Infectious

2-5-a. General Infectious Disease Guidelines

For patients transported with suspected infectious diseases and a recent travel history, early notification of the receiving hospital is important so that appropriate isolation precautions may be prepared. Use of appropriate Personal Protective Equipment and following infectious disease protocols will help protect EMS providers and their subsequent contacts from infections.

These precautions include:

1) Routine use of gloves, and frequent hand washing.

2) Use of anti-bacterial hand cleansers before and after patient contact.

3) Avoidance of contact of hands to face.

4) Barrier protection from bodily fluids (gloves, gowns, boot covers).

5) Careful removal of protective equipment is necessary to minimize infection risk after patient contact.

6) Eye protection from fluids or droplets.

7) Mouth and nose protection from inhaled pathogens (surgical mask on patient, N-95 mask on EMS provider).

8) Personal immunization for healthcare workers against appropriate infectious diseases is highly recommended.

2-5-b. Sepsis

1) If the patient is suspected of having an infection, with ≥ 2 of these:

a) HR > 100 bpm

b) Temp > 100°F or rigors (shaking chills)

c) SBP < 100 mmHg

d) RR > 20 per minute

e) Altered Mental Status / Delirium / Confusion / Agitation

2) Then sepsis is possible and you should:

a) Supplemental oxygen to O2 sat = 95-98%

b) IV NS 15 cc/kg up to a 1 liter bolus. This may be repeated once if SBP remains < 90 mmHg systolic.

c) Monitor vitals, and recheck lung sounds after every 500 cc of fluid infusion.

d) ETCO2 monitoring

3) Does the patient have any one (1) of the following toxic signs?

a) HR > 130 bpm

b) SBP < 90 mmHg

c) RR > 30 per minute

d) ETCO2 ≤ 25 mmHg

4) Then Severe Sepsis or Septic Shock is likely. Mortality Risk 20 – 50%, and you should:

a) Give IV NS 30 cc/kg or up to 2 liters total.

b) Notify receiving ED of suspected septic shock so they can prepare for blood cultures and antibiotics on arrival.