Firefighter Pre-hospital Care Disease Transmission ... Pre-hospital Care Disease Transmission / Designated Officer Program. ... • most common mode for infectious ... •Chicken pox

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  • Captain Randy Gwyn R.N., I.C.P.Captain Randy Gwyn R.N., I.C.P.Program DeveloperProgram Developer

    Captain Bill Sault BA, ACP Captain Bill Sault BA, ACP Program ManagerProgram Manager

    Firefighter Pre-hospital Care Disease Transmission /

    Designated Officer Program

  • Routes of TransmissionRoutes of Transmission

    There are 4 general routes of transmission

    Contact (Direct)

    Airborne (Indirect)

    Vehicle (Indirect)

    Vector (Indirect)

    There are 4 general routes of transmission

    Contact (Direct)

    Airborne (Indirect)

    Vehicle (Indirect)

    Vector (Indirect)

  • Contact TransmissionContact Transmission

    most common mode for infectiousdisease transmission

    infection may occur by Directcontact or Droplet contact

    most common mode for infectiousdisease transmission

    infection may occur by Directcontact or Droplet contact

  • Direct TransmissionDirect Transmission contact / person to person spread

    there must be actual physical contact between sourceand firefighter

    Droplet Spread (3 feet or less) by means of talking, sneezing or coughing

    i.e. Cold & flu viruses

    some sources of infection include:soil, eating utensils, door handles

    contact / person to person spread

    there must be actual physical contact between sourceand firefighter

    Droplet Spread (3 feet or less) by means of talking, sneezing or coughing

    i.e. Cold & flu viruses

    some sources of infection include:soil, eating utensils, door handles

  • Indirect ContactIndirect Contact

    Airborne Transmission Similar to droplet spread lighter particles from a sneeze or coughare carried on air currents

    Infections such as legionnaires diseasespread through the air systems ofbuildings, airplanes, etc.

    Airborne Transmission Similar to droplet spread lighter particles from a sneeze or coughare carried on air currents

    Infections such as legionnaires diseasespread through the air systems ofbuildings, airplanes, etc.

  • Vehicle TransmissionVehicle Transmission

    Infected person Inanimate object

    Non-infected personSources: Needle stick injury - HIV, Hepatitis B / C Contaminated water - Typhoid, Hep. A Contaminated food - Botulism / Salmonella

    Infected person Inanimate object

    Non-infected personSources: Needle stick injury - HIV, Hepatitis B / C Contaminated water - Typhoid, Hep. A Contaminated food - Botulism / Salmonella

    Indirect ContactIndirect Contact

  • Indirect TransmissionIndirect Transmission

    Vector Transmission Transmission by an intermediate carrier

    Sources include: Mosquito West Nile Raccoon - Rabies Tick Lymes Disease

    Vector Transmission Transmission by an intermediate carrier

    Sources include: Mosquito West Nile Raccoon - Rabies Tick Lymes Disease

  • Chain of Disease Transmission

    Chain of Disease Transmission

    Infectious Agent

    Reservoirs

    Portal of Exit

    Mode of Transmission

    Portal of Entry

    Susceptible Host

    Infectious Agent

    Reservoirs

    Portal of Exit

    Mode of Transmission

    Portal of Entry

    Susceptible Host

  • Chain of Disease Transmission

    Chain of Disease Transmission

    Break the Chain

    Transmission can not occur

    Break the Chain

    Transmission can not occur

  • Communicable Diseases of ConcernCommunicable Diseases of Concern

    Human Immunodeficiency Virus (HIV)

    A severe disorder of the immune system

    Not highly infectious to general population

    Transmitted by:Direct blood / body fluid contact

    PEP (post exposure prophylaxis) is available for asignificant exposure

    Human Immunodeficiency Virus (HIV)

    A severe disorder of the immune system

    Not highly infectious to general population

    Transmitted by:Direct blood / body fluid contact

    PEP (post exposure prophylaxis) is available for asignificant exposure

  • Communicable Diseases of ConcernCommunicable Diseases of ConcernHepatitis A, B, C

    Worldwide problem- All affect the liver but aredifferent infections/agents

    Hepatitis A - fecal, oral route

    Hepatitis B & C - blood, saliva, semen and otherbodily fluids

    Hepatitis B vaccine and PEP (post exposureprophylaxis) are available

    Hepatitis A, B, C

    Worldwide problem- All affect the liver but aredifferent infections/agents

    Hepatitis A - fecal, oral route

    Hepatitis B & C - blood, saliva, semen and otherbodily fluids

    Hepatitis B vaccine and PEP (post exposureprophylaxis) are available

  • Communicable Diseases of ConcernCommunicable Diseases of Concern

    Meningitis

    Inflammation of the meninges - what are they?

    May be viral or bacterial

    Primarily a disease of small children

    Exposure - shared saliva ( kissing contact ) Vaccine is available but is not currently

    recommended for healthcare workers (CanadianImmunization Guide Edition 6, 2002)

    Meningitis

    Inflammation of the meninges - what are they?

    May be viral or bacterial

    Primarily a disease of small children

    Exposure - shared saliva ( kissing contact ) Vaccine is available but is not currently

    recommended for healthcare workers (CanadianImmunization Guide Edition 6, 2002)

  • Exposure Determination

    Meningitis Meningococcal Disease

    hViral or Bacterial ?

    hNeisseria Meningitidis ( the bacteria's real name )

    hShared saliva ( a.k.a. kissing contact )i.e. shared utensils, cigarettes, airway management

    hExposures of exposures / Are they legitimate? e.g. family of exposed firefighter

  • Communicable Diseases of ConcernCommunicable Diseases of Concern

    Tuberculosis

    exposure to airborne droplet when the pt. coughs or sneezes ( prevention ? )

    transmission requires frequent and prolongedexposure

    growing problem in large urban areas

    Tuberculosis

    exposure to airborne droplet when the pt. coughs or sneezes ( prevention ? )

    transmission requires frequent and prolongedexposure

    growing problem in large urban areas

  • Caring for Patients who May Have TBCaring for Patients who May Have TB Use a fit tested N-95

    on yourself.

    Use a surgical maskon patient (iftolerated)

    Use a fit tested N-95 on yourself.

    Use a surgical maskon patient (iftolerated)

  • Tuberculosis

    hAirborne / Droplet contact

    hDid the patient have an active and productive cough ? Fever ?

    hIs patient currently under treatment?

    hWas patient masked? Was the firefighter?

    hWorking environment? Small, enclosed, poor ventilation and over an extended timeperiod?

    Exposure Determination

  • Other Exposures

    Antibiotic Resistant Organisms (AROs):

    hMRSA, VRSA, VRE, ESBLs, C-difficile

    hWest Nile Virus

    hG.A.S.

  • All firefighters should have physicals each year.

    Current immunization status or results of screening testsshould be determined for the following diseases:

    All firefighters should have physicals each year.

    Current immunization status or results of screening testsshould be determined for the following diseases:

    MMONITORING PERSONAL HEALTHONITORING PERSONAL HEALTH

    Hepatitis Tetanus/diphtheria Measles Mumps Rubella

    Hepatitis Tetanus/diphtheria Measles Mumps Rubella

    Chicken pox Polio Tuberculosis (TB) Influenza immunization Flu shots offered yearly

    Chicken pox Polio Tuberculosis (TB) Influenza immunization Flu shots offered yearly

  • Designated Officer Program

    hIdentifies police, fire and paramedics as high risk exposure group

    hDeveloped to educated emergency service workers

    hEstablish exposure protocols

    hProgram setup by MOH in 1994

  • Designated Officer Program1994 Ministry of Health Guideline

    Establishes a means of notification of exposures.

    Toronto Fire Services Designated Officer (DO) is on call 24/7/365 days a year. TFS program incorporates a Occupational Health and Safety component so is identified as the SDO (Safety/Designated Officer).

    Should be contacted IMMEDIATELY following a suspected exposure via communications.

    Contact TFS communications and ask that the on-call SDO be paged. You will then be contacted by the SDO directly.

  • Patient Confidentiality

    hThe Designated Officer will be working within a mutually shared environment with other health professionals.

    h It is imperative that the D.O. maintains the appropriate level of patient confidentiality (both firefighters and source patients)

  • Bill 105 Legislation enacted on Sept.1, 2003.

    Under specific circumstances, can legally mandate a source patient to provide a blood sample.

    A legal application must be made and specific process followed.

    Application can be denied.

    Process is lengthy and complicated.

  • Bill 105 The DO should be contacted IMMEDIATELY! The DO will assist with application process. TFS staff are encouraged to utilize the TFS

    Chief Medical Officer (Dr. Forman). All discussions with DO and/or Chief Medical

    Officer are CONFIDENTIAL.

  • DO advises firefighter to be evaluated and followed up by a doctor or other appropriate health care professional.

    Public Health notifies DO of possible exposure (contact tracing).

    Airborne Exposure Procedure

    The medical facility must notify public health within 48 hours.

    The medi