High-consequence infectious diseases, also known as special pathogens, pose significant public health risks as they are highly infectious, contagious, and can be fatal. Patients infected with special pathogens, such as Ebola Virus Disease, should be given priority for treatment and isolation in specialized biocontainment care units (BCUs). Emergency Medical Service (EMS) professionals are vital in safely and cautiously transporting patients afflicted by the most highly infectious pathogens to BCUs for proper care. This process involves the implementation of safety measures, such as the “identify, isolate, and inform” strategy, that can act as guidelines to prevent the spread of infectious diseases when handling and moving such patients to and from healthcare facilities.

Identify: This is a crucial first step in assessing the likelihood that the patient EMS personnel, or EMTs, will be interacting with might be infected with a high-consequence infectious disease. This entails gathering information through screening for recent travel or exposure history, and signs and symptoms of illness which can be done by the 911 call taker and the Emergency Medical Dispatch Center. Dispatch would then notify the EMS responding unit and supervisors so that they can properly prepare and assemble.

Isolate: This entails the implementation of infection control measures, such as Standard Precautions and Transmission-Based Precautions to protect responders from exposure to potentially infectious bodily fluids. Choosing the right personal protective equipment (PPE) depends on the level of risk associated with the specific pathogen.

Standard precautions: The minimum level of infection control precautions that are to be used in the care of all patients. Key elements include:

• Hand hygiene, proper washing of hands before and after patient contact
• Use of appropriate protective equipment (i.e., gloves and a gown) before patient contact
• Respiratory hygiene (i.e., covering your cough and sneeze)
• Injection and sharp object safety and proper disposal
• Cleaning of supplies and disposal of waste

  Transmission-Based Precautions: Used in addition to Standard Precautions for patients with known or suspected infections and include contact, droplet, and airborne precautions:

• [Contact precautions]: Use when interacting directly or indirectly with a patient, their immediate surroundings (such as their room), or items that have come into contact with the patient. These precautions are especially important when dealing with individuals who have known or suspected infections that carry a higher risk of spreading through physical contact. Key elements include:
  • Gloves and a gown
  • Mask and eye protection are additionally required if contact with bodily secretions is possible
• [Droplet precautions]: Use for patients known or suspected to be infected with pathogens transmitted by respiratory droplets that are generated by a patient who is coughing, sneezing, or talking. Key elements include:
  • Placing patients in individualized rooms if possible
  • In addition to standard precautions (gloves and a gown), personnel should always wear protective surgical masks before interacting with an infected patient or his/her environment
• [Airborne precautions]: Use for patients known or suspected to be infected with pathogens transmitted by the airborne route and remain in the environment for long periods (e.g., tuberculosis, measles, chickenpox, disseminated herpes zoster). Key elements include:
  • In addition to standard precautions (gloves and a gown), the CDC requires an approved N95 respirator properly fitted for each person working in the healthcare environment

Inform:  While protecting the privacy of the patient, it is crucial to inform others about your concern that the person you are caring for or interacting with might be infected with a high-consequence infectious disease, such as: 

• Supervisory personnel  
• Other responding personnel who have arrived on the scene 
• Receiving facility, so that space is made available to properly isolate the patient on arrival and to ensure that receiving healthcare personnel are in the appropriate PPE 
• Local and state public health authorities who may have resources available for special pathogen transport and other assistance they can render to manage and transport the patient  

Klarissa Garza is a 2^nd year Master of Public Health – Bioethics graduate student at the University of Texas Medical Branch School of Public and Population Health. She is also a Research Associate in the Neurology Lab on campus studying Alzheimer’s Disease and plans to go to medical school after completing her MPH. In her free time, she enjoys being outdoors, singing and playing the guitar and violin.

 Resources

Ebola Patient Transport Drill | Johns Hopkins Medicine and Lifeline 

EMS Biosafety Transport - Viral Hemorrhagic Fevers: Ebola Virus Disease 

https://repository.netecweb.org/files/original/287f5d5ebe8065e23b27152089392a62.pdf 

https://netec.org/2022/10/19/ems-strategies-for-ebola/ 

https://www.ncbi.nlm.nih.gov/books/NBK551555/