drtm - contagious patient

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Aeromedical Retrieval of the contagious patient Aeromedical retrieval of the contagious patient

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Page 1: DRTM - Contagious patient

Aeromedical Retrieval of the contagious patient Aeromedical retrieval of

the contagious patient

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Intro…

• Current situation• Clinical case• Risk Assessment • Infection control precautions/PPE• Minimising the transmission risk• Swine Flu 2009 – impact on NSW Ambulance

Retrieval Service

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http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/

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Disease Outbreak News - WHO

http://www.who.int/csr/don/archive/year/2017/en/

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H7N9 Avian Flu

• 1st human case March 2013

• Severe illness

• No sustained human-to human transmission… YET

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Clinical case

25 yo male with pneumonia and infective exacerbation of asthma– PMHx – Asthma– DHx - NKDA, PRN ventolin– PR 110 BP 105/74 RR 32 Sats 100% 15LHM

T 37.8 GCS 15 BSL 9.0

Rx: IVABx, O2, IV crystalloid resuscitation, Bronchodilators and steroids

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Broken Hill….

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First actions

• PPE!!

• Precautions – Standard, Airborne, Contact

• Reassess situation

• Ask for help – complex mission

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Considerations….

• Risk assessment– Patient– Disease– Transport– Aeromedical staff

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The Patient

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Mode of Transport

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The Staff/Crew

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The Disease

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P2/N95 Mask

• Fit Check • Fit testing - Qualitative– Aerosolised Saccharin Mist– Exercises – 1 minute each

1. Normal breathing

2. Deep breathing

3. Moving head side-to-side

4. Moving head up-down

5. Bending/jogging

6. Talking

7. Normal breathing again

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High Risk Interventions

• Advanced Airway management • Nebulised therapy • Invasive or ‘bloody’ procedures• Care within enclosed space• Post-response vehicle cleaning

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Care within enclosed space

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Airborne infection control

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Ebola Specific

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Challenges for the medical team

• Confined treatment area• No handwashing facilities • Lack of ventilation • Prolonged PPE• Dehydration/Heat related illness

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NSWA Vehicle decontamination

Current unresolved issues:•Measles/Varicella - ? Allow particles to settle

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Decontamination

• Wipe down of equipment – NIV BP Cuffs, stethoscopes, sphygs

• Fabric equipment:– Dr’s Thigh pouches– Medical packs– Loafs– Tourniquet

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NSW Environmental Cleaning Policy

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Swine Flu 2009• Pre-2009 GSA-HEMS T/F 7 ECMO pts• ECMO service established 1/12 prior to H1N1

– Funded for 10 per yr

• 1/6/09 – 31/8/09– 722 patients with confirmed H1N1 admitted to ICU– 456 required mechanical ventilation – 24 ECMO– 19 patients retrieved on ECMO

• During 2009 – 31 ECMO retrievals in total

Jones, C. Hommers, C. Burns, B. Forrest, C. ECMO Retrieval in NSW and beyond. Current Anaesthesia and Critical Care react-text: 55 21(5):282-286/October 2010

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Take home points

• Be vigilant• Risk assess• Phone a friend – SRC, DRC, PH, ID• Protect yourself and your colleagues• Follow up

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References:• Jones, C. Hommers, C. Burns, B. Forrest, C. ECMO Retrieval in NSW and beyond. Current Anaesthesia and Critical Care react-text: 55 21(5):282-286/October 2010

• MacIntyre, R., Dwyer, H., Seale, W., Quanyi, Z., Yi, P., Yang, S., Weixan. High risk procedures and respiratory infections in hospital healthcare workers – quantifying the risk. International Journal of Infectious Diseases 16S (2012) e317–e473

• Brouqui, P., Ippolitto, G. Clinical Management of Highly Infectious Diseases: European Network for Highly Infectious Diseases consensus guideline. Lancet ID.

• Tran, K., Cimon, K., Severn, M., Oessoa-Silva, L., Conly, J. Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review. PLoS ONE. April 2012/Vol 7/Iss 4/e35797

• ACB of Tranfser and Retrieval Medicine. A Law, J Hulme.Wiley Blackwell. 2015.

• http://www.who.int/csr/don/archive/year/2017/en/• http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/• http://www.nipcm.hps.scot.nhs.uk/documents/tbp-environmental-decontamination-and-terminal-cleaning/• https://www.cdc.gov/vhf/ebola/healthcare-us/emergency-services/interfacility-transport.html#care• https://idmic.net/2015/10/20/standard-precautions-infection-control-what-is-included/• https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/transmission-precautions/p2n95-

mask• http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2012_061.pdf

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Resources:• https://memegenerator.net/instance/66334797/i-will-find-you-meme-to-

whoever-started-the-office-man-flu-i-will-find-you-and-i-will-kill-you• http://apcollege.edu.au/toll-air-ambulance/• http://apcollege.edu.au/nsw-ambulance-jobs/• http://www.16right.com/16R%20Main• https://www.whywesnore.com/cpap/• https://www.backpackerdeals.com/australia/alice-springs/the-rock-tour-3d-2n-

alice-springs-to-alice-springs• http://www.jervisbaywild.com.au/australian-backpacker-bucket-list-jervis-bay/• http://qf1.info• https://au.pinterest.com/pin/130111876707797539/• https://au.pinterest.com/lama201484/infection-control/?lp=true• http://thepreventionist.info/tag/contact-precautions/• https://www.csiequipment.com/body-bag---heavy-duty_p31733.aspx• http://www.dailymail.co.uk/news/article-2204850/Portraits-famous-faces-

created-petri-dishes-artist-using-bacteria.html