Jeff Simons will be the YEMS representative for pandemic planning and response. Please direct any YEMS related pandemic questions or concerns to him.

1. PANDEMIC PLANNING
INFORMATION INSERVICE FOR
THE PREHOSPITAL CARE TEAM

2. First, some acronyms
• H1N1 – the ‘pig’ flu
• I.L.I. (ILI) – Influenza Like Illness
• EMS – Emergency Medical Services
• PPE – Personal Protective Equipment
• YCDC – Yukon Centre for Disease Control
• EHOT – Emergency Health Operations Team

3. H1N1 – What is it?
• H1N1 is a new type of Influenza A virus that has not
previously infected humans.
• Infection results in symptoms such as:
- Fever - Cough
- Runny nose - Sore throat
- Body aches - Fatigue
- Difficulty breathing - Loss of appetite
• H1N1 symptoms and methods of transmission are
similar to those associated with seasonal flu.

4. H1N1 Virus
• 7 Day incubation period & infectious for about
7 days
• May be infectious for up to 2 days before
signs/symptoms appear
• Travels in waves of 6-8 weeks during
Fall/Spring

5. So What?
• Prediction: 2+ weeks of 15-30% absenteeism
from work disrupting normal course of affairs.
• Increases demand on health care services and
their support networks.

6. How does it spread?
Two routes of transmission (vectors)
• INHALATION (very small particles that are
exhaled into the surrounding air that enter a
host directly via the airways.)
• CONTACT (larger “ballistic” particles that can
survive on other surfaces. These must be
transferred from the contaminated surface to
an airway opening for infection to occur.)

7. Inhalation
• All particles of inhalable size may contribute
to influenza infection.
• Risk of acquiring respiratory pathogens
decreases with distance.
• There is evidence that most influenza
pathogens are transferred at close range (< 2
meters.)

8. Contact
• Direct Contact – infection-bearing particles are
transferred directly onto the mucous membranes
of a new host (e.g. through kissing or direct
intake of ballistic particles.)
• Indirect Contact – infection-bearing particles are
conducted from a contaminated surface to a
location where they may enter the new host’s
airway (i.e. from table to hand to nose/mouth.)

9. How long can it live outside the body?
Hard Surfaces: 24 – 48 Hours
Soft Surfaces/Clothing: 8 – 12 hours
Skin/hands: 5 minutes
• However it will only infect a person for up to 8
hours after being deposited on a hard surface
and minutes on a soft surface or skin. This is
why routine hand washing and cleaning of
surfaces are so important.

10. The Evidence
Council for Canadian Academics:
1. Influenza is transmitted primarily at close
range (< 2 meters).
2. Influenza enters a new host primarily through
the oral or nasal airways.
3. Adopting a Hierarchy of Controls will deter
the spread of influenza – no single level of
deterrence will be effective on its own.

11. So how do we protect ourselves?
The Hierarchy of Control
Vaccines/Anti-viral Medications
Engineering - Barriers (the 2m. Rule)
Environmental Controls/Ventilation
Administrative – Screening/Sequestration
Hand Hygiene
Respiratory Etiquette
Personal Protective Equipment –
Masks/Gloves
Glasses/Gowns

12. How does this work?
Vaccines – introduce a small amount of the virus into
your body to encourage the development of immunity.
(A vaccine is on-line to be delivered in November.)
Anti-viral medication – if your body can not fight off the
virus on its own, there are two anti-viral medications
effective against H1N1:
- Tamiflu (Oseltamivir)
- Relenza (Zanamivir)
(Both have been distributed throughout the Territory
for use in specific cases under the direction of YCDC.)

13. How does this work?
Engineering Controls
- Environmental controls that lower humidity and
temperature decrease the life-time of influenza
pathogens outside a host’s body.
- Air filtering and venting prevents the re-circulation of
air thus removing infected particles from the
immediate environment.
- Maintaining a 2 meter distance from suspected hosts
of influenza decreases likelihood of inhalational or
direct contact with infected particles.

14. How does this work?
Administrative Controls
- Hand hygiene prevents the transfer of
pathogens from contaminated surfaces to
areas around your mouth and nose where they
can be inhaled.
- Routine cleaning prevents surfaces from
remaining contaminated.
- Respiratory etiquette (“sneeze in your sleeve”)
prevents contamination of surfaces.

15. How does this work?
P.P.E. - “The last line of defense”
Masks – Filter particles that are small enough to
enter the lungs.
Gloves – Prevent contamination of your hands.
Gowns – Prevent contamination of your
clothes.
Glasses – Prevent direct contact between
ballistic particles and your eyes.

16. Personal Protective Equipment
(Getting ready)
Gown
then
Mask
then
Glasses
then
Gloves

17. Personal Protective Equipment
(Taking it off)
Remove GLOVES
then
Remove GOWN
then
PERFORM HAND HYGIENE
then
Remove GLASSES (set aside)
then
Remove MASK
then
Place in a GARBAGE BAG
and
WASH YOUR HANDS again.

18. Screening
A series of questions asked by 811, central
ambulance dispatch or a community health
practitioner to determine if flu symptoms are
suspected.
Aim: 1. To determine if PPE should be worn
2. To determine where initial care should
be performed (home vs. hospital)
3. To prevent swamping health care facilities

19. Screening Questions:
1. Is there evidence of a respiratory illness? (Shortness
of breath, new cough or fever?)
AND
2. Is there a report of a sore throat, weakness, excessive
fatigue, joint pain or muscle pain?
3. Is there a recent history of contact with another
person who has any of the above symptoms?
(Recent travel may be relevant but should not be
used to determine whether or not Influenza-like
symptoms are present. “Yes” to #1 and ONE other
symptom indicates need for pre-hospital PPE.)

20. Screening Duties
• 811 – Will answer questions from the public and to
perform initial screening of reported flu symptoms.
• CENTRAL AMBULANCE DISPATCH– If the Computer
Aided Dispatch (CAD) system identifies a call-type
linked to shortness of breath, chest pain, general
illness or “unknown” the screening tool will be applied
and PPE recommended to the EMS crew when
indicated.
• COMMUNITY NURSING– Before sending a rural
ambulance crew to a residence, the community nurse
should determine whether PPE should be worn by the
responding crew. (If this information is not passed to
the EMS crew, they should ask if PPE is required.)

21. Medevac
• During the Triage/Nursing Report, the lead
Medevac attendant will determine if there is
evidence of ILI.
• The Medevac Lead Attendant will be responsible
for informing the flight crew and other EMS staff
when PPE are to be worn.
• The Medevac Lead Attendant will be responsible
for informing the receiving facility whenever a
patient with ILI symptoms is being transported.

22. Ground EMS
• Ambulance Crews – on arrival at scene, if the
symptoms outlined by the screening tool are
recognized the crew members should retreat,
apply PPE and then re-enter to provide care.
• Contaminated PPE must not be worn in the
driving compartment of the vehicle. If PPE is
worn in the driving compartment, the entire
vehicle must be cleaned after the call.

23. Patient Transport
• Whenever an EMS attendant is within 2
meters of a patient with ILI symptoms full PPE
will be worn.
• Before driving the ambulance, all PPE must be
removed by EMS staff not riding in the patient
compartment.
• Before re-establishing contact with the
patient, fresh PPE must be put on by all
attendants participating in patient movement.

24. Patient Transport (Con’t)
• Before arrival at any receiving facility, the
receiving staff must be advised that the
ambulance is transporting a patient with ILI
symptoms.
• On arrival the driver should contact the receiving
staff to determine the destination of the patient
within the facility. The shortest route to this
destination should be employed. (The patient
may remain in the ambulance with the attendant
until a bed/room is available.)

25. Vehicle Decontamination
• All surfaces that have been in contact with a
patient with ILI symptoms must be wiped
down.
• ANY cleaning solution (soap and water, bleach
solution, Virox wipes or commercial chemical
wipes) will be effective in eliminating H1N1
and flu particles.
• Ensure that full PPE are worn during
decontamination procedures.

26. Equipment Decontamination
• Hard surfaces may be decontaminated in the
same manner as the vehicle interior.
• Soft equipment (i.e., bags and packaging) may
be wiped down if not excessively
contaminated.
• If a bag or equipment package has been in
direct contact with contaminated particles
(i.e., sneezed or spit upon), it will have to be
emptied, removed from service and washed.

27. Clothing Decontamination
• If a gown is worn, most particles will be
prevented from contaminating clothing.
• If the gown has become saturated, infected
particles may penetrate to the clothing
beneath. At the earliest opportunity, soiled
clothing should be removed, the skin beneath
cleaned, and a fresh uniform applied.
• Machine washing or dry cleaning is effective
against ILI/H1N1 contaminants.

28. Questions and Answers
1. Is it safe to launder my uniforms at home?
2. How long will a N95 mask protect me?
3. How do I know when to use an N95 versus a
surgical mask?
4. How does the 2 meter rule protect me?
5. When should I wash my hands? How often?
6. If I get the flu, how do I know when I can
safely return to work?

29. Questions and Answers (Con’t)
7. What are the best cleaning solutions to use
for cleaning at home? My workspace? My
clothing?
8. What are the questions I can use to screen for
ILI? Whose job is it?
9. What is the plan to ensure that there is
enough PPE to protect our EMS responders
and support staff during a flu outbreak?

30. Questions and Answers (Con’t)
10. I think I (or someone that I care for) has the
flu. What should I do?
Resources:
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
811 – Telehealth Nurse on Call

31. YEMS Pandemic Representative
Jeff Simons – Medevac
Jeff.Simons@gov.yk.ca
jeffsimons@kos.net
Cell: 867 334 8851