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Wednesday, February 1, 2023

Guidance for Fire and EMS Response to the Current Outbreak of Monkeypox

To guard against the possibility of airborne transmission, EMS personnel should strictly adhere to standard, contact, and airborne precautions.

Monkeypox is a rare, pox-like viral disease found mainly in Central and Western Africa. In the past several years, cases of Monkeypox have been detected outside of Africa, typically linked to international travel or imported animals. On May 18, the Massachusetts Department of Public Health (DPH) confirmed a single case of monkeypox virus infection in an adult male with recent travel to Canada. The CDC has been tracking the U.S. case as well as multiple clusters of Monkeypox reported in several countries that typically do not see Monkeypox cases including Portugal, Spain, Sweden, Italy, and the United Kingdom (CDC).

EMS Strategies for Preventing the Spread of Monkeypox

Identifying the Signs, Symptoms, and Risk Factors for Monkeypox

  • The signs and symptoms of Monkeypox include flu-like symptoms (fever, headache, muscle aches) and swollen lymph nodes. Learn more about the signs and symptoms of Monkeypox.
  • One to three days after the onset of viral symptoms, the patient will develop a rash that becomes vesicular/pustular starting on the face and covering the whole body.
  • An individual who has recently traveled to a country where Monkeypox is endemic, including Central and Western African countries such as Nigeria or the Democratic Republic of Congo, parts of Europe where Monkeypox has been reported, other areas reporting Monkeypox, cases or had close contact with a person sick with Monkeypox in the last 5-21 days.

How to Prevent Person-to-Person Transmission of Monkeypox

  • A patient is considered infectious 5 days prior to rash onset until crusting of skin lesions.
  • Person-to-person transmission occurs through exposure to large respiratory droplets, which can be projected as far as 6 feet. It can also be transmitted by way of exposure to mucous membranes (eyes, nose, mouth), direct contact with body fluids or lesions, and indirect contact with lesions, such as through contaminated clothing or linens.

PPE for EMS Personnel Managing Patients Suspected of Infection with Monkeypox

  • To guard against the possibility of airborne transmission, EMS personnel should strictly adhere to standard, contact, and airborne precautions. This includes a NIOSH-approved, fit-tested N-95 respirator, gown, gloves, and eye protection with face shield or goggles.

Implementing a Hierarchy of Controls in EMS Care

  • Separate the driver compartment from the patient compartment.
  • Turn the exhaust fan on high in the patient compartment, if so equipped.
  • Adjust air handling to introduce fresh air in both compartments if possible.
  • Driver of ambulance should wear an N-95 respirator if isolation of driver compartment cannot be verified.
  • Limit the number of personnel making patient contact.
  • Use PPE checklists for donning and doffing, ideally with a trained observer. See NETEC’s guide on the role of the trained observer.
  • Exercise caution when performing aerosol-producing procedures, e.g., endotracheal intubation, airway suctioning, CPAP/BiPAP, CPR. Only perform these procedures if medically necessary and cannot be postponed.
  • Clean and disinfect all surfaces of the ambulance and equipment with an EPA-registered hospital grade disinfectant. Look for disinfectants with a label claim against vaccinia.

Infection Prevention and Waste Management When Caring for a Patient with Monkeypox

  • Apply a surgical mask to the patient if tolerated and consider covering the patient with an impervious sheet if rash is present.
  • Monitor personnel for signs and symptoms of illness for 21 days after transport if the patient is confirmed to have Monkeypox.
  • More guidance can be found in the EMS Infectious Disease Playbook in the “Special Respiratory Precautions” section.
  • Monkeypox contaminated waste must be managed as a Category A waste pathogen, requiring specific waste handling, transporting, and final disposal protocols. To determine if this waste may be exempt from category A Infectious Substance Regulations, contact the local public health authorities for further guidance.
  • View the CDC’s Guide, “Managing Solid Waste Contaminated with a Category A Infectious Substance,” to learn more.

Have a question about infection control and management, how to effectively use your PPE, or waste management for a Monkeypox case? Get an answer from a NETEC expert: send us your question today!

Informing Health Care Personnel and Public Health Authorities of a Suspected Case of Monkeypox

  • If you suspect a case of Monkeypox, contact your state health department for possible initiation of special pathogen transport protocols.
  • Inform other responding personnel if a risk of Monkeypox is suspected and prevent unprotected exposure to the patient.
  • Inform supervisory personnel – some communities may have dedicated transport teams and/or designated facilities for transport and management of patients suspected or confirmed to be infected with special pathogens.
  • Inform the receiving facility, as soon as possible, that you suspect a patient may be infected with Monkeypox, so that space is made available to properly isolate the patient on arrival (airborne isolation room if available) and that receiving healthcare personnel are in appropriate PPE.

Read more at the National Emerging Special Pathogens Training & Education Center

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The Government Technology & Services Coalition's Homeland Security Today (HSToday) is the premier news and information resource for the homeland security community, dedicated to elevating the discussions and insights that can support a safe and secure nation. A non-profit magazine and media platform, HSToday provides readers with the whole story, placing facts and comments in context to inform debate and drive realistic solutions to some of the nation’s most vexing security challenges.

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