Careers: EMT/Emergency Medical Technicians/Morbid Curiosity on Protocol

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QUESTION: Ok so I was reading a Medical Thriller fiction book. It was about this seriel killer who was using very contagious diseases and germs that makes health go quickly and people exposed get severely sick.

Obviously this is fiction but I was curious at how a emergency response team would handle this.

My husband said some parts of this book were in accurate on protocol.

So if your medical team responded to a severely sick person would any of you know if the person had buebonic plague or small pox or a similar highly dangerous or infectious disease?

What is protocol for severe infectious diseases and a medical teams exposure to them?

How is something like this usually handled?

This is morbid curiousity. I honestly do want to know how something like this would be handled. In the book the ambulance team was targeted so the sick person they picked up exposed the medical team and the medical team exposed the ambulence squad. But I would think they would have measures to protect from these things right?

Thank goodness this was fiction because it was actually creepy.

Thabks for your reply

ANSWER: This is actually an interesting question.

Basically we are on the front lines when it comes to disease exposure. Even as I write this our crews are dealing with a fairly severe outbreak of flu. So basically we have protocols and response guidelines that help to protect us. The protection comes in the form of prevention; our crews wear protective gear if there is even a remote chance of an exposure. If an exposure does (potentially) occur the crew members involved are provided with prophylactic treatment. Depending on what they were exposed to this treatment can include antibiotics, anti-virals, or simple follow-up test.

So what is it that strikes fear in me?

I am, in no way, in fear of plague or even smallpox. Plague, because it is bacterial, responds nicely to antibiotics and smallpox is not fatal in most cases. (in addition it was eradicated back in the late 70s and there have been no known cases since - it still exist in weaponized form but not "in the wild") Based on my knowledge I fear Ebola or Hanta. Both are caused by viruses, both are highly contagious, there is no known cure, and they are almost 100% fatal. The death is painful as the victim bleeds to death internally and externally. Thankfully they are so fatal that it would be difficult for anyone to use them as a weapon.

As for how we handle possible exposures, we have an Exposure Control Policy. I serve as the Infection Control Officer in our department and as such I have to investigate any potential exposure. How did it happen? Did PPE (personal protective gear) fail? Was it preventable? How severe was it?

The crew members involved fill out exposure forms. The source, under state and federal laws, is tested for diseases (assuming that the source is a person that is), and the crew is given whatever treatment is called for. Recently an entire crew was exposed to a patient who had viral meningitis - highly contagious and deadly. The patient had a high fever and, per our protocol, the crew donned protective mask. But there was still a question of the potential of an exposure and thus the forms were filled out to cover the crew members just in case. In the end the patient died but none of our crew members ended up becoming ill.

Do EMS and Fire crews ever get targeted? All of the time sadly. In Atlanta, in 1996, the Centennial Park Bomber intentionally placed a secondary device where he knew it would get the first responders. The only reason it failed was because he placed the bomb into a steel dumpster and the walls of the dumpster protected the crew members that were close by. So yes it is possible that someone could intentionally attack responders using disease processes. But we try to insure that our protocols and our equipment protects us. Nothing is guarateed though.

I hope this helps answer your question.
Jim Wilson

---------- FOLLOW-UP ----------

QUESTION: In the book I read the disease was a hybrid mutant for of leperosy. The medical crew had to call Center for Disease Control and ALL the members of the ambulence team and the ambulence itself were all quarentined. Has your team ever had to call or come in contact with CDC? Last question I promise. And thanks for a fast reply

Answer
Sorry it took some time to reply. There must have been a glitch in the AllExperts notification email service because I never received one. I found your follow-up by accident when I came online to reply to another question.

Anyway...

I have had to report diseases a couple of times to the ER I took the patient to and they then reported it to CDC. We would rarely, as field Paramedics, actually contact the CDC unless it was to get some advice. For example, in 2009 when we had a St. Louise Encephalitis outbreak I phoned them directly to find out if we needed to amend our protocols. The woman I spoke with was professional, cordial, knowledgeable, and most importantly helpful.

But as for being put in quarantine, thank goodness the answer has been "no" up to this point in my 31 year career.

Take care,
Jim Wilson

Careers: EMT/Emergency Medical Technicians

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Jim Wilson

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I can answer questions regarding training, education, and experiences as well as providing some incite into the world of Emergency Medical Services.

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I have over 25 years of experience in EMS, Fire, and Air Transport.

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BS, AS, EMT-P, ACLS (and instructor), BLS (and instructor), PALS (and instructor), PPC (and instructor), BTLS (and instructor), PHTLS, and NALS. Have instructed EMT and Paramedic in Florida since 1986.

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