Transport of Patients with Highly Hazardous Communicable Diseases

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Your crew arrives on scene to a call dispatched as a “sick person.” They find a 35-year-old male who recently returned from Saudi Arabia and is complaining of feeling unwell and has a cough. What measures can be taken by the crew to protect themselves and minimize exposure to others?

Emergency responders should adopt an identify, isolate, and inform strategy to ensure that they are aware of communicable disease hazards in their work environment and have a procedure to respond safely. To assist with identification of hazards, call centers can screen for travel history and signs and symptoms of highly hazardous communicable diseases (HHCD). Emergency responders can also screen patients. This strategy will help to identify patients at risk for having an HHCD. In this case, recent travel to the Arabian Peninsula, together with illness and cough, raises concern for Middle Eastern respiratory syndrome. Once this risk is identified , the patient should be isolated, meaning care should be taken to prevent unprotected exposure by other personnel. The patient should be asked to wear a surgical mask and responders who need to interact with the patient should don appropriate personal protective equipment (PPE). Informing supervisory personnel, the receiving facility, and local public health authorities will allow for safe transport of the patient to an appropriate facility and allow staff time to prepare for the patient’s arrival.

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You need to transport a patient who has screened positive for travel to a country with widespread transmission of Ebola virus disease. He has been having fever, nausea, vomiting, and diarrhea. What can you do to modify the ambulance to protect its environmental surfaces from contamination and the treatment team from unnecessary exposure?

When transporting a patient with confirmed or suspected HHCD, a hierarchy of controls must be implemented, which include environmental modifications, administrative policies and work practices, and appropriate use of safety equipment. The driver compartment of the ambulance should be isolated from the patient compartment to reduce likelihood of contamination. A positive-pressure environment can be created in the driver compartment using the ventilation system. The ventilation system in the driver compartment should be put in non-recirculating mode with the fan on high. The ventilation system in the back of the ambulance should not recirculate air and the exhaust fan should be set on high. This should maintain appropriate air exchange in the patient compartment.

The interior of the vehicle should be prepared to minimize exposure of environmental surfaces and equipment and to facilitate cleaning and disinfection following the mission. Various methods have been used to envelop the interior of the patient compartment with impervious barriers to protect against contamination of surfaces ( Fig. 81.1 ). This is especially important for patients who pose a high risk for sharing infectious bodily fluids through active bleeding, vomiting, or diarrhea. The stretcher can be protected with an impervious sheet, and essential medical equipment can be placed in a clear plastic bag.

Patients may also be asked to wear a disposable undergarment to capture diarrhea and may be asked to wear a coverall to protect the healthcare worker from draining wounds or contaminated clothing. If they are unable to comply, impervious sheets may be used to envelop the patient during transport. A patient isolation unit may be employed as an environmental control if feasible.

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