Emergency medical services (EMS) personnel and clinicians have an important role in providing initial medical care. Procedures should be in place to quickly screen all patients who present for care. EVD should be considered in anyone with a fever who has traveled to or lived in an area where EVD is present or who has had contact with a patient with EVD in the last 21 days.25,39,43 Patients who meet these criteria should be questioned further regarding the presence of signs or symptoms of EVD.3 To minimize potential exposure, only 1 EMS provider should approach the patient and perform the initial screening from at least 3 feet away from the patient. Based on the initial screening, if the clinician suspects the patient could have EVD, then PPE should be put on before coming into close contact with the patient. Other clinicians should remain farther away, while assuring they are still able to support the provider with primary assessment duties. No one should have direct contact with a patient who may have EVD without wearing appropriate PPE, as the use of appropriate PPE greatly reduces the risk of contagion.43
Patients should immediately be assessed for life-threatening conditions, especially given the often significant gastrointestinal fluid losses, which can compromise circulation and hemodynamics. In suspected cases of EVD, proper infection control measures should be initiated and efforts directed toward rapid resuscitation.43 Since there are currently no United States Food and Drug Administration (FDA)-approved vaccines or medications, the initial treatment by prehospital personnel is supportive. It should include maintaining oxygen status and intravenous fluids to maintain circulatory stability and treating organ dysfunction as necessary.43 The high risk of transmission of Ebola virus to healthcare workers necessitates meticulous infection control at all times. Prehospital resuscitation procedures such as endotracheal intubation, open suctioning of airways, and cardiopulmonary resuscitation frequently result in a large amount of secreted body fluids. As such, performing these procedures in a less-controlled environment (eg, a moving vehicle) increases the risk of exposure to infectious pathogens. These procedures should, preferably, be performed under controlled conditions.3 Nonetheless, transport to the hospital should not be delayed and EMS and medical first responders should call ahead and notify the receiving healthcare facility that they will be arriving with a suspected Ebola case. In the absence of early recognition and effective infection control measures, the risk of nosocomial spread of Ebola remains high. Initial management is underscored by the need for optimal education and a multifaceted approach to EVD management.
Marlie Dulaurier, MD;Katherine Moyer, DO;Rebecca Wallihan, MD
July 2, 2016
August 2, 2019
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME credits