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 legionnaire’s 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 legionnaire’s 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 – Lyme’s Disease
Vector Transmission• Transmission by an intermediate carrier
Sources include:• Mosquito – West Nile• Raccoon - Rabies• Tick – Lyme’s 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 (ARO’s):
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 firefighter’s and source patient’s)
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 medical facility diagnoses the disease in the client you treated.
You treat a client who is infected with a life-threatening airborne disease, such as TB, but you are not aware that the client is infected.
Bloodborne Exposure Procedure
All results of blood work will be received by ordering physician and reported to Public Health Unit.
If patient refuses to give sample, get your baselines and initiate a bill 105 application with Public health Unit (where patient resides).
If possible, attend same facility as source patient, the SDO will attempt voluntary consent for source patient bloodwork via attending physician.
Seek immediate medical attention, contact the SDO via communications and document the incident for worker’s compensation.
You come into contact with blood or body fluids of a patient, and you wonder if that patient is infected with life-threatening bloodborne disease such as HIV and/or HBV and/or HCV.
Self Study Suggestions
hUnderstand difference between bloodborne (HIV, Hep B, Hep C etc.) vs droplet (SARS, Meningitis, influenza etc.) exposures vs airborne transmission types
hReview Antibiotic Resistant Organisms (ARO’s) MRSA, VRE, ESBL’s, C-Difficile etc.
hReview known treatments of all aforementioned diseases
Self Study Suggestions cont...
hUnderstand difference between Meningococcal Disease and other Meningitis causing organisms
hUnderstand difference between Active Pulmonary T.B. versus Inactive or other site T.B.
hReview known treatments of all aforementioned diseases
Self Study Suggestions cont...
hReview applicable legislation
hBill 105, Bill 31, DO program
hReview patient confidentiality laws
hBill 105 application process
Exposure Risk Review
• Needle stick ? Needle type / function?• Uncooperative pt spits in face?• Blood splash in eyes?• Febrile, coughing pt in close quarters?• What about the driver? Families ?• Normal pt care duties?• To determine exposure, does pt’s disease
status matter?• How do you contact the DO??????
SOBERING REALITY
hPhiladelphia FD (2/3 size of TFS) have 200+ Hep.C positive firefighters
hMedical PPE use vs. SCBA use? Think 30 years ago (SCBA use) vs. 30 years from now (medical PPE use)?
Captain Randy Gwyn R.N., I.C.P.Captain Randy Gwyn R.N., I.C.P.Program DeveloperProgram Developer
Captain Bill Sault BA, ACPCaptain Bill Sault BA, ACPProgram ManagerProgram Manager
Questions ?