Big Tree Volunteer Fire Company's 2013 infectious disease training document provided instructions and objectives for its knowledge assessment on infectious diseases. It covered topics like universal precautions, personal protective equipment, disease transmission, exposure control plans, and relevant laws and regulations. The training was meant to educate firefighters on minimizing disease transmission risks and properly handling potential exposures.

1. Big Tree Volunteer Fire
Company, Inc.
2013

2. Instructions
Locate and print the associated knowledge assessment.
While paging through this PowerPoint presentation,
answer the questions.
When complete, return completed knowledge
assessment to Asst. Chief Makin or Asst. Chief Wagner.
If you have any questions, please contact any Chief.

3. Overview
* Infectious Diseases
* Universal Precautions
* Specific Disease Information
* Exposures and Exposure Control Plan
* Laws, Standards, Rules, Regulations, and Guidelines

4. Objectives
 Differentiate and define the terms infectious disease and bloodborne
pathogen.
 Identify circumstances in which universal precautions and body substance
isolation should be used.
 Describe when and how decontamination procedures should take place.

5. Objectives
 Identify methods of transmission, signs, symptoms, and, if they exist,
pre- and post-exposure prophylaxis, and counseling for:
 HIV Infection/AIDS
 Hepatitis A, B, and C
 Tuberculosis (TB)
 Be familiar with:
 Common Sexually Transmitted Diseases
 Meningococcal Diseases
 Viral Hemorrhagic Disease
 Measles, Mumps, Rubella (MMR)
 Influenza

6. Objectives
 List behaviors that increase the risk of exposure to bloodborne pathogens.
 Demonstrate exposure preparedness by identifying personal and
employment issues to consider if a Bloodborne Pathogens exposure occurs.
 Define significant exposure.
 Identify options regarding treatment and counseling for an exposure.
 Identify whom, when, and how you should tell about an exposure.
 Identify rights to confidentiality; your rights, the patient’s rights, and the
employer’s rights.

7. Infectious Disease (Activity)
On your knowledge verification report, please complete Table #1 using the following
diseases:
AIDS/HIV Chickenpox Whooping Cough (Pertussis)
Meningitis Influenza Herpes Zoster (Shingles)
Mononucleosis Lice Hepatitis A (infectious)
Measles Hepatitis C Hepatitis B (serum)
German Measles Hepatitis D Non-A, Non-B Hepatitis
Mumps (infectious parotitis) Herpes Simplex (cold sores)
Each disease will be used once.

8. Infection Control (Overview)
 Universal Precautions
 Personal Protective
Equipment
 Disposable Equipment
 Disinfection &
Decontamination

9. Universal Precautions
 Treat all body fluids as
potentially infectious
 Wear appropriate personal
protective equipment
 Be consistent and vigilant

10. Universal Precautions
Universal Precautions- Applies the same or
universal approach to all persons.
 Body Substance Isolation (BSI)- The part of Universal Precautions
that uses barriers to prevent exposure to infectious diseases.

11. Personal Protective Equipment
Where are these items on the ambulance?
 Gloves
Where are they on 7-1?
 Eyewear
Rescue 7?
 Mask Engine 1?
Engine 2?
 Gown

12. Personal Protective Equipment
Ambulance #8 Rescue #7-1

13. Personal Protective Equipment
Engine #1 Engine #2

14. Personal Protective Equipment
Rescue #7

15. Other Infection Control Techniques
 Personal Hygiene
 Hand-hygiene
 Immunization Program
 Decontamination Procedures
 Proper Waste Handling

16. Hand Hygiene
 The most fundamental measure to control
infection.
 Recommendations on hand-hygiene-
 MMWR, Recommendations and Reports, October
25th, 2002/Vol. 51/No.RR16 Guideline for Hand
Hygiene in Health Care Settings-
Recommendations of the Healthcare Infection
Control Practices Advisory Committee and the
HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

17. Hand Hygiene
Indications for handwashing and hand antisepsis
 These recommendations are written for healthcare workers in hospital
settings, but based on principles that apply to all healthcare workers.
When hands are visibly dirty or contaminated
with proteinaceous material or visibly soiled
with blood, or other body fluids, wash hands
with either a non-antimicrobial soap and
water or an anitmicrobial soap and water.

18. Hand Hygiene
Indications for handwashing and hand antisepsis
 If hands are not visibly soiled, use an alcohol-based hand rub for
routinely decontaminating hands…
 Alternatively, wash hands with an antimicrobial soap and water in each of the
following situations:
 After contact with a patient’s intact skin (e.g. when taking a pulse or blood
pressure, and lifting a patient)
 After contact with body fluids or excretions, mucous membranes, nonintact
skin, and wound dressings if hands are not visibly soiled
 After removing gloves (PPE)
 After each patient contact
 After contact with inanimate objects in the immediate vicinity of the patient
(cleaning and decontaminating equipment)
 After using the toilet or restroom
 Before eating
 Before and after handling food

19. Hand Hygiene
Indications for handwashing and hand antisepsis
“Wash hands with non-antimicrobial soap and
water or with antimicrobial soap and water if
exposure to Bacillus anthracis is suspected or
proven. The physical action of washing and
rinsing hands under such circumstances because
alcohols, chlorhexidine, iodophors, and other
antiseptic agents have poor activity against
spores.”

20. Hand Hygiene
Technique
“When decontaminating hands with an alcohol-based hand rub, apply
product to the palm of one hand and rub hands together, covering all
surfaces of the hands and fingers, until hands are dry. Follow manufacturer’s
recommendations regarding the volume of product to use.”
“When washing hands with soap and water, wet hands first with water,
apply an amount of the product recommended by the manufacturer to
hands, and rub hands together vigorously for at least 15 seconds, covering
all surfaces of the hands and fingers. Rinse hands with water and dry
thoroughly with a disposable towel. Use towel to turn off the faucet. Avoid
using hot water, because repeated exposure to hot water may increase the
risk of dermatitis.”

21. Disposable Equipment
What disposable equipment is carried by the Big Tree Volunteer Fire Company?
 Head restraints
 Straps (some)
 Eyewear
 Infection control kits (PPE+)
 Cervical collars
 Single patient stethoscope
 IV supplies
 Airway equipment (e.g. BVMs, non-rebreathers, nasal cannulas, etc.)
 Splints
 Suction canisters and tubing
 CPR Pocket masks
 Linens

22. Disinfection (Overview)
Disinfection Techniques
High-Level
Intermediate
Low-level
Environmental

23. Disinfection
High-Level Disinfection
 Destroys all forms of microbial
life except high numbers of
bacterial spores.
 Methods:
 Hot water pasteurization
 Exposure to an EPA registered
chemical sterilant, except for short
contact time

24. Disinfection
Intermediate Level Disinfection
 Destroys mycobacterium
tuberculosis, most viruses,
vegetative bacteria, and most
fungi, but not bacterial spores.
 Methods:
 Use of EPA-registered “hospital
disinfectant” chemical germicides
that claim to be tuberculocidal on
the label
 Hard-surface germicides as
indicated above or solutions
containing at least 500 ppm free
available chlorine. (1:100 dilution
of common household bleach)

25. Disinfection
Low-Level Disinfection
 Destroys some viruses, most
bacteria, some fungi, but not
mycobacterium tuberculosis or
bacterial spores.
 Methods
 Use of EPA-registered
“hospital disinfectants”

26. Disinfection
Environmental Disinfection
 Surfaces in the environment such as floors, ambulance seats,
countertops, and woodwork that are soiled (but not contaminated
by blood or other potentially infectious body fluids) should be
cleaned and disinfected with cleaners or disinfectant agents
intended for environmental use.

27. Disinfection
 The level of disinfection required for any reusable equipment or
any environment depends on its level of contamination as
indicated previously.
 OSHA 1910.1030 requires that the employer shall launder all
equipment required by paragraphs (d) and (e) at no cost to the
employee.

28. Hepatitis Alphabet
Viral Hepatitis-Overview
Type of Transmission Chronic
Virus Source Prevention
Hepatitis Route Infection
Pre/post exposure
A Feces Fecal-oral No
immunization
Blood/blood- Percutaneous Pre/post exposure
B Yes
derived body fluids Permucosal immunization
Blood donor screening;
Blood/blood- Percutaneous
C Yes risk behavior
derived body fluids Permucosal
modification
Blood/blood- Pre/post exposure
D derived body fluids Permucosal Yes immunization; risk
Percutaneous behavior modification
Ensure safe drinking
E feces Fecal-oral no
wwater

29. Hepatitis Signs & Symptoms
Jaundice
Fatigue
Abdominal pain
Loss of appetite
Intermittent
nausea
Vomiting

30. Hepatitis Vaccines and Prophylaxis
 Vaccines currently exist for Hepatitis A and B, but not for C
 Hepatitis D is rare and occurs only in patients who develop acute or
chronic Hepatitis B, so the vaccine for Hepatitis B effectively prevents
Hepatitis D
 Although vaccination is the best protection, development of both
Hepatitis A and B (and thus, D) can be reduced by post –exposure
prophylaxis (PEP) with Immunoglobulin
 Vaccination for Hepatitis B has reduced the rate of development of the
disease in healthcare workers

31. Hepatitis B Vaccination Program
Required by OSHA 1910.1030
The employee has a right to refuse the vaccination. Documentation of the
declination should be completed.
The vaccination series is usually given in a three part series. The second
vaccine is given 30 days after the initial vaccine and the third vaccine is given
180 days after the initial vaccine. Following vaccinations, a blood titer to
check antibody levels is recommended upon consultation with your
physician.
Research indicates that for many workers antibody titers decrease in the
years after vaccination. There is no evidence yet that these decreasing titers
result in lowered immunity. Therefore, CDC does not currently recommend
boosters.

32. HIV/AIDS
 HIV
 Human Immunodeficiency Virus
 AIDS
 Acquired Immunodeficiency Syndrome
HIV is first…AIDS may follow

33. HIV/AIDS
Changing Face of the Epidemic
Use of AZT in pregnant women who are HIV positive or
have AIDS has dramatically decreased maternal-child
(perinatal) HIV transmission
Use of combination therapies including antivirals and
protease inhibitors has increased the time from
infection (HIV positive status) and the development of
AIDS (the syndrome with symptoms of opportunistic
infections).
The proportion of women, Hispanics, African-
Americans, and persons exposed to HIV through
heterosexual contact living with AIDS continues to
increase.

34. HIV/AIDS
Which Health Care Providers are at risk?
The level of risk to health care workers
depends on:
The prevalence of HIV among the patient population
The nature and frequency of exposure
The risk of transmission per exposure

35. HIV/AIDS
Transmission Risks
The virus must live in blood, certain body fluids (blood and blood
products, semen, vaginal secretions, as well as cerebrospinal,
synovial, pleural, peritoneal, pericardial, and amniotic fluids), or cells;
it has to enter the body quickly and enter the bloodstream. This can
happen several ways:
 The most effective way is through a contaminated needle-stick
injury. Risk of transmission by this route is estimated as
approximately 0.3% (1 in 300)
 Intact or unbroken skin should protect against infection. Open
wounds, a cut, or any skin that is not intact (chapped, abraded,
weeping, or having rashes) can permit the virus to enter the body.
Risk of transmission by this route is estimated, on average, at less
than 0.1% (1 in 1,000)
 The mucous membranes of the eye, nose, or mouth can serve as a
route for the infected fluids to transmit the virus. Risk of
transmission by this route is estimated, on average, at 0.1% (1 in
1,000)

36. HIV/AIDS
Behaviors & Practices that put you at risk
Sharing drug needles and syringes with an infected
person
You can become infected by having sex (oral, anal, or
vaginal) with someone who is infected with HIV
Children born to infected women may be infected
before or during birth
There is no current risk of becoming infected from
donating blood, however if you received blood before
1985 you are at risk. Due to improved screening, the
risk from transfusions is much less after this date

37. HIV/AIDS
How the virus is not transmitted
 Cannot be “caught” as the common cold can. Not spread through
the air like cold viruses
 No medical evidence of HIV transmission by casual, everyday
contact such as sharing kitchens, bathrooms, laundries, eating
utensils, beds, or living space with infected people
 In nonsexual social situations, such as at work or through sharing
air, food, and water
 Insects such as mosquitoes show no evidence of being
transmission vectors
 HIV infection through contact with feces, nasal secretions, saliva,
sputum, sweat, tears, urine, and vomitus is extremely low or
nonexistent

38. HIV/AIDS
Signs & Symptoms
 No disease symptoms may be apparent for many years
 Loss of appetite
 Weight loss
 Fever
 Night sweats
 Skin rashes or lesions
 Diarrhea
 Fatigue
 Lack of resistance to infection
 Swollen lymph nodes
 As the syndrome takes hold, opportunistic infections of the skin, eyes,
lungs, and nervous system

39. HIV/AIDS
Disease Progression
AIDS is the result of the progressive destruction of a person’s immune
system. The destruction allows diseases that the body can normally fight to
threaten the person’s health and life.
Particularly dangerous types of pneumonia (pneumocystis carinii
pneumonia) and certain other infections often invade a body weakened by
HIV. Patients may suffer rare cancers like Kaposi’s sarcoma.
HIV can also attack the nervous system and cause damage to the brain. This
may take years to develop. The symptoms may include:
 Memory loss
 Indifference
 Loss of coordination
 Partial paralysis
 Mental disorders

40. HIV/AIDS
Treating the Infected Patient
Treating an HIV/AIDS infected person in an
emergency setting is the same as with any
other patient.
Treat the underlying symptoms the patient is
presenting.
There are no unique protocols for these
patients.
Compassion is essential as is in any patient-
provider relationship.

41. HIV/AIDS
Confidentiality
The HIV epidemic has posed two powerful, and conflicting, legal and ethical
obligations. The first obligation is in respect to the privacy of persons with
HIV infection and the second is the duty to inform persons who may be
exposed to HIV.
The Ryan White Act HIV/AIDS Treatment Extension Act of 2009 addresses
this issue in Part G.
“The purpose of Part G is to facilitate informing EREs that they may have
been exposed to potentially life-threatening infectious diseases, so they can
make better informed decisions about subsequent measures such as
diagnosis and, if necessary, prophylaxis or treatment. The medical facility
that receives and treats the victim of an emergency or ascertains the cause
of death may have or may be able to obtain the victim’s disease status
information, which the emergency response service may lack. Part G
provides a framework for medical facilities to inform EREs that they may
have been exposed to one of the listed diseases.”
- www.cdc.gov/niosh/topics/ryanwhite/

42. Tuberculosis
Epidemiology
The number of TB cases in the U.S. increased in the mid-1980s, peaking in 1992,
when TB cases and case rates again began decreasing in all populations, but not in
all population subgroups. CDC reports:
 1985-22,201 cases
 1992-26,673 cases
 1998-18,361 cases
 1999-17,531 cases (6.4 infected individuals for every 100,000 people)
 2000-16,377 cases
 2001-15,989 cases (2% decline from 2000, the smallest decline in 9 years)
 1997-1,166 TB related deaths
 1999-856 TB related deaths
Only 5% of people in the United States who have been exposed ever develop active TB

43. Tuberculosis
Methods of Transmission
The disease is not a highly contagious disease. Transmission occurs
by droplet spread from a person with the active disease:
 Airborne
 Most dangerous indoors
 Ultraviolet light kills the bacterium outdoors
 The bacterium can survive outside the body for long periods of
time and even when dried
Higher concentrations of TB cases are found in prisons, hospitals,
homeless shelters, and nursing homes presumably because they are
enclosed areas.

44. Tuberculosis
Incubation & Communicable Period
The incubation period is 4 to 8 weeks.
Infected individuals should be considered
communicable until their symptoms have
resolved under adequate therapy and until they
have had three consecutive negative sputum AFB
smears, which have been collected on different
days.

45. Tuberculosis
Signs & Symptoms
Initial infection usually minimal. Disease usually lies
dormant for many years before signs and symptoms
appear, including:
Night sweats
Headache
Cough
Weight loss (consumption)
Hemoptysis or blood tinged sputum (classic symptom)
Any person who complains of a cough, especially a chronic
cough, should be suspected of having TB

46. Tuberculosis
Protection
Universal Precautions & Body Substance Isolation
The 1994 CDC Guidelines specify standard performance criteria for
respirators for exposure to TB. These criteria include:
 The ability to filter particulates 1 µm in size in the unloaded state with a
filter efficiency of >95%
 The ability to be qualitatively or quantitatively fit tested in a reliable way
to obtain a face-seal leakage of < 10%
 The ability to fit the different facial sizes and characteristics of health
care workers which can usually be met by making the respirators
available in at least three sizes
 The ability to be checked for face piece fit, in accordance with OSHA
standards and good industrial hygiene practice, by health care workers
each time they put on their respirator

47. Tuberculosis
OSHA Recommendations
All personnel should be given a baseline TB Mantoux
(PPD [Purified Protein Derivative]) skin test when first
employed and every six months thereafter at the
employer’s expense.
If an individual tests positive, a chest x-ray should be
done to determine if the disease is active
Active TB (in which signs and symptoms have
developed) should be treated immediately, usually with
a combination of drugs to prevent the emergence of
the drug-resistant strains

48. Tuberculosis
Treatment & Management
 After exposure and before any symptoms appear, the most
common course is a one year treatment that usually consists of a
daily dose of isoniazid (INH) to prevent the development of active
TB
 Younger people benefit most from this treatment
 If you have been exposed to multiple drug resistant TB (MDR-TB) ,
the physician also may augment INH with rifampin, pyrazinamide,
and streptomycin or ethambutol
 The bacterium is slow growing and can be metabolically dormant
for long periods of time. The treatment, therefore, will last 9-18
months. The patient must complete the whole regimen of drug
therapy, otherwise the bacteria may mutate into strains resistant
to common drug therapies

49. Common Sexually
Transmitted Diseases
• Chlamydia
• Most frequently
reported infectious
disease in the U.S.
• Syphilis
• Gonorrhea

50. Chlamydia
Chlamydia is a sexually transmitted disease (STD) that is caused by the
bacterium Chlamydia trachomatis. Because approximately 75% of women
and 50% of men have no symptoms, most people infected with Chlamydia
are not aware of their infections and therefore may not seek health care.
When diagnosed, Chlamydia can be easily treated and cured. Untreated,
Chlamydia can cause severe, costly reproductive and health problems
including pelvic inflammatory disease (PID), which is the critical link to
infertility, and potentially fatal tubal pregnancy.
Up to 40 % of women with untreated Chlamydia will develop PID.
Undiagnosed PID caused by Chlamydia is common. Of those with PID, 20%
will become infertile; 18% will experience debilitating, chronic pelvic pain;
and 9% will have a life-threatening tubal pregnancy. Tubal pregnancy is the
leading cause of first-trimester, pregnancy-related deaths in American
women.

51. Chlamydia
Chlamydia may also result in adverse outcomes of pregnancy, including
neonatal conjunctivitis and pneumonia. In addition, recent research has
shown that women infected with chlamydia have a 3-5 fold increased risk of
acquiring HIV, if exposed.
Chlamydia is also common among young men, who are seldom offered
screening. Untreated Chlamydia in men typically causes urethral infection,
but may also result in complications such as swollen and tender testicles.
What is the magnitude of the problem?
Chlamydia is the most frequently reported infectious disease in the United
States. Though 526,653 cases were reported in 1997, an estimated 3 million
cases occur annually. Severe under reporting is largely a result of substantial
numbers of asymptomatic persons whose infections are not identified
because screening is not available.

52. Chlamydia
Treatment
Single-dose antibiotic therapy promises to substantially
enhance the likelihood of successful treatment- especially
in adolescents- as compared to commonly used 7-day oral
medication

53. Syphilis
Syphilis is a complex sexually transmitted disease (STD) caused by the
bacterium Treponema Pallidum. It has often been called the great imitator
because so many of the signs and symptoms are indistinguishable from
those of other diseases.
How is Syphilis spread?
The syphilis bacterium is passed from person to person through direct
contact with a syphilis sore. Sores mainly occur on the external genitals,
vagina, anus, or in the rectum. Sores also can occur on the lips and in the
mouth. Transmission of the organism occurs during vaginal, anal, or
oral sex. Pregnant women with the disease can pass it to the babies they are
carrying. Syphilis cannot be spread by toilet seats, door knobs, swimming
pools, hot tubs, bath tubs, shared clothing, or eating utensils.

54. Syphilis
What are the signs and symptoms in adults?
Stage 1
The time between picking up the bacterium and the start of the first
symptom can range from 10–90 days (average 21 days). The primary stage of
syphilis is marked by the appearance of a single sore (called a chancre). The
chancre is usually firm, round, small, and painless. It appears at the
spot where the bacterium entered the body. The chancre lasts 1–5 weeks
and will heal on its own. If adequate treatment is not administered, the
infection progresses to the secondary stage.

55. Syphilis
What are the signs and symptoms in adults?
Stage 2
The second stage starts when one or more areas of the skin break into a rash
that usually does not itch. Rashes can appear as the chancre is fading or can
be delayed for weeks. The rash often appears as rough, "copper penny" spots
on both the palms of the hands and the bottoms of the feet. The rash also
may appear as a prickly heat rash, as small blotches or scales all over the
body, as a bad case of old acne, as moist warts in the groin area, as slimy
white patches in the mouth, as sunken dark circles the size of a nickel or
dime, or as pus-filled bumps like chicken pox. Some of these signs on the
skin look like symptoms of other diseases. Sometimes the rashes are so faint
they are not noticed. Rashes typically last 2–6 weeks and clear up on their
own. In addition to rashes, second stage symptoms can include fever,
swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss,
muscle aches, and fatigue. A person can easily pass the disease to sex
partners when first or second stage signs or symptoms are present.

56. Syphilis
What are the signs and symptoms in adults?
Latent Stage
The latent (hidden) stage of syphilis begins when the secondary symptoms
disappear. If the infected person has not received treatment, he/she still has
syphilis even though there are no signs or symptoms. The bacterium remains
in the body and begins to damage the internal organs, including the brain,
nerves, eyes, heart, blood vessels, liver, bones, and joints.

57. Syphilis
What are the signs and symptoms in adults?
Third Stage
In about one-third of untreated persons, this internal damage shows up
many years later in the late or tertiary stage of syphilis. Late stage signs and
symptoms include not being able to coordinate muscle movements,
paralysis, no longer feeling pain, gradual blindness, dementia (madness) or
other personality changes, impotency, shooting pains, blockage or
ballooning of the heart vessels, tumors or "gummas" on the skin, bones,
liver, or other organs, severe pain in the belly, repeated vomiting, damage to
knee joints, and deep sores on the soles of the feet or toes. This damage
may be serious enough to cause death.

58. Syphilis
How is syphilis diagnosed?
The syphilis bacterium can be detected by a health care provider who
examines material from infectious sores under a microscope. Shortly after
infection occurs, the body produces syphilis antibodies that are detected
with a blood test. A syphilis blood test is accurate, safe, and inexpensive. A
low level of antibodies will stay in the blood for months or years after the
disease has been successfully treated, and antibodies can be found by
subsequent blood tests. Because untreated syphilis in a pregnant woman
can infect and possibly kill her developing baby, every pregnant woman
should have a blood test for syphilis.

59. Syphilis
What is the link between syphilis and HIV?
While the health problems caused by the syphilis bacterium for adults and
newborns are serious in their own right, it is now known that the genital
sores caused by syphilis in adults also make it easier to transmit and acquire
HIV infection sexually. There is a 2- to 5-fold increased risk of acquiring HIV
infection when syphilis is present. Areas of the U.S. that have the highest
rates of syphilis also have the fastest-growing HIV infection rates
in women of childbearing age.

60. Syphilis
Treatment
One dose of the antibiotic penicillin will cure a person who has had syphilis
for less than a year. More doses are needed to cure someone who has had it
for longer than a year. A baby born with the disease needs daily penicillin
treatment for 10 days. There are no home remedies or over-the-counter
drugs that cure syphilis. Penicillin treatment will kill the syphilis bacterium
and prevent further damage, but it will not repair any damage already done.
Persons who receive syphilis treatment must abstain from sexual contact
with new partners until the syphilis sores are completely healed. Persons
with syphilis must notify their sex partners so that they also can receive
treatment.

61. Syphilis
Will syphilis recur?
Having had syphilis does not protect a person from getting it again.
Antibodies are produced as a person reacts to the disease, and, after
treatment, these antibodies may offer partial protection from getting
infected again, if exposed right away. Even though there may be a short
period of protection, the antibody levels naturally decrease in the blood, and
people become susceptible to syphilis infection again if they are sexually
exposed to syphilis sores.

62. Gonorrhea
What causes gonorrhea?
Gonorrhea is caused by Neisseria gonorrhoeae, a bacterium that can grow
and multiply easily in mucous membranes of the body. Gonorrhea bacteria
can grow in the warm, moist areas of the reproductive tract, including the
cervix (opening to the womb), uterus (womb), and fallopian tubes (egg
canals) in women, and in the urethra (urine canal) in women and men. The
bacteria can also grow in the mouth, throat, and anus.

63. Gonorrhea
How do people get gonorrhea?
Gonorrhea is spread through sexual contact (vaginal, oral, or anal). This
includes penis-to-vagina, penis-to-mouth, penis-to-anus, mouth-to-vagina,
and mouth-to-anus contact. Ejaculation does not have to occur for
gonorrhea to be transmitted or acquired. Gonorrhea can also be spread from
Mother to child during birth.
Gonorrhea infection can spread to other unlikely parts of the body. For
example, a person can get an eye infection after touching infected genitals
and then the eyes. Individuals who have had gonorrhea and received
treatment may get infected again if they have sexual contact with persons
infected with gonorrhea.

64. Gonorrhea
What are the signs and symptoms of gonorrhea?
Men:
When initially infected, about 50% of men have
some signs or symptoms. Symptoms and signs include
• a burning sensation when urinating
• a yellowish white discharge from the penis
• painful or swollen testicles.

65. Gonorrhea
What are the signs and symptoms of gonorrhea?
Women:
In women, the early symptoms of gonorrhea are often mild, and many
women who are infected have no symptoms of infection. Even when a
woman has symptoms, they can be so non-specific as to be mistaken
for a bladder or vaginal infection. The initial symptoms and signs in
women include
• a painful or burning sensation when urinating
• a vaginal discharge that is yellow or bloody.
Women with no or mild gonorrhea symptoms are still at risk of developing
serious complications from the infection. Untreated gonorrhea in women can
develop into
pelvic inflammatory disease (PID).
Symptoms of rectal infection for both men and women include discharge, anal
itching, soreness, bleeding, and sometimes painful bowel movements. Infections
in the throat cause few symptoms.

66. Gonorrhea
When do symptoms appear?
In males, symptoms usually appear 2 to 5 days after infection, but it can take
as long as 30 days for symptoms to begin. Regardless of symptoms, once a
person is infected with gonorrhea, he or she can spread the infection
to others if condoms or other protective barriers are not used during sex.

67. Gonorrhea
What is the treatment for gonorrhea?
Many of the currently used antibiotics can successfully cure uncomplicated
gonorrhea in adolescents and adults. Penicillin is a common antibiotic that is
no longer used to treat gonorrhea, because many strains of the gonorrhea
bacterium have become resistant to penicillin. Because many people with
gonorrhea also have Chlamydia, antibiotics for both infections are usually
given together. Persons with gonorrhea should also be screened for other
STDs.
It is important to take all of the medication prescribed to cure gonorrhea,
even if the symptoms or signs stop before all the medication is gone.
Although medication will stop the infection, it will not repair any permanent
damage done by the disease. Persons who have had gonorrhea and have
been treated can also get the disease again if they have sexual
contact with an infected person.

68. Meningococcal Disease
• Meningitis
• Viral
• Bacterial
• Septicemia
Meningococcal disease can produce
both meningitis and septicemia

69. Meningitis
Meningitis is an infection in the fluid of a person's spinal cord and the fluid
that surrounds the brain. Meningitis is usually caused by a viral or bacterial
infection.
• Viral meningitis is generally less severe and resolves without
specific treatment
• Bacterial meningitis can be quite severe and may result in brain
damage, hearing loss, or learning disability.
Before the 1990s, Haemophilus influenzae type b (Hib) was the leading cause
of bacterial meningitis, but new vaccines being given to all children as part
of their routine immunizations have reduced the occurrence of invasive
disease due to H. influenzae.
Today, Streptococcus pneumoniae and Neisseria meningitidis are the leading
causes of bacterial meningitis.

70. Meningitis
What are the signs and symptoms of meningitis?
In anyone over the age of 2 years:
• High fever
• Headache
• Stiff neck
These symptoms can develop over several hours, or they may take 1 to 2 days.
Other symptoms may include:
• Nausea
• Vomiting
• Discomfort looking into bright lights (photophobia)
• Confusion
• Sleepiness
In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness
may be absent or difficult to detect, and the infant may only appear slow or inactive, or be
irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any
age may have seizures.

71. Septicemia
The U.S. CDC has summarized the data on meningoccemia below:
Clinical Features Fever, headache and stiff neck in meningitis cases, and sepsis and rash in
meningococcemia.
Causative Agent Multiple serogroups of Neisseria meningitidis.
Incidence Up to 2% in epidemics. During 1996-1997 213,658 cases with 21,830 deaths were
reported in west African countries. 0.5-5/100,000 for endemic disease, worldwide in distribution.
Disease Course 10–15% of cases are fatal. Of patients who recover, 10% have permanent hearing
loss or other serious resulting conditions.
Transmission Occurs through direct contact with respiratory secretions from a nasopharyngeal
carrier case–patient.
Risk Groups Risk groups include general population (for epidemics), infants and young children (for
endemic disease), refugees, household contacts of case patients, military personnel, college
freshmen (particularly those living in dormitories), and people exposed to active and
passive tobacco smoke.
The CDC is now recommending vaccination of college freshmen, particularly those who live in
dormitories. Although most people exposed will not develop the disease, prophylactic antibiotic
treatment is sometimes used.

72. Septicemia
Treatment
Treatment consists of antibiotic therapy.
Post-exposure prophylaxis (PEP)
For workers who have had intensive, unprotected (i.e., no mask) contact
with infected patients (airway management, mouth-to-mouth
resuscitation), CDC recommends rapid (within the first week) antibiotic
therapy with rifampin, ciprofloxacin, or ceftriaxone.
Asymptomatic exposed workers require no duty restrictions. Personnel who
develop meningococcal infection should be excluded from duty until 24
hours after the start of effective therapy.

73. Viral Hemorrhagic Fever
The term viral hemorrhagic fever (VHF) refers to a group of illnesses that are
caused by several distinct families of viruses. While some types of
hemorrhagic fever viruses can cause relatively mild illnesses, many of these
viruses cause severe, life-threatening disease.
Humans are not the natural reservoir for any of these viruses. Humans are
infected when they come into contact with infected hosts. However, with
some viruses, after the accidental transmission from the host, humans can
transmit the virus to one another. Human cases or outbreaks of hemorrhagic
fevers caused by these viruses occur sporadically and irregularly. The
occurrence of outbreaks cannot be easily predicted. With a few noteworthy
exceptions, there is no cure or established drug treatment for VHFs.

74. Viral Hemorrhagic Fever
What carries viruses that cause viral hemorrhagic fevers?
Viruses associated with most VHFs reside in an animal reservoir host or
arthropod vector. They are totally dependent on their hosts for replication
and overall survival. The multimammate rat, cotton rat, deer mouse, house
mouse, and other field rodents are examples of reservoir hosts. Arthropod
ticks and mosquitoes serve as vectors for some of the illnesses. However, the
hosts of some viruses remain unknown – Ebola and Marburg viruses are well-
known examples.

75. Viral Hemorrhagic Fever
Where are cases of viral hemorrhagic fever found?
Some hosts, such as the rodent species carrying several of the New World arena viruses, live in
geographically restricted areas. Therefore, the risk of getting VHFs caused by these viruses is
restricted to those areas. Other hosts range over continents, such as the rodents that carry viruses
that cause various forms of hantavirus pulmonary syndrome (HPS) in North and South America, or
the different set of rodents that carry viruses that cause hemorrhagic fever with renal syndrome
(HFRS) in Europe and Asia. A few hosts are distributed nearly worldwide, such as the common rat. It
can carry Seoul virus, a cause of HFRS; therefore, humans can get HFRS anywhere where the
common rat is found.
While people usually become infected only in areas where the host lives, occasionally people become
infected by a host that has been exported from its native habitat. For example, the first outbreaks of
Marburg hemorrhagic fever, in Marburg and Frankfurt, Germany, and in Yugoslavia, occurred when
laboratory workers handled imported monkeys infected with Marburg virus. Occasionally, a person
becomes infected in an area where the virus occurs naturally and then travels elsewhere. If the virus
is a type that can be transmitted further by person-to-person contact, the traveler could infect other
people. For instance, in 1996, a medical professional treating patients with Ebola hemorrhagic fever
(Ebola HF) in Gabon unknowingly became infected. When he later traveled to South Africa and was
treated for Ebola HF in a hospital, the virus was transmitted to a nurse. She became ill and died.
Because more and more people travel each year, outbreaks of these diseases are becoming an increasing
threat in places where they rarely, if ever, have been seen before.

76. Viral Hemorrhagic Fever
How are hemorrhagic fever viruses transmitted?
Viruses causing hemorrhagic fever are initially transmitted to humans when the
activities of infected reservoir hosts or vectors and humans overlap. The viruses
carried in rodent reservoirs are transmitted when humans have contact with
urine, fecal matter, saliva, or other body excretions from infected rodents. The
viruses associated with arthropod vectors are spread most often when the vector
mosquito or tick bites a human, or when a human crushes a tick. However, some
of these vectors may spread virus to animals, livestock, for example. Humans
then become infected when they care for or slaughter the animals.
Some viruses that cause hemorrhagic fever can spread from one person to
another. Ebola, Marburg, Lassa, and Crimean–Congo hemorrhagic fever viruses
are examples. This type of secondary transmission of the virus can occur directly,
through close contact with infected people or their body fluids. It can also occur
indirectly, through contact with objects contaminated with infected body fluids.
For example, contaminated syringes and needles have played an important role
in spreading infection in outbreaks of Ebola hemorrhagic fever and Lassa fever.

77. Viral Hemorrhagic Fever
What are the symptoms of viral hemorrhagic fever illnesses?
Specific signs and symptoms vary by the type of VHF, but initial signs and
symptoms often include:
• marked high fever
• fatigue
• dizziness
• muscle aches
• loss of strength and exhaustion
Patients with severe cases of VHF often show signs of bleeding under the skin, in
internal organs, or from body orifices like the mouth, eyes, or ears. However,
although they may bleed from many sites around the body, patients rarely die
because of blood loss. Severely ill patients cases may also show shock, nervous
system malfunction, coma, delirium, and seizures. Some types of VHF are
associated with renal (kidney) failure.

78. Viral Hemorrhagic Fever
How are patients with viral hemorrhagic fever treated?
Patients receive supportive therapy, but generally speaking, there is no other
treatment or established care for VHFs. Ribavirin, an anti-viral drug, has been
effective in treating some individuals with Lassa fever or HFRS. Treatment
with convalescent-phase plasma has been used with success in some
patients with Argentine hemorrhagic fever.

79. Smallpox
Smallpox is a serious, contagious, and sometimes fatal infectious disease.
There is no specific treatment for smallpox disease, and the only prevention
is vaccination. The name smallpox is derived from the Latin word for
“spotted” and refers to the raised bumps that appear on the face and body
of an infected person.
There are two clinical forms of smallpox. Variola major is the severe and
most common form of smallpox, with a more extensive rash and higher
fever. There are four types of Variola major smallpox: ordinary (the most
frequent type, accounting for 90% or more of cases); modified (mild and
occurring in previously vaccinated persons); flat; and hemorrhagic (both rare
and very severe). Historically, variola major has an overall fatality rate of
about 30%; however, flat and hemorrhagic smallpox usually are fatal. Variola
minor is a less common presentation of smallpox, and a much less severe
disease, with death rates historically of 1% or less.

80. Smallpox
How is smallpox transmitted?
Generally, direct and fairly prolonged face-to-face contact is required to
spread smallpox from one person to another. Smallpox can also be spread
through direct contact with infected bodily fluids or contaminated objects
such as bedding or clothing. Rarely, smallpox has been spread by virus
carried in the air in enclosed settings such as buildings, buses, and trains.
Humans are the only natural hosts of variola. Smallpox is not known to be
transmitted by insects or animals.
A person with smallpox becomes infectious or contagious after a rash
appears. At this stage, the infected person is usually very sick and not able to
move around in the community. After the appearance of a rash, the infected
person is contagious until the last smallpox scab falls off.

81. Smallpox
Incubation Period
(Duration: 7 to 17 days)
Not Contagious
Exposure to the virus is followed by an incubation period during which
people do not have any symptoms and may feel fine. This incubation period
averages about 12 to 14 days but can range from 7 to 17 days. During this
time, people are not contagious.
Initial Symptoms (Prodrome)
(Duration: 2 to 4 days)
Possibly Contagious
The first symptoms of smallpox include fever, malaise, head and body aches,
and sometimes vomiting. The fever is usually high, in the range of 101 to 104
degrees Fahrenheit. At this time, people are usually too sick to carry on their
normal activities. This is called the prodrome phase and may last for 2 to 4
days.

82. Smallpox

83. Smallpox
Early Rash
(Duration: about 4 days)
Highly Contagious
A rash emerges first as small red spots on the tongue and in the mouth.
These spots develop onto sores that break open and spread large amounts of the
virus into the mouth and throat. At this time, the person becomes contagious.
Around the time the sores in the mouth break down, a rash appears on the skin,
starting on the face and spreading to the arms and legs and then the hands and
feet. Usually the rash spreads to all parts od the body within24 hours. As the rash
appears, the fever usually falls and the person may start to feel better.
By the third day of the rash, the rash becomes raised bumps.
By the fourth day, the bumps fill with a thick, opaque fluid and often have a
depression in the center that looks like a bellybutton. (This is a major
distinguishing characteristic of smallpox.) Fever often will rise again at this time
and remain high until scabs form over the bumps.

84. Smallpox
Pustular Rash
(Duration: about 5 days)
Contagious
The bumps become pustules – sharply raised, usually round and firm to the
touch as if there’s a small round object under the skin. People often say the
bumps feel like BB pellets embedded in the skin.
Pustules and Scabs
(Duration: about 5 days)
Contagious
The pustules begin to form a crust and then a scab.
By the end of the second week after the rash appears, most of the sores
have scabbed over.

85. Smallpox
Resolving Scabs
(Duration: about 6 days)
Contagious
The scabs begin to fall off, leaving marks on the skin that eventually become
pitted scars. Most scabs will have fallen off three weeks after the rash
appears.
The person is contagious to other until all of the scabs have fallen off.
Scabs Resolved
Not Contagious
Scabs have fallen off. Person is no longer contagious.

86. Measles, Mumps, Rubella (MMR)
Measles
Measles (Rubeola) is an acute, very communicable viral disease. Early signs and
symptoms include fever, conjunctivitis, cough, and spots around the oral mucous
membranes. The characteristic red, blotchy rash appears around the third day of
illness, beginning on the face and then spreading. Diarrhea and middle ear
infections are frequent complications. Tuberculosis (TB) can be worsened by
coinfection with measles.
Mumps
Mumps is an acute viral disease characterized by fever, swelling, and tenderness
of one or more salivary glands. Prior to 1967, when a vaccine was licensed,
between 100,000 and 200,000 cases were reported annually, mostly in school-
age children. Since 1995, fewer than 1,000 cases are reported annually in the U.S.
Sterility in males past puberty is a possible result of the disease.
Rubella (German Measles)
Rubella is an acute viral disease, affecting people of any age. The disease is
usually mild in infants and children, but is much worse in adults and is associated
with fetal wasting and abnormal development. In 1969, the year of vaccine
licensure, nearly 60,000 were reported in the U.S. Since 1992, fewer than 500
cases are reported annually.

87. Measles, Mumps, Rubella (MMR)

88. Measles, Mumps, Rubella (MMR)
Treatment of MMR
Treatment for these viral diseases is supportive and typically treats the
symptoms.
Prevention
A combination vaccine for MMR is routinely administered in this country
beginning in infancy. MMR immunization is not required for entry into any
country, including the U.S. These diseases are still prevalent in countries that
do not routinely immunize against them.

89. Influenza
Influenza or “the flu” is a viral respiratory infection, producing a more severe
illness than most other viral respiratory infections. Signs and symptoms
include moderate to high fever in adults, often higher in children, and the
respiratory symptoms of cough, sore throat, and runny nose. Headache,
muscle ache, and fatigue are prominent.
Most people recover from the flu in 1-2 weeks, but some patients develop
life-threatening complications, such as pneumonia. In an average year, flu
results in more than 20,000 deaths and over 100,000 hospitalizations. The
elderly and people with chronic health problems are more likely to develop
serious complications than young, healthy people.

90. Influenza

91. Influenza
Prevention
Surveillance of emerging influenza virus strains usually allows the
preparation of effective vaccines annually. 110 National Influenza Centers in
83 countries and four World Health Organization Collaborating Centers for
Virus Reference and Research from FluNet, linking the global network of
centers electronically and allowing each authorized center to enter data
remotely every week and obtain full access to real-time epidemiological and
virological information. People at high risk for developing severe
complications from flu should be vaccinated.

92. BTVFC Occupational Exposure
Protection Plan
Policy Statement
The Big Tree VFC has established a written Exposure Control Plan that is
available to all “active” and “active life” members at all times
The Third Assistant Chief (9-3) of the Big Tree VFC shall serve as the Infection
Control Coordinator of the program. When the Third Assistant Chief is
absent, the following persons are responsible for administering the program:
• 1st Assistant Chief (9-1)
• EMS Captain (if not designated as 9-3)
• EMS Lieutenant
• AEMT=P, AEMT-CC, AEMT-I, or EMT in charge of the EMS call where the
exposure took place.
The Big Tree VFC is committed to full compliance with applicable laws and
policies dealing with infection control. The fire company will develop plans
leading to compliance for any deficient areas identified by this program.

93. BTVFC Occupational Exposure
Protection Plan
Member Responsibilities
It is mandatory that each member learn the basics of infection control,
including modes of disease transmission and exposure risks. Each member is
responsible for ensuring compliance with the policies and procedures
outlined in the Exposure Control Plan. All members shall attend an initial
training course in bloodborne pathogens and a refresher annually thereafter.

94. BTVFC Occupational Exposure
Protection Plan
Big Tree VFC Responsibilities
• Designate the BTVFC Third Assistant Chief (9-3) as the Infection Control
Coordinator
• The Infection Control Coordinator will appoint a qualified individual to
instruct all members on the epidemiology, modes of transmission, and
prevention of HIV and other bloodborne infections.
• The EMS officers will emphasize the need for routine use of universal blood
and body fluid precautions on all patients.
• Equipment and supplies will be provided to minimize the risk of infection with
HIV and other bloodborne pathogens. This includes, whenever possible,
needleless angios and IV medications.
• Member adherence to recommended protective measures will be monitored.
When monitoring reveals a failure to follow the recommended precautions,
appropriate counseling, education, or retraining will be provided. If these
measures are unsuccessful, appropriate disciplinary action will be considered.
• Annually review and update this plan to incorporate new technologies,
address legislative changes, or make revisions as deemed appropriate.

95. BTVFC Occupational Exposure
Protection Plan
Measures for Prevention
• The Big Tree VFC will routinely provide to each member the appropriate personal protective
equipment (PPE) to reduce the risk of bloodborne disease exposure.
• The Big Tree VFC will assure that PPE is readily accessible to all members in the appropriate sizes.
• All PPE will be maintained in a sanitary manner.
• All PPE will be properly cleaned, laundered, repaired, replaced, or disposed of as needed at no cost
to the member.
• All members will be required to follow universal precautions at all times prior to initiating patient
care.
• All members will be required, when possible, to wash their hands with warm water and soap after
the removal of gloves that have come into contact with blood or other potentially infectious
materials, even if the gloves appear to be intact, at the hospital emergency room, or by using
antiseptic hand detergent that is found in the ambulance and trauma bag on Rescue #7 and flycar
#7-1
• All members will be required to remove contaminated PPE (i.e. jumpsuit, turnout gear) when
possible, upon leaving the emergency scene and placing the equipment in a biohazard bag for
washing, decontamination, or disposal.
• All members will perform procedures involving blood or other infectious materials in a manner that
minimizes splashing and spraying.
• When using needles or other sharp objects, the member will not shear, bend, break, recap, or re -
sheath with two hands. Used needles will be placed directly in a sharps container on the
ambulance.

96. BTVFC Occupational Exposure
Protection Plan
Immunizations/Vaccinations
• Immunizations reduce the risk of contracting a communicable disease. The
Big Tree VFC will provide the Hepatitis B vaccine to all members, free of
charge, after initial training (which will include Hepatitis B, Hepatitis B
vaccination, the efficacy, safety, method of transmission, and benefits of the
vaccination, and the availability of the vaccine) within 10 days of initial
swearing in of the company, unless (1) the member has previously received
the complete Hepatitis B vaccination series, (2) antibody testing reveals that
the member is immune or, (3) medical reasons prevent the member from
being vaccinated. Any booster doses recommended by the U. S. Public Health
Service also will be provided.
• All medical evaluations and procedures will be performed by, or under, the
supervision of a licensed physician, or an appropriately trained and licensed
health care provider, and administered according to current
recommendations of the U.S. Health Service. Members will receive their
vaccinations through designated sites set up on a regular basis.
• Vaccinations will be provided even of the member initially declines, but later
accepts treatment. Members who decline the vaccination must sign a
declination form. Refer to the SOG entitled “Physical Examinations” for more
information.

97. BTVFC Occupational Exposure
Protection Plan
Exposure Determination
This is a listing of possible different levels of exposure that personnel may
encounter:
• Level I
• Possible affected personnel could include, but is not limited to, EMT, EMT-D, EMT-I,
non first-aiders, drivers, firefighters, and fire police.
• Exposure is limited to merely being in the presence of a person suspected of having
a communicable disease.
• This should be reported to the Infection Control Coordinator and an EMS Agency
Exposure Notification Form should be filled out.
• Level II
• Possible affected personnel could include, but is not limited to, EMT, EMT-D, EMT-I,
non first-aiders, drivers, firefighters, and fire police.
• This is an exposure to healthy, intact skin from a victim’s body fluids.
• This should be reported to the Infection Control Coordinator and an EMS Agency
Exposure Notification Form should be filled out.

98. BTVFC Occupational Exposure
Protection Plan
Exposure Determination
• Level III
• Possible affected personnel could include, but is not limited to, EMT, EMT-I, non
first-aiders, drivers, firefighters, and fire police.
• This is an exposure involving contact with infected blood or body fluids through
open wounds, mucous membranes, or parenteral routes (i.e. piercing mucous
membranes or the skin barrier through needle-sticks, human bites, cuts, and
abrasions).
• Examples of a Level III exposure include:
• Needle-stick injury
• Cut with a contaminated sharp object covered with blood or body fluids.
• Contamination of a mucous membrane (i.e. splash to the eyes, nose, or mouth)
• Contamination of blood or body fluids with non-intact skin (i.e. especially when
the skin is chapped, abraded, or affected with dermatitis)
• Any injury sustained while working with contaminated equipment.

99. BTVFC Occupational Exposure
Protection Plan
Injury Care
Injuries involving unused, sterile needles should be reported to the Infection Control
Coordinator the same way as any other minor injury. Care at the time of injury should
consist of:
• Local wound care
• Consideration of need for tetanus-diphtheria toxoid.
Level III Occupational Exposures with a KNOWN contamination source should be handled
as follows:
• The hospital receiving the patient will be contacted and informed that a Level III Occupational
Exposure has occurred.
• The Infection Control Coordinator will contact the receiving hospital to find out whether the
patient has an infectious disease. Determination of the risk will be based on medical information
possessed by the medical facility treating the patient. New York State law does not permit
testing for infectious disease without the permission of the patient. The medical facility must
respond to the Department’s request in writing as soon as practical but not later than 48 hours
after receipt of such request. Hospitals also have an affirmative responsibility to notify the
designated officers of a possible exposure to infectious pulmonary tuberculosis.
• The injured firefighter/provider should be interviewed regarding any history of Hepatitis, risk
factors for exposure to Hepatitis B, and Hepatitis B immunization status. The following blood
tests will be requested:
• Anti-Hep BsAg (antibody to Hepatitis B surface antigen)
• HIV antibody

100. BTVFC Occupational Exposure
Protection Plan
Injury Care (con’t.)
Any personnel receiving a Level III exposure from an HIV positive patient
should have an additional HIV antibody test done six weeks post exposure.
The HIV antibody test needs to be redone at 3, 6, and 12 month intervals.
The results of these tests will be provided to the firefighter/provider with
counseling from a physician. The results of these tests will remain in strict
confidence between the firefighter/provider and the appointed Licensed
Physician. The member will provide the Big Tree VFC with information
necessary to comply with worker’s compensation laws and other fire
company policies only. These tests will be done at the expense of the Big
Tree VFC.

101. BTVFC Occupational Exposure
Protection Plan
Medical Surveillance
Big Tree VFC will provide all evaluations, procedures, vaccinations, and post-
exposure management to the member at a reasonable time and place, and
according to standard recommendations for medical practice.
Record Keeping
The Big Tree VFC will:
• Maintain accurate medical records for each member for at least the duration of
membership plus thirty years.
• Keep all member medical records confidential and not release them to any person
within or outside the company except as required by law.
• Maintain all training records for five years in compliance with Section 29, Code of
Federal Regulations, 1910.20

102. BTVFC Occupational Exposure
Protection Plan
Medical Record Confidentiality
The Big Tree VFC will keep all medical records confidential and are not
disclosed or reported without the members expressed written consent
except as may be required by law.
The Big Tree VFC emergency response personnel will use knowledge of a
patient’s communicable disease status for patient care only, not infection
control purposes.
The same confidentiality standards apply to information regarding the
communicable disease of members involved in emergency services
response. This information is between the member and the attending
physician. The sharing of this information through any other means,
including the “grapevine”, is a violation of confidentiality standards.
Appropriate disciplinary action will be taken towards individuals who violate
these confidentiality standards.

103. BTVFC Occupational Exposure
Protection Plan
More information regarding the Big Tree VFC Occupational Exposure
Protection Plan can be found in our Standard Operating Guidelines Manual
located in the Watch Room at Station #2. Also located in the Watch Room is
the Big Tree VFC Bloodborne Pathogens Exposure Control Book which
contains the OSHA 1910.1030 Standard and the applicable Exposure Report
Forms.

104. BTVFC Exposure Report

105. BTVFC Equipment
Decontamination Procedures
Cleaning and Decontaminating Spills of Blood
• Put on gloves (P2-High Risk) before the clean-up procedure.
• Remove the visible material with absorbent towels or other appropriate
means that will ensure that there is no direct contact with blood.
• If splashing is anticipated, wear protective eyewear and a gown which
provides a protective barrier.
• Wash the surface with soap and water or a germicide and then apply a
disinfectant and allow the surface to dry.
• Clean and disinfect soiled cleaning equipment or place in an appropriate
biohazard bag for disposal.
• Wash hands following the removal of gloves.

106. BTVFC Equipment
Decontamination Procedure
Periodic Cleaning of the Rescue Vehicles
• On a regular basis (i.e. weekly monthly) as determined by the frequency
of vehicle use and obvious need, the floors, walls, interior, and exterior
cabinets and drawers, benches, and other surfaces, should be thoroughly
cleaned. On a weekly basis, on Mondays, the ambulance will be checked
and cleaned. All equipment and working surfaces will be cleaned routinely
after each EMS call.

107. BTVFC Equipment
Decontamination Procedure
Decontamination of Linen and Clothing
Linen Handling- The removal of linen should focus on limiting dispersal of
organisms into the air, proper containment, and hand washing. Linen should be
rolled or folded during removal and by avoiding shaking or waving. Linen should
be left at the hospital facility or it should be placed in a plastic bag for laundering
by the hospital facility. Following the removal of the linen, hands should be
washed. In the event that the linen is heavily soiled and not left at the hospital,
gloved should be worn and the linen placed in a plastic bag.
Management of Contaminated Clothing- Contaminated clothing should be
handled similarly to linen. Clothing which has dried blood or other body fluid
spatters should be removed as soon as practical (i.e. at the station house or
home) If protective garb is not worn, and clothing becomes soaked with blood or
other body fluids, the member should, to the extent possible under the
circumstances, take steps to prevent direct contact with the skin. Ideally, the
clothing should be removed from the body. Alternatively, a protective barrier can
be placed between the skin and soaked area until the clothing can be changed.
Detergent washing and drying in a dryer renders materials safe.
Bleach can be used if it is compatible with the fabric. Dry cleaning is an effective
decontamination method for clothing which cannot be laundered.
Laundry facilities (washer and dryer) are available at Big Tree Station #2 to be
used for any contaminated clothing.

108. BTVFC Equipment
Decontamination Procedure
Care of Specific Contaminated Equipment
ARTICLE Cleaning Procedure
Airways (ET tubes, OPA, NPA) 1
B/P Cuffs 2
Backboards 2
Bag Valve Masks 1
Bulb Syringe 1
Cannulas, Masks 1
Cervical Collars 1 Cleaning Key
Dressings & Paper products 1 (1) Dispose
Electronic Equipment 3
Emesis Basins 1 (2) Cleaning
Firefighter Protective Equipment 5 (3) Disinfection (1:10
Humidifiers 1
Regulators and tanks 2 bleach:water
KED 3
Laryngoscope and blades 4 solution)
Linens 1 or 5 (4) High-Level
MAST 3
Needles 1 Disinfection (LPH)
Penlights 1 (5) Launder
Pocket masks 1 or 4
Restraints 2
Resuscitators (BVM) 1 or 4
Scissors 3
Splints ` 1
Stethoscope 3
Stretcher 3
Stylets 1
Suction Catheters 1
Suction Unit (Collection Jar) 3
Jumpsuits 5

109. BTVFC Equipment
Decontamination Procedure
Infectious Waste Disposal
Big Tree VFC will
• Treat any waste which has had contact with any body substance as regulated
medical waste. Such waste will be placed in a red biohazard bag and left at the
receiving hospital facility for ultimate incineration. Red biohazard bags are available
on Big Tree #8 in the waste basket receptacles.
• All sharps, used and unused, are included in the definition of regulated medical
waste. Sharps containers will be secured when full and disposed of with other red
bag waste. The ambulance is equipped with puncture resistant containers.
• Disposal of intravenous bags, whether or not they have had contact with blood, will
be disposed of with other red bag waste.
• All other waste which has not had contact with a body substance may be disposed
of in the general waste stream. White garbage bags are available on Big Tree #8.

110. Knowledge Assessment
Please take the time to complete the knowledge assessment to the best of
your ability.
Once completed, turn the knowledge assessment document into the 1 st
Assistant Chief or 2 nd Assistant Chief.
If you have any questions, please contact the Infection Control Coordinator
(9-3) or 1st Assistant Chief.