Ebola

The following is the most current information we have regarding Ebola.  Links to the original documents have been included at the top of this page.

The updated PPE guidance for confirmed Ebola patients can be found on CDC’s website: http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html.
CDC’s PPE guidance for clinically stable persons under investigation for Ebola can be found here: http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html

The CDC’s FAQ Page

Ebola EMS Agency Memo (18 December 2015)

Ebola Advisory (18 December 2015)

St Lukes Cornwall Hospital – Ebola Patient Arrival Instructions

CDC EMS Ebola Checklist

CDC Ebola Screening for EMS

County Of Dutchess Memo to First Responders

Original Document: Ebola Notification

Original Document: Ebola Guidance

Original Document: Ebola REMAC Advisory – Current as of 25 October 2014

Original Document: Ebola Advisory from NYS DOH – Current as of 8 December 2014

For the most up-to-date information from the New York State Department of Health (10/15/2014):

http://www.health.ny.gov/diseases/communicable/ebola/#ems_providers

August 2, 2014
TO: Healthcare providers, Hospitals, Local Health Departments

FROM: NYSDOH Bureaus of Communicable Disease Control (BCDC) and Healthcare Associated
Infections (BHAI)
HEALTH ADVISORY: GUIDELINES FOR EVALUATION OF U.S. PATIENTS SUSPECTED OF HAVING EBOLA VIRUS DISEASE
(CDC HAN 364)

For healthcare facilities, please distribute immediately to infectious disease specialists,
intensive care physicians, primary care physicians, hospital epidemiologists, infection control
professionals, hospital administration, emergency departments, microbiology laboratories, and all
patient care areas.
On August 1, 2014, the Centers for Disease Control and Prevention (CDC) issued HAN 364: Guidelines
for Evaluation of US Patients Suspected of Having Ebola Virus Disease (EVD). The purpose of this
CDC HAN is to update guidelines for Ebola virus disease patient evaluation, to clarify specimen
collection, and to provide guidance for infection control. The HAN is attached in its entirety
below and can also be accessed at http://www.bt.cdc.gov/han/han00364.asp.

Heathcare providers who are evaluating patients with suspected Ebola virus disease should
immediately contact the Local Health Department where the patient resides.

Further questions should be appropriately directed to the Bureau of Communicable Disease Control at
518-473-4439 or the Bureau of Healthcare Associated Infection’s Healthcare Epidemiology and
Infection Control (HEIC) program at 518-474-1142.

This is an official CDC HEALTH ADVISORY

Distributed via the CDC Health Alert Network August 1, 2014 20:00 ET (8:00 PM ET) CDCHAN-00364

Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease
Summary

The Centers for Disease Control and Prevention (CDC) continues to work closely with the World
Health Organization (WHO) and other partners to better understand and manage the public health
risks posed by Ebola Virus Disease (EVD). To date, no cases have been reported in the United
States. The purpose of this health update is 1) to provide updated guidance to healthcare providers
and state and local health departments regarding who should be suspected of having
EVD, 2) to clarify which specimens should be obtained and how to submit for diagnostic testing, and
3) to provide hospital infection control guidelines.

U.S. hospitals can safely manage a patient with EVD by following recommended isolation and
infection control procedures. Please disseminate this information to infectious disease
specialists, intensive care physicians, primary care physicians, hospital epidemiologists,
infection control professionals, and hospital administration, as well as to emergency departments
and microbiology laboratories.

Background

CDC is working with the World Health Organization (WHO), the ministries of health of Guinea,
Liberia, and Sierra Leone, and other international organizations in response to an outbreak of EVD
in West Africa, which was first reported in late March 2014. As of July 27, 2014, according to WHO,
a total of 1,323 cases and 729 deaths (case fatality 55-60%) had been reported across the three
affected countries. This is the largest outbreak of EVD ever documented and the first recorded in
West Africa.

EVD is characterized by sudden onset of fever and malaise, accompanied by other nonspecific signs
and symptoms, such as myalgia, headache, vomiting, and diarrhea. Patients with severe forms of the
disease may develop hemorrhagic symptoms and multi-organ dysfunction, including hepatic damage,
renal failure, and central nervous system involvement, leading to shock and death. The fatality
rate can vary from 40-90%.

In outbreak settings, Ebola virus is typically first spread to humans after contact with infected
wildlife and is then spread person-to-person through direct contact with bodily fluids such as, but
not limited to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8– 10
days (ranges from 2–21 days). Patients can transmit the virus while febrile and through later
stages of disease, as well as postmortem, when persons touch the body during funeral preparations.

Patient Evaluation Recommendations to Healthcare Providers

Healthcare providers should be alert for and evaluate suspected patients for Ebola virus infection
who have both consistent symptoms and risk factors as follows: 1) Clinical criteria, which includes
fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms
such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained
hemorrhage; AND 2) Epidemiologic risk factors within the past 3 weeks before the onset of symptoms,
such as contact with blood or other body fluids of a patient known to have or suspected to have
EVD; residence in—or travel to—an area where EVD transmission is active; or direct handling of
bats, rodents, or primates from disease-endemic areas. Malaria diagnostics should also be a part of
initial testing because it is a common cause of febrile illness in persons with a travel history to
the affected countries.

Testing of patients with suspected EVD should be guided by the risk level of exposure, as described
below:

CDC recommends testing for all persons with onset of fever within 21 days of having a high-risk
exposure. A high-risk exposure includes any of the following:

• percutaneous or mucous membrane exposure or direct skin contact with body fluids of a person
with a confirmed or suspected case of EVD without appropriate personal protective equipment (PPE),
• laboratory processing of body fluids of suspected or confirmed EVD cases without appropriate
PPE or standard biosafety precautions, or
• participation in funeral rites or other direct exposure to human remains in the geographic
area where the outbreak is occurring without appropriate PPE.

For persons with a high-risk exposure but without a fever, testing is recommended only if there are
other compatible clinical symptoms present and blood work findings are abnormal (i.e.,
thrombocytopenia <150,000 cells/µL and/or elevated transaminases) or unknown.

Persons considered to have a low-risk exposure include persons who spent time in a healthcare
facility where EVD patients are being treated (encompassing healthcare workers who used appropriate
PPE, employees not involved in direct patient care, or other hospital patients who did not have EVD
and their family caretakers), or household members of an EVD patient without high-risk exposures as
defined above. Persons who had direct unprotected contact with bats or primates from EVD-affected
countries would also be considered to have a low-risk exposure.
Testing is recommended for persons with a low-risk exposure who develop fever with other symptoms
and have unknown or abnormal blood work findings. Persons with a low-risk exposure and with fever
and abnormal blood work findings in absence of other symptoms are also recommended for testing.
Asymptomatic persons with high- or low-risk exposures should be monitored daily for fever and
symptoms for 21 days from the last known exposure and evaluated medically at the first indication
of illness.

Persons with no known exposures listed above but who have fever with other symptoms and abnormal
bloodwork within 21 days of visiting EVD-affected countries should be considered for testing if no
other diagnosis is found. Testing may be indicated in the same patients if fever is present with
other symptoms and blood work is abnormal or unknown. Consultation with local and state health
departments is recommended.

If testing is indicated, the local or state health department should be immediately notified.
Healthcare providers should collect serum, plasma, or whole blood. A minimum sample volume of 4 mL
should be shipped refrigerated or frozen on ice pack or dry ice (no glass tubes), in accordance
with IATA guidelines as a Category B diagnostic specimen. Please refer to

http://www.cdc.gov/ncezid/dhcpp/vspb/specimens.html for detailed instructions and a link to the
specimen submission form for CDC laboratory testing.

Recommended Infection Control Measures

U.S. hospitals can safely manage a patient with EVD by following recommended isolation and
infection control procedures, including standard, contact, and droplet precautions. Early
recognition and identification of patients with potential EVD is critical. Any U.S. hospital with
suspected patients should follow CDC’s Infection Prevention and Control Recommendations for
Hospitalized Patients with Known or Suspected Ebola Hemorrhagic Fever in U.S. Hospitals
(http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html). These
recommendations include the following:

• Patient placement: Patients should be placed in a single patient room (containing a private
bathroom) with the door closed.
• Healthcare provider protection: Healthcare providers should wear: gloves, gown (fluid
resistant or impermeable), shoe covers, eye protection (goggles or face shield), and a facemask.
Additional PPE might be required in certain situations (e.g., copious amounts of blood, other body
fluids, vomit, or feces present in the environment), including but not limited to double gloving,
disposable shoe covers, and leg coverings.
• Aerosol-generating procedures: Avoid aerosol-generating procedures. If performing these
procedures, PPE should include respiratory protection (N95 filtering facepiece respirator or
higher) and the procedure should be performed in an airborne isolation room.
• Environmental infection control: Diligent environmental cleaning and disinfection and safe
handling of potentially contaminated materials is paramount, as blood, sweat, emesis, feces and
other body secretions represent potentially infectious materials. Appropriate disinfectants for
Ebola virus and other filoviruses include 10% sodium hypochlorite (bleach) solution, or
hospital-grade quaternary ammonium or phenolic products. Healthcare providers performing
environmental cleaning and disinfection should wear recommended PPE (described above) and consider
use of additional barriers (e.g., shoe and leg coverings) if needed. Face protection (face shield
or facemask with goggles) should be worn when performing tasks such as liquid waste disposal that
can generate splashes. Follow standard procedures, per hospital policy and manufacturers’
instructions, for cleaning and/or disinfection of environmental surfaces, equipment, textiles,
laundry, food utensils and dishware.

Recommendations to Public Health Officials

If public health officials have a patient that is suspected of having EVD or has potentially been
exposed and intends to travel, please contact CDC’s Emergency Operations Center 1 (770) 488-7100.

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by
preventing and controlling diseases and injuries; enhances health decisions by providing credible
information on critical health issues; and promotes healthy living through strong partnerships with
local, national and international organizations.
DEPARTMENT OF HEALTH AND HUMAN SERVICES

Ebola Guidance: New York State Bureau of EMS and Trauma Services Statment

August 8, 2014

To: All NYS EMS Agencies and Personnel From: Bureau of Emergency Medical Services Re: Recent
Ebola Concerns
The New York State Department of Health (NYSDOH) Bureau of Emergency Medical Services (BEMS) has
been closely monitoring the most recent outbreak of Ebola in Africa and the potential for
transmission of the virus to citizens in the State of New York.

NYSDOH BEMS has been working closely with the New York City Department of Health and Mental Hygiene
(NYCDOHMH), the Center for Disease Control and Prevention (CDC), the Fire Department of New York
City (FDNY) as well as other state and national entities.

As of the date of this letter, there have been no confirmed cases of Ebola in the State of New
York. However, EMS providers and agencies must be vigilant in their daily operations to assure that
they are prepared for potential cases of Ebola and any other communicable diseases they may
encounter. With this in mind, BEMS is issuing this guidance document and attached documents to
provide EMS with the most up-to-date information we have.

The NYC Regional EMS Council (NYC REMSCO) has already had an EMS protocol approved by NYSDOH BEMS
for Acute Febrile Respiratory Illness, Including Influenza-Like-Symptoms. This protocol contains
concise information that should be utilized everyday by EMS for any potential communicable disease,
including Ebola. The NYC REMSCO has updated their information to now include Ebola. BEMS strongly
encourages EMS providers and agencies to review the attached information so they have a better
understanding of patient symptoms as well as what is needed and not needed to appropriately treat
the patient and protect themselves.

Important items to remember:

• Vigilant usage of standard PPE is crucial in your daily operations,
• Assuring EMS personnel have been properly fit tested and/or provided the proper N95 mask and
other PPE such as goggles, shoe covers, suits, etc.,
• Placing a surgical type mask on the patient if the patient’s condition allows for its usage,
• Questioning patients on any recent travel outside of the state or contact with others who have
traveled to parts of the world where an outbreak is currently happening,
• Utilization of respiratory devices with one-way-valves for the delivery of nebulized
medications, etc.,
• Timely notification to the hospital that you are transporting a patient with signs and
symptoms of potential communicable disease. This will provide the hospital the ability to prepare
resources and determine where and how the patient will enter their facility,
• Assuring proper disposal or cleaning of PPE, patient linens and any other equipment utilized
during the call.
• Hospitals and the EMS agencies who are contracted to provide transport of patients to other
healthcare facilities should be communicating with each other to develop policies and procedures
concerning the transfer of these patients with unconfirmed or confirmed communicable diseases.
The CDC is continuously providing updates on the current situation world-wide, as well as providing
healthcare workers with pertinent information to protect themselves and to better treat their
patients. BEMS encourages all EMS personnel to monitor the CDC web site for the most up-to-date
information at: http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-
recommendations.html.
BEMS is also monitoring the recent developments regarding the Middle East Respiratory Syndrome
(MERS). The most up-to-date information on MERS can be found at
http://www.cdc.gov/coronavirus/MERS/US.html.

The BEMS will continue to provide updated information on our web site at
http://www.health.ny.gov/professionals/ems/ and through email correspondences as they are
warranted.

 

THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
NYC REMAC
Advisory No. 2014-06
Title: Ebola hemorrhagic fever (Ebola HF) General Information for EMS Personnel
Issue Date: August 7, 2014 Effective Date: Immediate
Re-Issued:
Supercedes: N/A Page: 1 of 2
The Regional Emergency Medical Advisory Committee (REMAC) of New York City created General
Operating Procedure: Acute Febrile Respiratory Illness, Including Influenza-Like-Illness (ILI) in
2009.
Currently, as a precaution due to the outbreak of Ebola HF in Guinea, Liberia, Sierra Leone, and
Nigeria, EMS Personnel must review this protocol (attached).
EMS providers should refer to General Operating Procedure: Acute Febrile Respiratory Illness,
Including Influenza-Like-Illness (ILI), whenever they encounter patients as described below:

1. Patient with fever of greater than 101.5 degrees Fahrenheit, and additional symptoms such as
severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND
2. Within the past 3 weeks before the onset of symptoms:
a. Contact with blood or other body fluids of a patient known to have or suspected to have Ebloa
HF, OR
b. Has traveled to an area where Ebola HF transmission is active, OR
c. Is a person (or had contact with a person) who has direct handling of bats, rodents, or
primates from disease-endemic areas.
Attachments:
• NYC DOHMH Outpatient Ebola guidance_8 6 14
• NYSDOH Ebola HF Notification_17047
Current and Updated Protocols can be accessed at the Regional EMS Council website:
www.nycremsco.org. Owners/operators of Ambulance and ALS First Response Services providing
prehospital medical treatment within the five boroughs of the City of New York are responsible to
provide copies of the NYC REMAC Prehospital Treatment Protocols to their personnel, and to ensure
that Service Medical Directors and EMS personnel are informed of all changes/updates to the NYC
REMAC Prehospital Treatment Protocols.
Lewis W. Marshall, Jr., MD, JD Marie C. Diglio ,EMT-PChair, Executive Director Operations
Regional Emergency Medical Advisory Committee Regional Emergency Medical Services
Council of New York City of New York City
THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
Ebola hemorrhagic fever (Ebola HF) – General Information for EMS Personnel

Ebola hemorrhagic fever (Ebola HF), also known as Ebola Viral Disease (EVD), is one of numerous
Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates
(such as monkeys, gorillas, and chimpanzees). Ebola HF is characterized by sudden onset of fever
and malaise, accompanied by other nonspecific signs and symptoms, such as myalgia, headache,
vomiting, and diarrhea. Patients with severe forms of the disease may develop hemorrhagic symptoms
and multi-organ dysfunction, including hepatic damage, renal failure, and central nervous system
involvement, leading to shock and death. The fatality rate can vary from 40-90%.

Ebola is spread person-to-person through direct contact with bodily fluids such as, but not limited
to, blood, urine, sweat, semen, and breast milk. The incubation period is usually 8–10 days
(ranges from 2–21 days). Patients can transmit the virus while febrile and through later stages of
disease, as well as postmortem, when persons touch the body during funeral preparations.

EMS Providers and Agencies should have decontamination procedures for personnel and vehicles in
place. This includes the disposal of used PPE, linens and decontamination of the interior of the
ambulance. PPE should be maintained during decontamination of the ambulance and equipment.
Additional Educational Resources:
Please review the information provided at the following web sites:
• http://www.nyc.gov/html/doh/html/em/ebola.shtml
• http://www.cdc.gov/vhf/ebola/prevention/index.html
• http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html
• http://www.cdc.gov/HAI/prevent/ppe.html
• http://www.cdc.gov/vhf/ebola/index.html
Regional Emergency Medical Advisory Committee
Advisory 2014-06
New York City
Page 2 of 3
THE REGIONAL EMERGENCY MEDICAL SERVICES COUNCIL OF NEW YORK CITY, INC.
Ebola hemorrhagic fever (Ebola HF) – General Information for EMS Personnel

ACUTE FEBRILE RESPIRATORY ILLNESS, INCLUDING INFLUENZA-LIKE-ILLNESS (ILI)
In the event that a competent authority determines that a severe communicable respiratory illness
[acute febrile respiratory illness, including influenza-like-illness (ILI)] is being transmitted in
the New York City region:
1. The safety of both the EMS crew and public is paramount. Do not endanger yourselves or others.
2. EMS personnel shall wear appropriate Personal Protective Equipment (PPE), which includes an N95
respirator, gloves and eye protection.
• Fit-tested N-95 respirators, eye protection (goggles or face shields), and gowns should
ALWAYS be worn by EMS personnel performing aerosol-generating procedures on patients with febrile
respiratory illness
• Aerosol-generating procedures include nebulized treatments, intubation, tracheal suctioning,
and laryngoscopy performed on patients with acute febrile respiratory illness
3. If possible, a surgical mask should be placed on the patient to contain droplets during
coughing.
4. Oxygen delivery with a non re-breather face mask may be used to provide oxygen support during
transport.
5. In addition, the following shall be implemented:
▪ Administration of nebulized (aerosolized) medications (e.g., Albuterol) may only be done via a
nebulizer with a one-way valve or via a disposable metered dose inhaler (MDI) with spacer.
▪ As an alternative, epinephrine IM (including via an epinephrine auto-injector for BLS providers)
should be considered as a Medical Control Option.
▪ Endotracheal intubation may continue (unless otherwise notified through a separate class order),
but it is preferable to use a Bag Valve Mask when assisted ventilation is required.
▪ ONLY the patient is to be transported in the ambulance (i.e., no other individuals besides the
crew) unless the patient is a minor, in which case parents or guardians may accompany the patient,
but should also wear a surgical mask.
▪ When possible, an attempt should be made to notify healthcare facilities in advance that they are
receiving a patient with suspected communicable respiratory illness.

NOTE: THIS PROTOCOL SHALL NOT BE UTILIZED UNLESS ACTIVATED BY NYC REMAC AND/OR THE FDNY OFFICE OF
MEDICAL AFFAIRS
Regional Emergency Medical Advisory Committee
Advisory 2014-06
New York City
Page 3 of 3

New York City Department of Health and Mental Hygiene
BACKGROUND: Several outbreaks of Ebola virus disease (EVD) are occurring in parts of West Africa.
On
August 1, 2014, Centers for Disease Control and Prevention (CDC) released a health advisory with
guidelines for the evaluation of patients presenting to a health care setting and suspected of
having Ebola virus disease (EVD) (http://emergency.cdc.gov/han/han00364.asp).
SYMPTOMS AND RISK FACTORS: Fever greater than 38.6° Celsius (101.5⁰F), and travel to or residence
in an affected country within 3 weeks prior to symptom onset. Currently involved countries are
Guinea, Sierra Leone, and Liberia; check CDC travel notification website for most up to date
information: http://wwwnc.cdc.gov/travel/notices ).

WHAT TO DO IF YOU HAVE A SUSPECT PATIENT:

1. For any ill patient reporting recent travel (3 weeks prior to onset of symptoms)to an area
with ongoing EVD transmission as mentioned above
a. Screen upon presentation and immediately place patient in a private room with closed door
b. Provide the patient with surgical mask and demonstrate proper use
c. Minimize number of staff interacting with the patient
d. Staff interacting with the patient should follow standard, droplet, and contact precautions
(http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control- recommendations.html).
e. Call the NYC Health Department for consultation (Provider Access Line: 1-866-692-3641) to
determine if further evaluation is needed
2. When you call the NYC Health Department, be prepared to:
a. Describe the patient’s risk factors and travel history, including contact with sick patients
in areas with ongoing EVD transmission
b. Describe the patient’s presenting symptoms, signs, and duration of illness
3. When you call the NYC Health Department, you can expect:
a. Doctor on call will discuss the case and possible recommendations for testing
b. Doctor on call will provide consultation on need to transport the individual to a hospital for
further workup and testing
c. Doctor on call will assist to arrange transport to another medical facility if needed
4. Do NOT refer patients to Emergency Department, hospital, or other facility without consulting
the NYC Health Department by calling the Provider Access Line at 1-866-692-3641

ADDITIONAL INFORMATION:
http://www.nyc.gov/html/doh/html/em/ebola.shtml
http://www.cdc.gov/vhf/ebola/index.html
EBOLA GUIDANCE DOCUMENT: Evaluation of patients presenting to primary care, urgent care, or
other outpatient settings with signs, symptoms, and travel history concerning for Ebola virus
disease
August 8, 2014
Student/Staff Guidance Document Version

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