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Ebola

Level 1

Ebola EMT Refresher Course EMSNeeds.com Continuing Education

Overview | Assessment | Treatment | Roles

Objectives

In this Ebola Virus Disease (EVD) course you will earn 2 CE hours. This course is accredited for all levels since all EMS personnel are technically First Responders.

At the end of this course you will be able to:

  • Identify the biosafety precautions.
  • Notice the onset and progression of illness.
  • Explain the origin and spread of the virus.
  • State the ways that it is spreading throughout the world..
  • List the high risk and low risk factors.
  • Describe the symptoms of Ebola.

References for content used by permission are on the left side under "EMS Resources."

There are four sections: Overview, Assessment, Treatment, and Roles. Take the section tests in order by clicking the Take Test button. Your results are saved if you are interrupted. Then do the next section—no lost time or effort with mini-test sections!

EMS Course Levels
Overview

Ebola is a viral illness that is most often spread by bats in Africa. The outbreak that has spread to the United States in 2014 has come most often from healthcare workers who have treated patients in West Africa. The most obvious source is fruit bats that are migrating and roost in colonies. One source of contact is with bat droppings and with saliva from fruit that is partially eaten. However, in the US, bats spread rabies and not Ebola.

As of October 2014, Ebola is endemic only in three countries in West Africa, not all of Africa. Only Liberia, Sierra Leone, and Guinea are affected at this time. Even though there have been patients treated in New Jersey, New York, and Texas, people living in those states are not at risk for Ebola.

Some hosts of Ebola that are infected are antelopes and great apes. How does this transfer to humans? Incidental hosts who receive cuts or are exposed to the blood of these animals by hunting or butchering them are transmitters.

How many people die from Ebola?

The rate of death is 50%, where there are no IV fluids and critical care provided. Severe viral hemorrhagic fever results from Ebola with a high mortality rate. Current research reveals that there are five virus species in the genus Ebolavirus.

This outbreak in 2014 of the Zaire ebolavirus species is the most widespread in the history of the disease. DNA sequencing is revealing more details about the likelihood of spreading EVD. When it broke out in 1995 in Kikwit, Democratic Republic of the Congo, only 28 of 173 cases developed. No families with direct contact became infected then. In 2000 in Gulu, Uganda, the virus was contained. Where decontamination is frequent, the virus is less capable of transmission. However, in 2014 over half of the healthcare workers have died from it (244 out of 450, recorded as of October 23, 2014). In the US, two cases were imported, with one death, and two other cases of the Ebola virus disease were acquired locally.

Definitions

  • Asymptomatic - showing no evidence of disease
  • Bodily fluids - blood, saliva, sweat, vomit, feces, urine, semen, breast milk, tears, etc.
  • CNS - central nervous system
  • Close Contact - Within 3 feet of someone showing signs of Ebola without having PPE for a longer period of time.
  • Coma - a state of prolonged unconsciousness, including a lack of response to stimuli, fromwhich it is impossible to rouse a person
  • Delirium - a more or less temporary disorder of the mental faculties, as in fevers,disturbances of consciousness, or intoxication, characterized by restlessness,excitement, delusions, hallucinations, etc.
  • Diarrhea - an intestinal disorder characterized by abnormal frequency and fluidity of fecalevacuations
  • Donning - putting on
  • Doffing - putting off
  • EVD - Ebola virus disease
  • Hemorrhage - a profuse discharge of blood, as from a ruptured blood vessel; bleeding
  • Jaundice - yellow discoloration of the skin, whites of the eyes,etc., due to an increase of bile pigments in the blood, often symptomatic of certaindiseases, as hepatitis
  • Myalgia - pain in the muscles; muscular rheumatism
  • Pancreatitis - inflammation of the pancreas (a gland, situated near the stomach, that secretes a digestive fluid into the intestinethrough one or more ducts and also secretes the hormone insulin)
  • Petechiac - characterized by a minute, round, nonraised hemorrhage in the skin or in a mucous or serous membrane called a petechiae
  • Replication - the production of exact copies of complex molecules, such as DNAmolecules, that occurs during growth of living organisms
  • PPE - personal protective equipment
  • Percutaneous - administered, removed, or absorbed by way of the skin, as an injection, needle biopsy, or transdermal drug
  • Quarantine - keep in isolation
  • Somnolence - tending to cause sleep

Accurately assess and record vital signs.

Stop the panic about Ebola.

 


Assessment

How Does Ebola Begin?

Ebola is only contagious when patients are symptomatic. It begins like flu. There are body aches with low-grade fever that spikes. Some report having pulsating headaches. These symptoms may not be evident for several days because the incubation period is 5-10 days, and the range can be a few as 2 days and as long as 3 weeks. This disease, that is hard to get, is most obvious in one week.

The way this virus kills is that it replicates or repeats itself. Unlike the flu that usually lasts for a few days, the Ebola virus victim becomes worse with time. This systemic cycle causes cellular destruction.  A significant amount of vomiting results. Diarrhea ensues that may turn bloody. Not everyone hemorrhages; only around one-third do. Then various organ systems shut down.

After the flu, there is an abrupt onset with headache, fever, myalgia. As the viral infection continues, there is jaundice and pancreatitis.

Ebola is only spread by body fluids, the same as hepatitis or HIV. It is not spread by the route of respiration or breathing. It is harder to spread Ebola than the measles. There has to be a droplet onto a mucous membrane, or on the skin that then touches mucous. Droplets can be airborne. However, airborne studies indicate that transmission by air has not been demonstrated in humans.

Asymptomatic people are not contagious. Ebola is only contagious when patients are symptomatic. Respiratory Distress Syndrome, SARS, and mumps are easier to catch than Ebola.

How long is Ebola alive outside the body? Experiments have shown that cultures on surfaces that are dry are unable to replicate. In other words, after a body fluid with Ebola is dry, there is not a great chance of transmission. Therefore, be most careful around body fluids.

Ask the patient these questions first:

  1. Have you traveled to Liberia, Sierra Leone, or Guinea in the last 3-4 weeks?
  2. Have you had any contact with people who have traveled to those countries?
  3. Did you have any contact with someone known to have Ebola?

Your job is to assess. Have they come from an isolation ward? Is the quarantine still in effect? What other risk factors are to be considered when evaluation of people with the Ebola virus disease? The CDC lists four categories based on exposure.

High Risk

  • They have had something like a needle stick (percutaneous) or have had mucous exposed to someone with symptoms of Ebola.
  • They have not worn PPE and have been exposed to body fluids of someone with symptoms of Ebola.
  • They have direct contact with corpses that have symptoms of Ebola.
  • They lived in the same house with someone who has symptoms of Ebola.

Some Risk

  • While they were wearing PPE, they have direct contact with someone who has symptoms of Ebola.
  • They were in close contact in a household, a community area, or facility for health care with a person who has symptoms of Ebola.

Low Risk

  • In the last 21 days they were in one of the three countries in West Africa where Ebola is widespread, but they did not know of any exposure to it.
  • Without wearing PPE, they touched someone who had the early stages of Ebola.
  • They were near a person with symptoms of Ebola for a short time.
  • In countries without the widespread transmission, they have direct contact with a person who has symptoms of Ebola, but they were wearing appropriate PPE.

No Identifiable Risk

  • They were with someone who did not have Ebola, but that person had contact with someone who did.
  • They were with a person who at the time did not have Ebola and who now has Ebola.
  • They have been in a country that does not have widespread Ebola virus transmission and do not have any other contact as described above.
See map of countries here.

Gathering information

 

 

Taking pulse

 

 

 

Pulse rate


Treatment

Currently there is no specific medication, treatment, or vaccine for Ebola. Therefore, treatment is primarily related to giving the patient fluids and keeping them alive by addressing the serious health problems that arise from the infection of various organs.

First, protect yourself. Take biosafety precautions.. (See Roles and Responsibilities in the next section.)

No one has got Ebola by being around them. When a patient is coughing or sick, wear a protective mask. Put one on them, too. If you are not as well gowned and gloved when someone is terminal, you may put yourself at risk for catching the Ebola virus disease. Without these precautions, you may contract Ebola.

What can you do?

If a woman who is pregnant contracts Ebola, there is risk for miscarriage. She may become hypertensive, and they lose their blood pressure. Their organs may shut down. Mortality may be higher. She is at increased risk. Breast milk is contaminated.

If you not an emergency medical technician, paramedic, medic, policeman, or healthcare worker, limit who is near the one you think may be at risk of having Ebola. Avoid direct contact with them and call 911.

If you are a family member or one who has to touch the person, wear gloves and a mask. Put a mask on that person also. You will not get Ebola if you do this. All body secretions may cause you to catch the flu, HIV, hepatitis, or just the common cold.
If you suspect Ebola, take a blood sample. Send it to the Center for Disease Control (CDC). In nine hours they would either confirm or deny the case to be Ebola. Usually EVD is detected at the onset of symptoms, but may not be reliable during the first three days.

REMEMBER: Your hands are vectors of transmission.

Signs and Symptoms

Accurate measurement and recording

Take blood pressure.


Roles and Responsibilities

Protecting Yourself and Others

Doctors Without Borders are serving in these areas to provide what is needed to save more lives. They view themselves as potentially contaminated until they clean up with alcohol or diluted bleach. They do not rub any mucous areas like their eyes, nose, and mouth until their personal protective equipment (PPE) is off and stored away. They keep their hands clean, rubbing with alcohol at each stage of PPE donning and doffing and let their hands dry in the interim. More precautions and recommendations are below.

  • While somebody may look “normal” to you or without a fever, they may not be infectious. Sometimes those you treat may even tell you that they have Ebola to distance you, but they really do not because the virus has to multiply in the body before they can transmit the virus. If you suspect that there may be Ebola, have no skin exposed.
  • It is hard to get Ebola. Only spread by body fluids, the same as hepatitis or HIV. Be careful.
  • If you are wearing gloves and have a mask on your face, you cannot catch Ebola unless there are shed bodily fluids.
  • Clean up body fluids afterwards by using alcohol or bleach (dilute bleach 1:10 or 1 part bleach to 10 parts water). Hand wipes that contain one or the other of these chemicals will kill the virus on a surface. Merely getting your hands wet with alcohol will kill Ebola. Sanitation wipes or liquid will work.
  • PPE is essential. Know how to put on and take off protective equipment. At every stage of removal of PPE, clean your hands. Be careful removing your gloves. Put them in a secure place.
  • Be responsible for yourself.
  • As needed hazmat units can clean up the rest. They will spray down the area.
  • Use the sterile inside of the glove that has your hands decontaminated.
  • Use common sense.

Participating in Drills

  • Educate yourself by learning about lab safety and environmental waste disposal.
  • Repeat these skills. Knowing is not enough. Practice these skills, such as donning and doffing PPE by established protocols.
  • Test yourself to see if you can recognize symptoms early. Try to eliminate our enemies of ignorance and fear that spreads panic.
  • Practice setting perimeters. Unless you have had Ebola, do not enter. Guard the hot zone. Unless you are trapped in the hot zone, stay out.

Being Aware that TRANSMISSION Is by Close Contact

  • You are at risk if you are a healthcare worker or anyone who touches patients, works within their soiled area, or you are a funeral or burial person.
  • Police or sentries at the doors of patients in isolation are there to protect others from exposure.
  • You are at risk if you are a family member who is caring for the sick person or bathing the body for burial.
  • The Ebola epidemic will probably subside. However, there will always be people who intentionally want to give you infections or make false reports.
  • Remember to be mindful of what you touch.
  • If you accidentally step in vomit, blood, or feces, your shoe is potentially a carrier. Do not get more of it on you. Decontaminate immediately.
  • Those who are going to help in the affected countries will probably be kept in isolation for 21 days before entering the public arena again.

Practice


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