Wearing protective clothing and storing uniforms at work can reduce the risk of infectious particles being carried home on clothing. When transporting soiled uniforms, they should be sealed in a laundry bag and kept separate from other clothes. It is safest to minimize the time contaminated items spend in the home before being washed.

2. It is possible for ballistic particles to be carried back to your
home on your uniform. Wearing a gown when in contact
with potentially infectious persons and storing your
uniforms at work until it is time to launder them are two
strategies to keep your families free from infectious contacts.
When bringing laundry home, it should be carried, not
worn, and separated from other clothing using a laundry
bag or other such container. Remember that boots are
seldom cleaned and are often exposed to the same
contamination as your uniform clothing – they are best left
at work. While it is relatively safe to launder your clothing
at home, leaving contaminated clothing to the laundry pile
may result in members of your family coming into contact
with any substances on your clothing. The time that soiled
clothing spends in the home should be minimized.

3. In the pre-hospital context, a disposable N95 will
last for the duration of a single patient contact.
The manufacturer suggests that a mask will
provide protection until it becomes wet, soiled, oil
saturated or crushed. However, once a mask
comes into contact with a source of infection, the
pores of the filter become contaminated. To re-use
a mask from patient to patient may provide a
vector for disease transfer. Since all pre-hospital
patient contacts that meet the screening criteria are
considered to be infectious, each new patient
contact must be met with a fresh mask.

4. Think of the five ‘Right’s of mask application: The right mask on the right person for
the right reason at the right time in the right manner.
 A surgical mask should be worn whenever you are within 2 meters of a suspect
ILI/H1N1 patient.
 A surgical mask may also be placed over the nose and mouth of a patient with
ILI/H1N1 symptoms. This mask may also be placed over an oxygen delivery
device such as nasal prongs or NRB.
 N95 masks must be worn when providing a nebulized therapy such as a Ventolin
treatment, when dealing with airway secretions as in suctioning, when
providing airway management using an adjunct (OPA, NPA, ETT or KingLT)
and/or providing assisted ventilations (using a BVM).
 When in doubt you may elect to wear an N95 mask. If you feel a mask is required
then a gown, goggles, and gloves are also required.
 For the purpose of a field response to a patient with ILI symptoms it is acceptable
to default to wearing an N95 mask.

5. There are three particle sizes that may act as vectors for the flu:
 Very small particles carried in the breath of an infected person dissipate rapidly
into the air and become diluted the further they get from their host.
 Medium sized particles may be carried forward by a sneeze or cough. These
larger particles are affected by gravity and fall out of the air the further
they get from the source of their introduction into the air.
 Large particles, known as ballistic particles, also result from a cough or sneeze
but are transferred directly onto a surface such as a tabletop, item of
clothing or hand. These particles may survive for some time outside a
host and can be re-transferred through direct contact to other surfaces.
To infect someone, however, the particles must be carried from the
contaminated surface to close proximity to the nose or mouth where they
are inhaled.

6. The 2 meter rule (also known as staying at
handshake distance) keeps you outside the
direct transmission range of an infected
person’s breath, outside the ‘spray’ range of a
cough or sneeze and away from the reach of
someone who may have contaminated particles
on their skin or clothing. In addition to the 2
meter rule, frequent hand washing and
application of PPE will reduce your likelihood
of bringing infectious particles into the range of
your respiratory pathways.

7. This depends on your frequency of contact
with potentially infected surfaces. At a
minimum you should clean your hand
following use of the washroom facilities, before
eating or touching your nose/mouth, after
touching someone else’s hands, clothing or a
surface that may have come into contact with
ballistic particles. In the pre-hospital care
environment you should perform hand
hygiene following administration of any
therapy and after removing gloves or any other
item of PPE.

8. Right now YCDC advocates that you return to
work no sooner than 7 days after the onset of
symptoms or 24 hours after all symptoms have
disappeared – whichever is greater.

9. Any cleaning solution or soap is sufficient to
clean surfaces that have become contaminated.
It is more important to disturb the particles
than to disinfect them. There is no ‘best’
cleaning product to deal with H1N1 or flu
transmitting particles. Frequent, diligent
cleaning is the key.

10. Screening should have been provided by
Central Dispatch or a Community Nurse prior
to EMS’ contact with a potentially infectious
person. If symptoms are suspected upon your
arrival, the following questions may be
employed to screen the patient:

11.  Is there evidence of a respiratory illness?
(Shortness of breath, new cough or fever?)
AND
 Is there a report of a sore throat
or weakness
or excessive fatigue
or joint pain or muscle pain?
AND/OR
 Is there a recent history of contact with another
person who has any of the above symptoms?

12.  We will be fit testing all YEMS staff for N95 masks. Following the
fit testing, all ambulances and YEMS vehicles will be supplied
with ‘pre-loads’ of PPE. Each pre-load contains the PPE required
for one attendant for one patient call.
 Once all the ambulances are supplied to the same level, every
community station will receive a blue plastic container containing
resupplies for the ambulance pre-loads. Initially every station will
receive the same supply but more can be requested as individual
communities use the PPE that has been supplied.
 It is unlikely that all communities will be impacted by H1N1 to
the same level. We must centralize our stores with a plan to
rapidly deploy them to wherever they may be needed. Pre-loads
of PPE containing 10 patient contact’s worth of PPE will be
available for priority shipping.

13. Call 811. The nurse on call (Telehealth) will
screen the symptoms that are presenting and
will guide you as to the next steps. Not
everyone needs to )or should) be seem by a
Community Nurse or a Doctor. Mild cases of
H1N1/IlI will be cared for outside of medical
institutions. Only moderate to severe cases will
be asked to seek medical attention.

14. The following are good websites for information:
Council of Canadian Academics:
www.scienceadvice.com
Public Health and Safety Canada:
www.phac-aspc.gc.ca
Yukon Health and Social Services:
www.hss.gov.yk.ca
OR
811 – Telehealth Nurse on Call

15. The YEMS Pandemic Representative is:
Jeff Simons
Jeff.Simons@gov.yk.ca
jeffsimons@kos.net
Cell: 867 334 8851