
Results 1 - 10 of about 49,000,000 for H1N1. (0.05 seconds)
Results 1 - 10 of about
186,000,000 for Michael Jackson .
(0.08 seconds)
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9/23/2009
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“It never went away.”
The virus has not changed to become more deadly.
Drug-resistant strands emerging.
Child deaths--had at least one severe underlying illness or underlying disability, actually, rather than illness, in most of the cases -- cerebral palsy, muscular dystrophy, long-standing respiratory or cardiac problems.
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9/23/2009
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Child deaths--had at least one severe underlying illness or disability-cerebral palsy, muscular dystrophy, long-standing respiratory or cardiac problems.
Children who didn't have an underlying condition and who did become severely ill, and they were generally infected also by bacteria.
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9/23/2009
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Most people recover from infection without the need for hospitalization or medical care.
Causes more serious lung disease than seasonal flu strains and sheds from the lung and throat tissue where it reproduces at higher rates.**
High fever post viral infection??
Suspect bacterial pneumonia.
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9/23/2009
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Twenty-one states are reporting widespread influenza activity at this time.
Reports of widespread influenza activity in September are very unusual.
Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses.
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6/12/2009 National Association of State EMS
Officials
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9/23/2009 10

9/23/2009
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Some schools in Florida and Canada have banned hand sanitizers because of the high concentration of alcohol.
Officials worried about flammability and potential misuse as an intoxicant.
Must store larger pump containers and extra bottles in fireproof cabinets or outdoor sheds.
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9/23/2009
“The potential benefits of preemptively dismissing students from school are often outweighed by negative consequences, including students being left home alone, health workers missing shifts when they must stay home with their children, students missing meals, and interruption of students’ education.”
World Health Organization, September 2009
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9/23/2009 13

Estimated Need
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More than 30 billion masks needed in a pandemic
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27B surgical masks
5 billion N-95
US Stockpile
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SNS contains 119 million masks
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39 million surgical
80 million N-95’s
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9/23/2009
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One anecdotal report— 7000 masks in caring for ONE H1N1 Influenza A patient in one ICU
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9/23/2009
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CDC – “We want to ensure that health care workers are safe.”
Revised guidance expected this week
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9/23/2009
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The committee was not charged with considering implementation issues, which include cost, availability of equipment, and other considerations (such as effective vaccines) in the implementation of such guidance.
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9/23/2009
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An emphasis is needed on implementing a range of strategies across all levels.
Studies on influenza transmission show that airborne transmission is one of the potential routes of transmission.
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9/23/2009
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The committee endorses the current CDC guidelines and recommends that these guidelines should be continued until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.
Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations…
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9/23/2009
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The use of respirators should be for those in initial contact with individuals presenting with unidentified febrile respiratory illnesses and those healthcare workers in close contact with individuals with confirmed or suspected H1N1.
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9/23/2009
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PPE needs to be viewed as one part of a continuum of controls to ensure worker and patient safety that range from engineering controls and administrative approaches to pharmaceutical measures.
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9/23/2009
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Emergency medical responders
Fit-tested disposable N-95 respirator if in close contact
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Aerosol generating activities
Interfacility transfers
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9/23/2009
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Last week, American Society for Microbiology
Meeting describes first randomized controlled trial comparing N95 to facemasks
MacIntyre Study found that surgical masks had no protective effect. In contrast, the N95s, compared with the controls, were linked with
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60% reduction in risk for any respiratory illness
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75% reduction in flu-like illness
56% decrease in lab-confirmed respiratory illness
75% reduction in confirmed flu
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The researchers found that fit-testing of the made no difference in protection.
Published at: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/sep1709resp ir-jw.html
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9/23/2009
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136 entries so far
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Topics on this Page
Air System Products
Body Wash Products
Device Products
Gel Products
Gloves Products
Hand Sanitizer Products
Herbal Extract Products
Inhaler Products
Kit Products
Mask Products
Shampoo Products
Spray Products
Supplement Products
Tea Products
Test Products http://www.accessdata.fda.gov/scripts/h1n1flu/
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9/23/2009 26

6/12/2009 National Association of State EMS
Officials
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9/23/2009
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FDA has licensed H1N1 vaccine
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(4 of 5 manufacturers, so far)
Good antibody response
90,000 distribution sites
Live, attenuated virus (easiest and quickest to make)
Triggers immune response, can’t infect individuals
3.4 million (inhalable) doses ready by 1 st week of
October
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195 million doses available by the end of the year
Should be available to anyone who wants it
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9/23/2009
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FluMist is approved for healthy individuals between 2 and 49
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No kids under 2
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No pregnant women
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No immuno-compromised
Expect inactivated vaccines to become available early to mid-October
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9/23/2009
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Pregnant women
Health care workers and emergency medical responders
People caring for infants under 6 months of age
Children and young adults from 6 months to 24 years
People aged 25 to 64 years with underlying medical conditions (e.g. asthma, diabetes)
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9/23/2009
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Could be minor variations from the federal list in the states
Feds won’t intervene to supersede
State priorities
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9/23/2009
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NEJM Preliminary Report
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Swiss firm Novartis and the Australian firm CSL report that nearly 300 adults given experimental pandemic vaccines
"unexpectedly" developed protective antibodies after just one dose
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Published at www.nejm.org September 10, 2009
(10.1056/NEJMoa0907413)
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9/23/2009
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Influenza virus infection has also been associated with GBS.
Baseline rates of GBS and miscarriages (1 per 100,000 pop.)
In 1976, there was a small risk of
GBS following influenza (swine flu) vaccination (approximately 1 per
100,000 persons vaccinated).
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9/23/2009
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Numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found.
Two studies suggested that approximately 1 person out of 1 million vaccinated persons may be at risk of GBS associated with seasonal influenza vaccine.
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9/23/2009
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H1N1 has high level of susceptibility to antivirals
Best outcomes associated in treatment within
48 hours
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9/23/2009
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CDC Guidance – can resume activities
24 hours after fever subsides
Two small studies—Canada and
Singapore—H1N1 patients may be infectious 10+ days
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6/12/2009 National Association of State EMS
Officials
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9/23/2009
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CMS Memorandum to State Agencies
August 2009-”Extraordinary surges”
Hospitals can establish alternative screening sites ON CAMPUS to perform MSE’s for persons presenting to the ED with ILI.
Can be redirected after qualified person determines there is no obvious EMC.
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9/23/2009
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Off-site ILI screening centers
Can’t refer patients there from ED.
Can’t be used to screen patients for other urgent, unscheduled illnesses or conditions.
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9/23/2009
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Seasonal influenza results in 200,000 hospitalizations annually in the United
States.
Seasonal influenza causes 36,000 thousand deaths each year in the US, ranking it among the nation’s top 10 causes of death.
Influenza related deaths are usually due to secondary pneumonias, exacerbated cardiopulmonary conditions, or other chronic diseases.
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9/23/2009
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Respiratory Hygiene
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Cover your mouth when you sneeze or cough
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WASH YOUR HANDS
FREQUENTLY
Avoid touching your face, eyes, nose, mouth
If you are sick, STAY
HOME
Immediately discard used tissues and then
WASH YOUR HANDS!
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9/23/2009
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Stay home if you are sick for 7 days after your symptoms begin or until you have been symptomfree for 24 hours, whichever is longer.
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The epidemiology of the disease caused by the 2009
H1N1 influenza virus in the
Southern Hemisphere is very similar to that described in the
United States this past spring.
There have been no significant changes detected in the 2009 H1N1 influenza virus isolated from persons in the Southern Hemisphere as compared to viruses isolated from persons in the Northern
Hemisphere.
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9/23/2009
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Phone: 703.538.1799
Email: info@nasemso.org
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