The document provides information about the 2014 Ebola outbreak in West Africa. It summarizes that as of October 24th there have been over 10,000 cases and 5,000 deaths, making it the largest Ebola outbreak in history. If current trends continue, the CDC estimates there could be over 500,000 cases in Liberia and Sierra Leone by January 2015. The document also provides background information on Ebola transmission, symptoms, testing and treatment. It directs EMS to CDC guidance and outlines next steps for Vermont EMS to develop protocols and train on proper PPE use.

1. VERMONT EMS EBOLA VIRUS
DISEASE EDUCATION
Patsy Kelso PhD, Vermont Department of Health State
Epidemiologist
and Vermont EMS

2. 2014 Ebola Outbreak
Vermont Department of Health - EMS

3. The Outbreak
 Reports as of October 24:
 10,141 cases
 4,922 deaths
 This is the largest Ebola epidemic in history
 CDC’s response is the largest international
outbreak response in CDC’s history
 On August 8, the World Health Organization
(WHO) declared the current Ebola outbreak a
Public Health Emergency of International Concern
(PHEIC)
 The PHEIC declaration underscored the need for a
coordinated international response to contain the
spread of Ebola
Vermont Department of Health - EMS

4. Future Estimates of Ebola Cases in Liberia
and Sierra Leone
 In September 23 edition of MMWR,* CDC estimated the
future number of Ebola cases if current trends continue in
Liberia and Sierra Leone:
 Without additional interventions or changes in community
behavior, CDC indicated by January 20, 2015 there will be
approximately 555,000 Ebola cases in Liberia and Sierra
Leone, or 1.4 million if correction for underreporting are
made.
 Cases in Liberia are currently doubling every 15-20 days,
and those in Sierra Leone and Guinea are doubling every
30-40 days.
* The MMWR article: Estimating the Future Number of Cases in the Ebola Epidemic – Liberia and Sierra
Leone, 2014-2015It is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/su63e0923a1.htm, and a
Q&A on the report is available at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/qa-mmwr-estimating-
future-cases.html
Vermont Department of Health - EMS

5. Outbreak Challenges in West Africa
 Overburdened
public health
and healthcare
systems
 Unpaid
healthcare
workers
 Insufficient
treatment
centers, beds,
medical
supplies, and
personal
protective
equipment
Vermont Department of Health - EMS

6. Background on Ebola
Vermont Department of Health - EMS

7. Ebola is a rare and deadly disease
 First discovered in
1976 near the Ebola
River in the
Democratic Republic
of the Congo
 Outbreaks occur
sporadically in Africa
 Family of zoonotic
RNA viruses
 Historically, death
rates from Ebola
range from 50%-90%
Vermont Department of Health - EMS

8. Transmission
 Ebola virus is spread through direct contact
(through broken skin or mucous membranes) with:
 A sick person’s blood or body fluids, including urine,
saliva, sweat, feces, vomit, and semen
 Contaminated objects (like needles and syringes)
 Infected animals (by contact with their blood, fluids, or
infected meat)
 Ebola virus has been detected in breast milk, but
is not know if the virus can be transmitted through
breastfeeding
 Not transmitted by mosquitos or other insects
Vermont Department of Health - EMS

9. Symptoms
 Signs of Ebola include fever (greater than
38.0oC or 100.40F) (87%) and symptoms
such as:
 Fatigue (76%)
 Vomiting (68%)
 Diarrhea (66%)
 Loss of appetite (65%)
 Severe headache
 Muscle pain
 Abdominal pain
 Unexplained hemmorrhage
 The incubation period is 2 to 21 days
(average 8-10 days)
 A person with Ebola is not contagious until
symptomatic
Vermont Department of Health - EMS

10. Testing & Treatment
 Virus is generally detectable in blood by real-time
RT-PCR between 3-10 days post-onset of
symptoms, but has been detected for several
months in certain secretions (e.g., semen)
 No FDA-approved vaccine or antiviral drug is
available
 Symptoms are treated as they appear. Basic
interventions, when used early, can significantly
improve the chances of survival.
 Providing IV fluids and balancing electrolytes
 Maintaining oxygen status and blood pressure
 Treating other infections if they occur
Vermont Department of Health - EMS

11. Patient Recovery
 Recovery from Ebola depends on good supportive
care and the patient’s immune response
 People who recover from Ebola infection develop
antibodies that last for at least 10 years, and
possibly longer
 It isn’t know if people who recover are immune for
life or if they can become infected with a different
species of Ebola
 Some people who have recovered from Ebola
have developed long-term complications (joint and
muscle pain, and vision problems)
Vermont Department of Health - EMS

12. CDC & EMS
 http://www.cdc.gov/vhf/ebola/hcp/interim-guidance-emergency-medical-services-systems-
911-public-safety-answering-points-management-patients-known-suspected-
united-states.html
Vermont Department of Health - EMS
Vermont
EMS is
following the
CDC’s
guidance –
please read!

13. Vermont EMS Ebola Virus Disease
Protocol

14. Vermont EMS Ebola Virus Disease
Protocol

15. CDC & EMS PPE
 http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html
Vermont Department of Health - EMS
Vermont EMS
has
developed a
check-list
following this
guidance!

16. Vermont EMS PPE Donning & Doffing
Checklist
 Printable
version is
attached to
this
presentation
as a document
and is also
viewable.
 Please print as
many color
copies as
necessary.
Vermont Department of Health - EMS

17. Alternative Vermont EMS PPE Donning & Doffing
Checklist
 Due to limitation
in available PPE,
the following
checklist still
adheres to
available
guidance
 Printable version
is attached to
this presentation
as a document
and is also
viewable.
 Please print as
many color
copies as
necessary.
Vermont Department of Health - EMS

18. Next Steps
 Watch the following video (approximately 21
minutes) on donning and doffing of PPE
 NOTE: Please be cognizant of the poor foot hygiene
at the end of the video (stepping in clean shoes in
areas where booties were worn)
 Review the Vermont EMS Ebola Virus Disease
Protocol
 Review the Vermont EMS PPE Donning & Doffing
Checklist
 Train with your service! (Train the trainer for
Donning & Doffing coming soon)
Vermont Department of Health - EMS

19. Next Steps
 Any questions should be addressed to:
VTEMS@state.vt.us
 FAQs are being developed
 This training will be updated as needed
Vermont Department of Health - EMS