Part VI—Influenza and EMTALA & Part VII– Planning Considerations

Part VI—Influenza Part VI—Influenza and EMTALA &and EMTALA &Part VII– Planning Part VII– Planning ConsiderationsConsiderations

A “Just-in-Time” Primer on H1N1 Influenza A and Pandemic A “Just-in-Time” Primer on H1N1 Influenza A and Pandemic Influenza provided by the National Association of State EMS Influenza provided by the National Association of State EMS

OfficialsOfficialsRevised June 12, 2009

Table of ContentsTable of Contents

Part I--Understanding Influenza and the Part I--Understanding Influenza and the Current Influenza PandemicCurrent Influenza Pandemic

Part II--Understanding the TerminologyPart II--Understanding the Terminology Part III—Understanding H1N1 Influenza APart III—Understanding H1N1 Influenza A Part IV—Personal Protective Equipment Part IV—Personal Protective Equipment

(PPE) for EMS(PPE) for EMS Part V--Decontamination of AmbulancesPart V--Decontamination of Ambulances Part VI—Influenza and EMTALAPart VI—Influenza and EMTALA Part VII– Planning ConsiderationsPart VII– Planning Considerations

6/12/2009 National Association of State EMS Officials

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DisclaimerDisclaimer

This self-learning module was developed by the This self-learning module was developed by the National Association of State EMS Officials. The National Association of State EMS Officials. The content was collated from various sources and content was collated from various sources and current as of June 12, 2009. Users are strongly current as of June 12, 2009. Users are strongly encouraged to review situational reports and updates encouraged to review situational reports and updates from the Centers for Disease Control and Prevention, from the Centers for Disease Control and Prevention, the US Department of Health and Human Services, the US Department of Health and Human Services, the US Department of Agriculture, the World Health the US Department of Agriculture, the World Health Organization, and similar entities as revised and Organization, and similar entities as revised and additional information becomes available. NASEMSO additional information becomes available. NASEMSO did not review or approve material which may have did not review or approve material which may have been added beyond the distributed version which is been added beyond the distributed version which is on our web site at on our web site at www.nasemso.org . .

6/12/2009 3National Association of State EMS Officials

http://www.nasemso.org/

EMS & 9-1-1EMS & 9-1-1Critical Components of the Critical Components of the

National StrategyNational Strategy


EMS and 9-1-1 documents are available for download at www.ems.gov

Current H1N1 OverviewCurrent H1N1 Overview

Most people recover from infection without Most people recover from infection without the need for hospitalization or medical care. the need for hospitalization or medical care.

Overall, national levels of severe illness from Overall, national levels of severe illness from influenza A (H1N1) appear similar to levels influenza A (H1N1) appear similar to levels seen during local seasonal influenza periods, seen during local seasonal influenza periods, although high levels of disease have occurred although high levels of disease have occurred in some local areas and institutions. in some local areas and institutions.

Overall, hospitals and health care systems in Overall, hospitals and health care systems in most countries have been able to cope with most countries have been able to cope with the numbers of people seeking care, although the numbers of people seeking care, although some facilities and systems have been some facilities and systems have been stressed in some localities. stressed in some localities.


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INFLUENZA AND EMTALAINFLUENZA AND EMTALA

Part VIPart VI

6/12/2009 National Association of State EMS Officials 6

Influenza Patient Influenza Patient DestinationDestination

Increased referrals from primary Increased referrals from primary care practices TO 9-1-1, EMS, care practices TO 9-1-1, EMS, and hospital emergency and hospital emergency departments have been departments have been documented.documented.

Hospitals CAN divert influenza Hospitals CAN divert influenza patients away from the ED and patients away from the ED and not violate EMTALA.not violate EMTALA.


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Influenza, ED Triage, and Influenza, ED Triage, and EMTALAEMTALA

CMS permits hospitals to move CMS permits hospitals to move individuals out of their dedicated individuals out of their dedicated emergency departments to another emergency departments to another part of the hospital (on the hospital’s part of the hospital (on the hospital’s same campus) in order to provide the same campus) in order to provide the required medical screening required medical screening examination (MSE) and then, if an examination (MSE) and then, if an emergency medical condition is found emergency medical condition is found to exist, to provide stabilizing to exist, to provide stabilizing treatment or arrange for an treatment or arrange for an appropriate transfer. appropriate transfer.


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Influenza, ED Triage, and Influenza, ED Triage, and EMTALAEMTALA

Prior to directing the individual elsewhere in Prior to directing the individual elsewhere in the hospital, if qualified medical personnel the hospital, if qualified medical personnel in the emergency department completed an in the emergency department completed an appropriate MSE and determined that the appropriate MSE and determined that the individual does not have an emergency individual does not have an emergency medical condition, then the hospital has no medical condition, then the hospital has no further EMTALA obligation to that individual further EMTALA obligation to that individual and the issue of moving the individual to an and the issue of moving the individual to an alternate site, either on or off the hospital’s alternate site, either on or off the hospital’s campus, would be moot from an EMTALA campus, would be moot from an EMTALA perspective.perspective.


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““Worried Well”Worried Well”

At some location before the person reaches At some location before the person reaches the emergency department, the facility can the emergency department, the facility can post signs or staff that direct non-ill persons post signs or staff that direct non-ill persons who would like or need information about who would like or need information about the flu to another site on the campus that the flu to another site on the campus that would not require medical screening, would not require medical screening, establishment of a medical record or logging establishment of a medical record or logging in. in.

That location could serve as an education or That location could serve as an education or information distribution center to ease the information distribution center to ease the public’s concerns.public’s concerns.


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Proactive Collaboration Proactive Collaboration Is Essential!!Is Essential!!

EMS should partner with the local EMS should partner with the local health authority and health care health authority and health care facilities to help determine appropriate facilities to help determine appropriate community policies regarding community policies regarding influenza. influenza.

EMS should accurately communicate EMS should accurately communicate influenza patient status and needs in a influenza patient status and needs in a timely manner to the receiving facility.timely manner to the receiving facility.

Confrontational communications Confrontational communications regarding influenza patient destination regarding influenza patient destination during transport should be avoided!during transport should be avoided!6/12/2009 National Association of State EMS

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More on Influenza and More on Influenza and EMTALAEMTALA

http://www.cms.hhs.gov/Emergency/10_PandemicFlu.asp http://www.cms.hhs.gov/Emergency/10_PandemicFlu.asp http://www.cms.hhs.gov/Emergency/Downloads/http://www.cms.hhs.gov/Emergency/Downloads/

H1N1_QsAs.pdf H1N1_QsAs.pdf


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PLANNING PLANNING CONSIDERATIONSCONSIDERATIONS

Part VIIPart VII


EMS & 9-1-1EMS & 9-1-1Critical Components of the Critical Components of the

National StrategyNational Strategy


EMS and 9-1-1 documents are available for download at www.ems.gov

www.pandemicflu.govwww.pandemicflu.gov


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EMS Planning PrioritiesEMS Planning Priorities

EMS participation in health EMS participation in health surveillancesurveillance

Vaccination and prophylaxis for Vaccination and prophylaxis for personnel (and families when personnel (and families when feasible)feasible)

Sheltering employeesSheltering employees Role in medical surgeRole in medical surge Supply chains (& expanded storage)Supply chains (& expanded storage) Operational continuity in face of Operational continuity in face of

competing demands for servicecompeting demands for service6/12/2009 National Association of State EMS

Officials16

Looking forward…Looking forward…

Preliminary analysis of serum from Preliminary analysis of serum from people immunized with the seasonal people immunized with the seasonal influenza vaccine done at the CDC influenza vaccine done at the CDC suggests that the seasonal vaccine is suggests that the seasonal vaccine is unlikely to provide protection against unlikely to provide protection against 2009-H1N1. 2009-H1N1.

This virus does not have the genetic This virus does not have the genetic markers for virulence seen in the markers for virulence seen in the 1918 pandemic virus, or seen today in 1918 pandemic virus, or seen today in the H5N1 virus in Asia that has been the H5N1 virus in Asia that has been lethal among people.lethal among people.


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Looking forward…Looking forward…

The Southern The Southern Hemisphere is just Hemisphere is just going into their flu going into their flu season and how this season and how this virus behaves will give virus behaves will give us some clues about us some clues about what we can expect for what we can expect for the Northern the Northern Hemisphere in Fall Hemisphere in Fall 2009.2009.

Some experts predict Some experts predict re-emergence with re-emergence with increased viral acuity, increased viral acuity, higher rates of disease higher rates of disease and death.and death.



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Part VI—Influenza and EMTALA & Part VII– Planning Considerations