FIREFIGHTERS AND EBOLA: 10 WAYS TO PROTECT YOURSELF AND YOUR FAMILY

ebola and firefighters

UPDATED EDITORS NOTE: This article was written in 2014 at the height of the Ebola outbreak in Africa, when several cases popped up in the United States. Most medical and first responder agencies quickly realized they were unprepared to address the potential of a disease with the rapid spread and high mortality rate of Ebola.

During the Ebola outbreak of 2014, most medical and first responder agencies reactively scrambled to educate their members about the disease, gather appropriate equipment to safe guard members during potential responses, and set new policies to deal with a potential local outbreak.

The article below is focused on Ebola, specifically from a firefighter/first responder perspective. Even though the Ebola cases in the United States and elsewhere (outside of Africa) were contained, the article will give you a good background into Ebola and first responder agency’s concerns when dealing with it. You are strongly encouraged to read this article, because the information and precautions can be applied to other infectious diseases you will encounter this flu season and beyond.

A new, more general article on infectious diseases is currently being written and will be published soon. Some of the information will overlap, but knowing we will soon be full-swing into flu season, both articles will be worth reviewing and discussing with your crews to keep you and your families safe.

Be prepared, take precautions and stay safe.

ORIGINAL EBOLA ARTICLE:

Now that Ebola has made its way beyond the borders of Africa, emergency responders in other areas need to be aware of the risks this disease poses and the preventative measures that can be taken to reduce those risks.

Many departments around the nation are feeling the pressure to prepare for Ebola’a potential arrival. Firefighters and firefighter unions are sounding the alarm to the fact that first responders are not adequately trained or have the proper safety equipment to deal with Ebola cases if the need arises.

Controversy is increasing over what the proper protective equipment should consist of when dealing with potential Ebola patients. Since Ebola is not currently established in the U.S., some departments are instructing firefighters to rely on their current, everyday medical PPE, usually consisting of some type of smock or jacket, gloves, eye protection and N95 or P100 mask. Other departments are following the CDC’s (Centers for Disease Control and Prevention) guidelines of an impermeable/fluid resistant gown, gloves, eye protection consisting of face shield or goggles and leg covers and shoe covers as needed (The CDC is currently revising their guidelines to recommend full skin coverage). Still other departments are preparing their firefighters to use full covering Level B suits with respirators or positive pressure breathing apparatus.

Another point in question is whether PPE should be disposable after single use or should be decontaminated and used repeatedly. Of course disposable PPE will create higher financial burdens for departments, but decontaminating PPE has its own risks of cross contamination. Training to safely remove PPE is also needed, since removing PPE, whether disposable or reusable, has proven to be a significant source of contamination to medical workers.

Departments are also being forced to address ways to equip crews with sanitizing disinfectants to use on potentially contaminated surfaces encountered on-scene. Bleach solutions, Viral Oxide spray and ultraviolet lights are a few of the disinfectants that are being issued.

Many 911 dispatchers are receiving training to screen calls prior to dispatching crews in order to alert first responders to potential Ebola cases. Some transporting departments are designating specific ambulances to be solely used for Ebola patients, and some EMS agencies are developing new medivac flight criteria to address Ebola contamination concerns.

Regardless of where individual departments fall on the Ebola preparedness scale, every first responder should be proactive in their own education regarding Ebola. We all need to know what Ebloa is, how it spreads, what the signs and symptoms are and what we can do to minimize our risks of contraction.

Share this information with your crew. Discuss it and make sure your department is being proactive with Ebola related training and equipment. As with the rest of our training and responses, preparation is our best asset to ensure our success and safety.

What Is Ebola?

Ebola is a virus, which is now known as Ebola Virus Disease (EVD). It was previously known as Ebola hemorrhagic fever. Ebola is a systemic disease that attacks the organs and tissues in the body and causes simultaneous blood clotting and hemorrhaging issues.

After entering the body, the virus infiltrates the cells where it replicates itself and spreads. A protein called ebolavirus glycoprotein, is released and attaches to the endothelial cells on the inside of the blood vessels. This results in increased permeability of the vessels leading to blood leaking and the beginning of the hemorrhaging process.

The Ebola virus has a way of turning the body’s immune system against itself. Macrophages (immune cells) are invaded by the virus and those infected macrophages then spread the virus to other organs in the body such as the liver, kidney, spleen and brain.

Ebola wreaks significant damage in the liver, destroying cells needed to produce coagulation proteins and other components of plasma, effectively destroying the body’s ability to slow bleeding. Once established in the adrenal gland, the virus cripples the cells that make steroids to regulate blood pressure and causes circulatory failure that can starve organs of oxygen.

Molecules called cytokines are usually responsible for activating an inflammatory response to alert the body of an attack; however, with Ebola and its rapid replication of cells, the cytokine response is overwhelming and leads to a Cytokine Storm. During a cytokine storm, the body’s immune system releases everything it has to combat the virus, including platelets and white blood cells. As a result, the blood becomes even more permeable and causes further and more rapid hemorrhaging. The body then releases nitric oxide to try to regulate the blood pressure, but this thins the walls of the blood vessels, further weakening them and accelerating the hemorrhaging.

Due to the hemorrhaging blood vessels and the body’s inability to effectively combat the virus attack, the outcome will frequently lead to multiple organ failure, shock and quite often, death.

There are no known vaccines for Ebola (EVD). Supportive care such as I.V. fluids and medications to help regulate the heart and keep the blood pressure up are the most common treatments at this time.

How Is Ebola (EVD) Spread:

Ebola is considered extremely infectious, but only moderately contagious. The difference being that it only takes a very tiny amount of the virus (1-10 aerosolized viral particles) to infect another person, which makes it very infectious. However, since it’s believed Ebola can only be transferred through direct contact with infected bodily fluids, it is considered only moderately contagious. Here is an NPR article that explains the contagious rates of Ebola compared with other more common illnesses.

The Ebola virus is only contagious after symptoms are present. During the incubation period it is not contagious; however, once the symptoms (fever, sweats, vomiting, diarrhea, etc.) appear, the virus is transferrable to others.

The Ebola virus is spread through human-to-human transmission via direct contact with bodily fluids such as blood, saliva, sweat, vomit, breast milk, semen, urine and feces. These fluids (only a tiny amount required for transmission) must enter the new host via mucus membranes or broken skin. Ebola can also be spread through contact with needles or syringes that have been contaminated with the virus.

While Ebola (EVD) is not a respiratory disease (coughing and sneezing are not typical symptoms of Ebola), if you encounter an Ebola patient who is exhibiting those symptoms, extra caution should be taken. According to the CDC, if an Ebola patient coughs or sneezes and droplets of their mucus or saliva come into contact with the mucus membranes of another person, the fluid droplets can transfer the disease.

In addition, the virus can live outside the host, on door knobs, countertops, etc for several hours and can be transferred during that period. The virus can also live for several days in blood and other bodily fluids at room temperature, so extra caution should be taken around bedding, clothing and other items contaminated with infected bodily fluids.

The virus can be transferred through improper handling of the bodies of the deceased. If you respond to a suspected DOA that you think could be infected with Ebola, take all precautions in your scene assessment prior to making contact with the patient or any items that could be a source for transmission.

As far as animals are concerned, it’s well known and documented that the Ebola virus can be spread to humans through contact with infected primates and bats. There is no current evidence that typical domestic pets such as dogs and cats can contract or transfer the disease.

Hospital grade disinfectants and bleach can be used to disinfect surfaces of Ebola virus (EVD).

Signs And Symptoms Of Ebola

There are distinct stages of progression with the Ebola virus that first responders should be aware of to help identify the possibility of the disease and to determine the level of crew safety precautions that should be implemented.

The incubation period for Ebola, the time interval from exposure/infection to the time of onset of symptoms, is typically 4-10 days, but can range between 2-21 days. Patients will be contagious once the symptoms appear, which will typically be the period firefighters and first responders will be called.

INITIAL SIGNS AND SYMPTOMS OF EBOLA will usually include sudden onset of:

  • Fever (greater than 101.5F)
  • Fatigue/Weakness
  • Headache
  • Muscle Pain
  • Sore Throat

LATER SIGNS AND SYMPTOMS OF EBOLA will usually include:

  • Abdominal Pain
  • Diarrhea
  • Vomiting
  • Possibly a Rash
  • Symptoms of impaired kidney and liver function
  • Internal and external hemorrhage (bruising, bleeding from gums or blood in the stools)

LAST SIGNS AND SYMPTOMS OF EBOLA will include:

  • Multi-organ failure
  • Shock
  • Coma
  • Death

A TYPICAL EBOLA (EVD) TIMELINE is as follows:

  • Time of Exposure
  • Incubation period: typically 4-10 days, but can range between 2-21 days before symptoms             appear.
  • Course of illness (when symptoms appear after incubation period): typically 6-10 days
  • Days 1-3: Patient presents flu-like symptoms and weakness
  • Days 4-7: Patients may experience vomiting, diarrhea, nausea, headaches, low blood  pressure and anemia (from blood/volume loss).
  • Days 7-10: Near the end of the illness, patients often experience confusion, bleeding (both internal and external), which may be visible in bruising or bleeding of the gums, nose or eyes. These symptoms increase until multi-organ failure, shock, coma and death.

As first responders it’s important to understand the disease, the modes of transmission and the various stages of symptoms. Only from this can we quickly assess situational awareness and appropriate scene safety protocols, to ensure proactive precautions are implemented.

10 Ways Firefighters Can Minimize Ebola Risk To Themselves And Their Families

1.  BE PROACTIVE: Educate yourself and your crew about Ebola (EVD), including the signs and symptoms, the risks, modes of transmission and precautions to take. Be proactive in this education/training, not reactive after Ebola becomes established in your area.

2.  COMMUNICATE: Even though the initial Ebola symptoms describe typical flu-like symptoms we see on a regular basis, ALL patients who present these symptoms should be asked if they or anyone they’ve had contact with recently traveled to Africa or anywhere else Ebola becomes established.

3.  PPE: Utilize universal precautions and wear full PPE. Ideally this will include a Level B suit that fully covers the wearer and a respirator or positive pressure breathing apparatus. At the very minimum follow the CDC guidelines of an impermeable gown, double gloves, respiratory protection (respiratory or P100 mask) eye protection with a face shield and leg covers and shoe covers/booties. Basically, you want your skin covered, respiratory system protected and your eyes and other mucus membranes protected. 

4.  MASK PATIENT: If a patient is suspected as a potential Ebola patient, place a P100 mask on them to help contain any contaminated saliva.

5.  DOFFING PPE: After patient has been transported, use extreme care when removing PPE and place PPE in biohazard bags for disposal or decontamination procedures. The removal of contaminated PPE has proven to be a common source of virus transfer to health workers. Wear double gloves so you can maintain a barrier while removing the main contaminated gloves and other PPE. See this CDC produced infographic on safely removing PPE.

6.  WASHING/SANITIZING: Hands should be washed with soap and water (preferred) or a waterless, alcohol-based hand sanitizer containing at least 60% alcohol immediately after removing PPE. Soap and water should be used if hands are visibly soiled.

7.  DECONTAMINATING EQUIPMENT: If you think you have been in an exposed environment, decontaminate as much of your gear prior to getting into the apparatus or returning to the station. Since the virus can live on surfaces, it’s important to take precautions to disinfect gear, shoes, etc, prior to returning to the station or home.

8.  REPORTING AND DOCUMENTATION: If you suspect you’ve been exposed to an Ebola patient, advise your department’s EMS Officer PRIOR to returning to the station and follow up with appropriate exposure forms. (Remember, this documentation is to protect your rights if the exposure turns out to be positive and is contracted by you.)

9.  HOME/FAMILY SAFETY: If you suspect you have been exposed to Ebola, exercise caution before going home or taking gear home. While there is an incubation period before patients become contagious, that incubation timeframe varies by person. You would not want to unnecessarily expose your family.

10. SELF MONITORING FOR SYMPTOMS: If you believe you were exposed, closely monitor your own vitals and symptoms and ensure your crew does the same. The best survivability rates have come from quick diagnosis and supportive treatment. If any symptoms appear after a potential exposure, immediately advise your EMS officer and medical staff.

While Ebola (EVD) is not well established outside of Africa, there have been isolated cases in the United States and Europe. With modern travel practices Ebola can spread and become established anywhere in the world at any time. Proactive education about the disease will help firefighters be prepared if this disease does spread.

Your safety is ultimately your responsibility, and if you are a company officer, your crew’s safety is also your responsibility. And of course, we all have a responsibility to keep our families safe. The best safety measures we can take right now are educating ourselves and dialoging within our departments to ensure we are all prepared ahead of time.

For further information:

World Health Organization (WHO) Ebola Factsheet:

Center for Disease Control (CDC): Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States

CDC’s Case Definition for Ebola Virus Disease (EVD)

If you have any other Ebola related thoughts, tips or advice for firefighters and first responders, please share them below.