It is possible for ballistic particles to be carried back to your home on your uniform. Wearing a gown when in contact with potentially infectious persons and storing your uniforms at work until it is time to launder them are two strategies to keep your families free from infectious contacts. When bringing laundry home, it should be carried, not worn, and separated from other clothing using a laundry bag or other such container. Remember that boots are seldom cleaned and are often exposed to the same contamination as your uniform clothing – they are best left at work. While it is relatively safe to launder your clothing at home, leaving contaminated clothing to the laundry pile may result in members of your family coming into contact with any substances on your clothing. The time that soiled clothing spends in the home should be minimized.

In the pre-hospital context, a disposable N95 will last for the duration of a single patient contact. The manufacturer suggests that a mask will provide protection until it becomes wet, soiled, oil saturated or crushed. However, once a mask comes into contact with a source of infection, the pores of the filter become contaminated. To re-use a mask from patient to patient may provide a vector for disease transfer. Since all pre-hospital patient contacts that meet the screening criteria are considered to be infectious, each new patient contact must be met with a fresh mask.

Think of the five ‘Right’s of mask application: The right mask on the right person for the right reason at the right time in the right manner.

  A surgical mask should be worn whenever you are within 2 meters of a suspect

ILI/H1N1 patient. A surgical mask may also be placed over the nose and mouth of a patient with

ILI/H1N1 symptoms. This mask may also be placed over an oxygen delivery device such as nasal prongs or NRB.

N95 masks must be worn when providing a nebulized therapy such as a Ventolin treatment, when dealing with airway secretions as in suctioning, when providing airway management using an adjunct (OPA, NPA, ETT or KingLT) and/or providing assisted ventilations (using a BVM).

When in doubt you may elect to wear an N95 mask. If you feel a mask is required then a gown, goggles, and gloves are also required.

For the purpose of a field response to a patient with ILI symptoms it is acceptable to default to wearing an N95 mask.

There are three particle sizes that may act as vectors for the flu:   Very small particles carried in the breath of an infected person dissipate

rapidly into the air and become diluted the further they get from their host.

  Medium sized particles may be carried forward by a sneeze or cough.

These larger particles are affected by gravity and fall out of the air the further they get from the source of their introduction into the air.

  Large particles, known as ballistic particles, also result from a cough or

sneeze but are transferred directly onto a surface such as a tabletop, item of clothing or hand. These particles may survive for some time outside a host and can be re-transferred through direct contact to other surfaces. To infect someone, however, the particles must be carried from the contaminated surface to close proximity to the nose or mouth where they are inhaled.

The 2 meter rule (also known as staying at handshake distance) keeps you outside the direct transmission range of an infected person’s breath, outside the ‘spray’ range of a cough or sneeze and away from the reach of someone who may have contaminated particles on their skin or clothing. In addition to the 2 meter rule, frequent hand washing and application of PPE will reduce your likelihood of bringing infectious particles into the range of your respiratory pathways.

This depends on your frequency of contact with potentially infected surfaces. At a minimum you should clean your hand following use of the washroom facilities, before eating or touching your nose/mouth, after touching someone else’s hands, clothing or a surface that may have come into contact with ballistic particles. In the pre-hospital care environment you should perform hand hygiene following administration of any therapy and after removing gloves or any other item of PPE.

Right now YCDC advocates that you return to work no sooner than 7 days after the onset of symptoms or 24 hours after all symptoms have disappeared – whichever is greater.

Any cleaning solution or soap is sufficient to clean surfaces that have become contaminated. It is more important to disturb the particles than to disinfect them. There is no ‘best’ cleaning product to deal with H1N1 or flu transmitting particles. Frequent, diligent cleaning is the key.

Screening should have been provided by Central Dispatch or a Community Nurse prior to EMS’ contact with a potentially infectious person. If symptoms are suspected upon your arrival, the following questions may be employed to screen the patient:

Is there evidence of a respiratory illness? (Shortness of breath, new cough or fever?)AND

Is there a report of a sore throator weaknessor excessive fatigue or joint pain or muscle pain?AND/OR

Is there a recent history of contact with another person who has any of the above symptoms?

We will be fit testing all YEMS staff for N95 masks. Following the fit testing, all ambulances and YEMS vehicles will be supplied with ‘pre-loads’ of PPE. Each pre-load contains the PPE required for one attendant for one patient call.

Once all the ambulances are supplied to the same level, every community station will receive a blue plastic container containing resupplies for the ambulance pre-loads. Initially every station will receive the same supply but more can be requested as individual communities use the PPE that has been supplied.

It is unlikely that all communities will be impacted by H1N1 to the same level. We must centralize our stores with a plan to rapidly deploy them to wherever they may be needed. Pre-loads of PPE containing 10 patient contact’s worth of PPE will be available for priority shipping.

Call 811. The nurse on call (Telehealth) will screen the symptoms that are presenting and will guide you as to the next steps. Not everyone needs to )or should) be seem by a Community Nurse or a Doctor. Mild cases of H1N1/IlI will be cared for outside of medical institutions. Only moderate to severe cases will be asked to seek medical attention.

The following are good websites for information:Council of Canadian Academics: www.scienceadvice.comPublic Health and Safety Canada: www.phac-aspc.gc.caYukon Health and Social Services: www.hss.gov.yk.caOR811 – Telehealth Nurse on Call

The YEMS Pandemic Representative is:

Jeff SimonsJeff.Simons@gov.yk.ca jeffsimons@kos.net Cell: 867 334 8851