Transcript High Risk Infectious Disease Response Team

High Risk Infectious Disease
Response Team
Patrick Auger BHSc, MEmgt, MEd(c) CCP
Introduction & Background
2
Population & Call Volume
• 13,678,740
• 38.5%
of Canada’s
Population
• Approximately
21 000
calls for service per
year
page 3
Introduction & Background
page 4
Scope of Practice
Adult/Pediatric and Obstetrical Critical Care
Transport.
Example of skill set
• Rapid Sequence Intubation
• Difficult & Advanced Airway Management &
Tools (Air-traq, Bougie, Needle Cric etc.)
• Mechanical Ventilation
• Needle thoracostomy
• Intravenous, Intraosseous, umbilical vein
catheterization
• Gastric tubes and foley catheters
• Gastroesphageal balloon monitoring
• Chest Drainage Systems
• X-ray, Lab, 12 interpretation
• Arterial/central line maintenance & monitoring
• Transcutaneous & Transvenous pacing
• Blood product administration
Emergency Medical Assistance
Team & Paramedics
page 6
CBRN Trained Paramedics
page 7
EVD outbreak in West Africa
• 1st
cases notified in
march 2014
8th WHO
declared a Public
Health Emergency of
International concern.
• August
page 8
Ebola Virus Disease (EVD)
•
A severe, often fatal illness
•
Transmitted to people from wild animals and spreads
through human to human transmission
•
Average EVD case fatality rate is around 50%. Varied
from 25% to 90% in past outbreaks
page 9
What were we asked to do….
•
Transport confirmed EVD cases that required
advanced or critical care.
page 10
PPE Training
Donning Requirements
• Fit Tested N95
• Goggles
• Face shield
• Hood
• Full body barrier protection
• Double Gloves
Challenges of fit
page 11
PPE Training
Doffing Requirements
• Prevention of cross
contamination
•
Safety Officer with
Checklist
Step by step process to
remove PPE under the
direction of a safety Officer
page 12
Validating Training
page 13
Challenges of PPE
for Paramedics
Heat Stress
• Inside the suit is a
microenvironment
•
•
•
•
Inside Temperature
Humidity
Air currents
Work Rest Cycles
Donning
Patient
Care
Rest
Increased metabolic work
Doffing
•
Reduction in speed,
thought and alertness
page 14
Modification of PPE for High Risk
Infectious Disease Team
page 15
Powered
Air Purifying Respirator (PAPR)
Positive Pressure System
•APF 1000
Flow Pattern – Hood –
Suit – outside
Cooling effect
page 16
Checklists
1.
2.
3.
4.
5.
6.
7.
Issues
Donning
Doffing
Engineering Controls
Safety Officer
Patient Preparation &
Packaging
Biocontainment
Work Rest Cycles
Visual Guides
page 18
Visual Guide – Bio-Bag
page 19
Personal Kit List
Team Framework
Modular & Scalable
Team
Leader
Safety
Officer
Paramedic
Crew 1
Paramedic
Crew 2
Paramedic
Crew 3
page 21
Patient
Preparation
& Packaging
Patient
Transport
Patient
Transfer of
Care
page 22
Donning
Crew 1
Patient
Preparation
&
Packaging
Patient
Transport
Patient
Transfer of
Care
page 23
Donning
Crew 1
Patient
Preparation
&
Packaging
Donning
Crew 2
Doffing
Crew 1
Patient
Transport
Patient
Transfer of
Care
page 24
Donning
Crew 1
Patient
Preparation
&
Packaging
Donning
Crew 2
Doffing
Crew 1
Patient
Transport
Donning
crew 3
Doffing
crew 2
Patient
Transfer of
Care
page 25
Donning
Crew 1
Patient
Preparation
&
Packaging
Donning
Crew 2
Doffing
Crew 1
Patient
Transport
Donning
crew 3
Doffing
crew 2
Patient
Transfer of
Care
Doffing
Crew 3
page 26
Donning Crew 1
Patient
Preparation &
Packaging
Donning Crew 2
Doffing Crew 1
Patient Transport
Donning crew 3
Doffing crew 2
Patient Transfer of
Care
Doffing Crew 3
Decontamination
and Bio
Containment
page 27
Call Organization – Major Issues
Patient
Information
Equipment &
Ambulance
Preparation
Duration of
transport &
estimated
work/rest cycles
Designated
Driving Route
Patient Care
Plan
Doffing areas &
Bio-containment
Designated
Security Access
& Ingress
Donning
Area/Location
Identified
Support Vehicles
& Recovery area
page 28
Donning Principles
Safety Officer Check
Time Documented
page 29
Patient Preparation
& Packaging
Tubes & Lines Prepared
All potential Infusion
Medications anticipated
page 30
Patient Preparation
& Packaging
Ingress & Egress
Access
page 31
Patient Preparation & Packaging
page 32
Patient Transport
Egress issues
Patient Loading
page 33
Two Ambulances
Mitigate Logistical
Challenges
Support
Primary Ambulance
Vehicle/Secondary
Ambulance
page 34
Doffing Principles
Checklists & Safety Officer
Designated Marked Area
page 35
Doffing Principles
Rolling outer layer
page 36
Doffing Priniciples
Colour Coded Gloves
Red Biohazard Bags &
Container(s)
page 37
Doffing Principles
Reusable Equipment
page 38
Doffing Principles
Suit Size very important
page 39
Bio-containment
Everything Wiped Down
Sealed Drums
page 40
Recovery Phase
After Action Report
• Lessons Learned
•
Corrective Action Plan
Decontamination
• Vehicle Decontamination
•
Equipment
Decontamination
•
Supply Replacement
page 41
Questions?
page 42