This document provides information on Ebola virus disease (EVD), including definitions of persons under investigation (PUI) for Ebola, probable and confirmed Ebola cases, high and low risk exposures, treatment recommendations, EMS management and personal protective equipment guidelines, notification procedures, and general EMS documentation and treatment tips. Key points include that Ebola will most likely be contained to West Africa but global travel means it could spread more widely, a PUI meets clinical criteria and epidemiological risk factors, and EMS personnel should take appropriate precautions like PPE for suspected Ebola patients to address safety and limit contact during assessment and transport.

1. Ebola
Just some basic information.
Most likely this will be contained to West
Africa.
However, you can fly everywhere in hours.
You can’t rely on the Comm Center to do
the screening.

2. Person Under Investigation (PUI)
Person Under Investigation (PUI)
A person who has both consistent symptoms and risk factors as
follows:
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
epidemiologic risk factors within the past 21 days before the onset of
symptoms, such as contact with blood or other body fluids or human
remains 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 or non-human primates from
disease-endemic areas.

3. Probable Case
– A PUI whose epidemiologic risk factors
include high or low risk exposure(s) (see
below)
Confirmed Case
– A case with laboratory-confirmed diagnostic
evidence of Ebola virus infection

4. High risk exposures
A high risk exposure includes any of the following:
– Percutaneous (e.g., needle stick) or mucous membrane
exposure to blood or body fluids of EVD patient
– Direct skin contact with, or exposure to blood or body fluids of,
an EVD patient without appropriate personal protective
equipment (PPE)
– Processing blood or body fluids of a confirmed EVD patient
without appropriate PPE or standard biosafety precautions
– Direct contact with a dead body without appropriate PPE in a
country where an EVD outbreak is occurring*

5. Low1 risk exposures
A low risk exposure includes any of the following
– Household contact with an EVD patient
– Other close contact with EVD patients in health care facilities or
community settings. Close contact is defined as
– being within approximately 3 feet (1 meter) of an EVD patient or
within the patient’s room or care area for a prolonged period of
time (e.g., health care personnel, household members) while not
wearing recommended personal protective equipment (i.e.,
standard, droplet, and contact precautions; see Infection
Prevention and Control Recommendations)
– having direct brief contact (e.g., shaking hands) with an EVD
patient while not wearing recommended personal protective
equipment.
Brief interactions, such as walking by a person or moving through a
hospital, do not constitute close contact

6. Treatment
No specific vaccine or medicine (e.g., antiviral drug) has been
proven to be effective against Ebola.
Symptoms of Ebola are treated as they appear. The following basic
interventions, when used early, can significantly improve the
chances of survival:
Providing intravenous fluids (IV)and balancing electrolytes (body
salts)
Maintaining oxygen status and blood pressure
Treating other infections if they occur
Some experimental treatments developed for Ebola have been
tested and proven effective in animals but have not yet been tested
in randomized trials in humans.
Recovery from Ebola depends on the patient’s immune response.
People who recover from Ebola infection develop antibodies that
last for at least 10 years, possibly longer.

7. EMS management
Address scene safety:
– If PSAP call takers advise that the patient is
suspected of having Ebola, EMS personnel should
put on the PPE appropriate for suspected cases of
Ebola (described below) before entering the scene.
– Keep the patient separated from other persons as
much as possible.
– Use caution when approaching a patient with Ebola.
Illness can cause delirium, with erratic behavior that
can place EMS personnel at risk of infection, e.g.,
flailing or staggering.

8. During patient assessment and management,
EMS personnel should consider the symptoms
and risk factors of Ebola: All patients should be
assessed for symptoms of Ebola (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). If the patient has
symptoms of Ebola, then ask the patient about
risk factors within the past 3 weeks before the
onset of symptoms, including:

9. Contact with blood or body fluids of a patient known to
have or suspected to have Ebola;
Residence in—or travel to— a country where an Ebola
outbreak is occurring : Guinea, Liberia,Sierra Leone,
Nigeria and Senegal
Direct handling of bats or nonhuman primates from
disease-endemic areas.

10. EMS Treatment
Limit contact: IV’s, injections, Airway
Airway: King. I would not stick my face
near their’s to intubate. I’m using a
glidescope.
Not airborne but use N95 if you need to be
near airway.
Access: IV/IO only in truly unstable pts
– Never in moving ambulance/uncontrolled
scene
Meds: Nebs or intranasal.
– Remember IN midazolam if they are delerious

11. Notification
If you have someone who meets the
criteria, make an online medical control
call and notify during the prehospital radio
report.

12. General (Not ebola) comments
Documentation:
– Arrests: please document rhythm. “no shock
indicated” does not help later on.
If all you have is an AED, then yes, document what
it says.
– Airway: document ETCO2 waveform on
intubated pts.
– RMA’s with dementia (mild) document some
form of assessment on decision-making and
that family agrees.

13. General (Not ebola) comments
Drugs
– Narcotics without IV: If you can’t get IV,
please give it IM or IN (fentanyl/versed) if
needed. It still works.
– CHF/COPD remember albuterol/iprotroprium
does not help CHF. Nitro and CPAP does.

14. General (Not ebola) comments
Airway
– Advise C-Collar after intubation to limit movement
– ETCO2 if they are intubated and it gets clogged,
replace the sensor to continue
monitoring/confirmation. A flat waveform is
clogged or esophageal placment, just like
asystole is dead or just not attached. Check
equipment.
– Still consider ETT in arrests: Good animal data
shows KING/combutibe cut off the carotids at
CPR blood pressures.

15. General (Not ebola) comments
Airway:
– I love bougies.
– Much easier to pass bougie 1st time than tube
with stylet (and infinitely easier than tube
without)
– In arrest, easier to slip in bougie during
compressions or brief pause (resuming as
soon as bougie is through cords

17. Other bougie use:
– Confirm placement regardless of blood/vomit
Pass through tube
– If it stops about 30cm it’s in the trachea
– If you can pass it all the way, it’s esophageal.

18. Thanks
Keep up the great work.
As always questions, concerns.
robmchughdo@gmail.com