drtm - contagious patient
TRANSCRIPT
Aeromedical Retrieval of the contagious patient Aeromedical retrieval of
the contagious patient
Intro…
• Current situation• Clinical case• Risk Assessment • Infection control precautions/PPE• Minimising the transmission risk• Swine Flu 2009 – impact on NSW Ambulance
Retrieval Service
http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/
Disease Outbreak News - WHO
http://www.who.int/csr/don/archive/year/2017/en/
H7N9 Avian Flu
• 1st human case March 2013
• Severe illness
• No sustained human-to human transmission… YET
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
Broken Hill….
First actions
• PPE!!
• Precautions – Standard, Airborne, Contact
• Reassess situation
• Ask for help – complex mission
Considerations….
• Risk assessment– Patient– Disease– Transport– Aeromedical staff
The Patient
Mode of Transport
The Staff/Crew
The Disease
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
High Risk Interventions
• Advanced Airway management • Nebulised therapy • Invasive or ‘bloody’ procedures• Care within enclosed space• Post-response vehicle cleaning
Care within enclosed space
Airborne infection control
Ebola Specific
Challenges for the medical team
• Confined treatment area• No handwashing facilities • Lack of ventilation • Prolonged PPE• Dehydration/Heat related illness
NSWA Vehicle decontamination
Current unresolved issues:•Measles/Varicella - ? Allow particles to settle
Decontamination
• Wipe down of equipment – NIV BP Cuffs, stethoscopes, sphygs
• Fabric equipment:– Dr’s Thigh pouches– Medical packs– Loafs– Tourniquet
NSW Environmental Cleaning Policy
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
Take home points
• Be vigilant• Risk assess• Phone a friend – SRC, DRC, PH, ID• Protect yourself and your colleagues• Follow up
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
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