Emergency Medical Services
H1N1 INFLUENZA

Agent Information:	H1N1 influenza is caused by an influenza (flu) virus (Novel H1N1 influenza)
			predominantly found in pig populations. People do not normally get H1N1 
			influenza, but this strain has the ability to transmit from pigs to humans, and 
			humans to humans. An outbreak of human cases is occurring internationally.

			Since this is a unique virus, humans will not have natural immunity. There is 
			the potential that this outbreak can become a pandemic.

Signs and Symptoms:	Acute Respiratory Illness – Recent onset of at least two of the following: runny 
			nose or nasal congestion, sore throat, cough, and fever or chills.
			Influenza-like Illness - Fever >37.8°C (100°F), plus cough or sore throat. 

Suspected Case 		1.	A person with an acute respiratory illness who was in close 
Definition of H1N1		contact with a confirmed case of H1N1 influenza infection while
influenza virus:		the person was ill OR
			
			2.	A person with an acute respiratory illness with a recent history of 
				contact with an animal with confirmed or suspected H1N1 
				influenza infection OR

			3.	A person with an acute respiratory illness who has traveled to an 
				area where there are confirmed cases of H1N1 influenza within 7 
				days of illness onset.

Transmission:          	Although the method of transmission is unconfirmed, it is suspected to be via 
		       	airborne droplets from mucosal passages. Airborne transmission occurs when 
		       	bacteria or viruses travel on dust particles or on small respiratory droplets that 
		       	may become aerosolized when people sneeze, cough, laugh or exhale.

Protective Measures:   	* If PSAP advises that the patient has been screened for and has symptoms of 
			  acute febrile respiratory illness symptoms, EMS personnel should apply
			  Personal Protective Equipment (PPE) prior to entering scene.

			* ALL patients should be evaluated for potential flu symptoms. When possible, 
			  minimize the number of providers who have contact with potential flu patients.

			* Follow appropriate Body Substance Isolation (BSI) precautions. Use PPE. 

			* Recommended PPE for taking care of ill/potentially infected patients includes:
			  disposable gowns, gloves, goggles/face shields and masks.

			* Place a surgical mask on all patients with suspected symptoms, using non-	
			  rebreather masks when oxygen is required.
	
			* Personnel engaged in aerosol generating activities (patient nebulizers, bag-
   		          valve-mask, suction, intubation and CPR) for suspected and/or confirmed
			  H1N1 influenza cases would follow strict droplet precautions including N95 
			  mask, gloves, goggles/face shields, disposable gowns.

			* Alert receiving hospital personnel of the possibility of an infectious patient as 
			  soon as possible and consider holding suspected infectious patients in the
			  ambulance until their destination in the hospital is known, rather than
			  immediately moving them into the emergency department.

			* Emergency Services Providers who exhibit signs and/or symptoms of H1N1 
			  Flu should refrain from all EMS-related activities until they are well. The 
			  CDC recommendation is that persons infected with H1N1 Flu “stay home 
			  from work or school and limit contact with others to keep from infecting them.”

Decontamination: 	* Hand washing before and after all patient contacts and contact with patient 
			  care equipment.
							
			* After the patient has been removed and prior to cleaning, the air within the 
			  vehicle may be exhausted by opening the doors and windows of the vehicle 
		          while the ventilation system is running. This should be done outdoors and 
			  away from pedestrian traffic.

			* Perform a thorough cleaning of the stretcher and all equipment that has come 
    		          in contact with or been within 6 feet of patient, with an approved disinfectant 
			  upon completion of the call. When possible, this should be done at the 
			  hospital prior to returning to service. 

			* Dispose of durable goods (disposable masks, gowns) in biohazard containers.
  
			* Providers should change clothing/uniforms as soon as possible after completing 
			  a shift, and shower to remove potential viral particles.

Prophylaxis:            General prophylaxis is not recommended at this time. However, if you are 
			someone who has a greater risk of complications from the flu, seek advice from your 
			medical doctor. 

			Persons at greater risk of complications include:
			
			*    People with chronic medical conditions.
							
			*    People over age 65 or under age 5.
							
			*    Pregnant women.
							
			If you fall into one of these three categories, or live in a household with
			someone in one of these three categories, seek additional medical advice.
			
Treatment:             	The virus is susceptible to antiviral drugs. Supportive care recommended. 


** For additional information in regards to H1N1 influenza, please refer to the CDC website: www.cdc.gov. 
            


24/7 Emergency Contact Number:  1-888-295-5156
Revised: 08/2009   Doc. # 35-05-20/09/08/9A