Severe Acute Respiratory Syndrome (SARS) ALERT:
Consistent with the National Association of Emergency Medical Technicians commitment to work towards creating the safest work environment possible for EMS members, we issue this position paper and alert about the emerging Severe Acute Respiratory Syndrome. This information is drawn from multiple sources including but not limited to:
  • General and Scientific Media
  • The Centers for Disease Control
  • The World Health Organization
At this time, the cause of SARS is not conclusively known. Public health and other medical authorities reportedly believe it is likely a virus, nevertheless this has yet to be confirmed. National and international surveillance, laboratory testing and collaboration are underway. As of this morning the World Health Organization reports more than 1300 patients worldwide affected by this malady. To date, more than 50 deaths have been reported. The CDC reports that these cases span the globe and include the US and Canada.
The Province of Ontario, Canada has declared a public health emergency and of particular note is the quarantine of twenty-two Paramedics. In addition, three paramedics are hospitalized with suspected SARS.
Severe Acute Respiratory Syndrome (SARS) Interim Case Definition
Suspected Case:
Respiratory illness of unknown etiology with onset since February 1, 2003, and the following criteria:
  • Measured temperature >100.4 °F (>38° C)
  • One or more clinical findings of respiratory illness (e.g. cough, shortness of breath, difficulty breathing, hypoxia, or radiographic findings of either pneumonia or acute respiratory distress syndrome)
  • Travel within 10 days of onset of symptoms to an area with suspected or documented community transmission of SARS (see list below; excludes areas with secondary cases limited to healthcare workers or direct household contacts)
Multiple cases of suspected Severe Acute Respiratory Syndrome (SARS) have occurred in healthcare personnel, including Paramedics who had cared for patients with SARS.
During the course of the investigation, CDC has received anecdotal reports that aerosol-generating procedures may have facilitated transmission of the etiologic agent of SARS in some cases. Procedures that induce coughing can increase the likelihood of droplet nuclei being expelled into the air these potentially aerosol-generating procedures include aerosolized.
medication treatments (e.g., albuterol), diagnostic sputum induction, bronchoscopy, airway suctioning, and endotracheal intubation. For this reason, healthcare personnel should ensure that patients have been evaluated for SARS before initiation of aerosol-generating procedures.
Evaluation for SARS should be based on the most recent case definition for SARS. Aerosol-inducing procedures should be performed on patients who may have SARS only when such procedures are deemed medically necessary. These procedures should be performed using airborne precautions as previously described for other infectious agents, such as Mycobacterium tuberculosis; Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Facilities.
Recommended Protective Practices for EMT's/Paramedics Rendering Care to Suspected SARS Patients
  • Standard universal/body fluid precautions should be exercised when providing patient care to all patients, consistent with existing standards of operation.
  • Protective examination gloves should be worn when caring for patients where there is risk of exposure to blood or body fluids.
  • The N95 Particulate Respirator Mask should be used when managing patients who present with high fever, signs and symptoms of respiratory illness and history of travel/contact with a known case of SARS.
  • N95 Particulate Respirator Mask should be placed on the suspected patient whenever possible. EMS providers are reminded to consult and adhere to local protocols for respiratory distress patients. Oxygen administration should not be withheld in lieu of use of protective mask.
  • Safety eye-wear should be worn whenever there is any risk of splashing of blood or body fluids.
  • Infection control gowns should be worn if there is risk of contamination of clothing or exposed skin by blood or body fluids.
  • Hand washing with soap and water or using an alcohol-based hand cleanser should be done immediately following any patient contact and frequently during your tour of duty.
Standard surgical masks do not afford the same level of protection as a N95 Particulate Respirator, because they filter less than 50% of airborne particles that are 1-5 microns in size and have marked leakage because of loose facial seals.
Bio-hazardous waste, (dressings, bandages, gloves, masks, gowns, gloves, contaminated sheets, etc.) are to be placed in an appropriate biohazard waste receptacle, following applicable biohazard waste protocol and disposed of according to local EMS and public health policy.
Infection Control Precautions
Guidelines for Preventing the Transmission of Mycobacterium tuberculosis
Upon completion of an assignment involving a suspected SARS patient, EMT's and Paramedics should decontaminate the vehicle, stretcher and equipment used during the call in accordance with local EMS and public health policy, prior to returning to service and encountering additional patients.
References:
POSITION STATEMENT: http://www.naemt.org
WHO Website
CDC SARS Website

 

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