Pandemic Planning & the Swine/H1N1 Flu

Click here to access EMS Magazine online exclusive content detailing how officials in the San Antonio region put their pan flu plans into action and scroll down for additional resources.

     Our experts agree - EMS agencies need to stay informed about the status of the ongoing swine flu (H1N1) outbreak and to look first to their local and state pandemic preparedness guidelines. They should also inquire about any special instructions or notifications at their local, state or federal level.

     "This is a critical time," says Raphael M. Barishansky, public health emergency preparedness expert and EMS Magazine editorial advisory board member. "EMS agencies need to take this opportunity to be proactive in getting guidance and information."

     Following the initial outbreak in late April, the flu continued to spread through May but lacked the virulence or fatality factor initially feared. As of May 11, the CDC reported 2,618 cases with three deaths in the U.S. in a total of 44 states. Worldwide, 30 countries had officially reported a total of 4,694 cases.

     However, federal officials warned that it is too early for complacence. The CDC announced that it anticipates "more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks because the population has little to no immunity against it."

     Officials also remain concerned that even if the flu fizzles out now, it might follow a cycle like the common flu and come back harder in the fall, although by then, they hope to have a vaccine.

     Regardless of whether this outbreak becomes a true pandemic, it has provided a revealing glimpse into modern global reaction and response.

     The World Health Organization (WHO) was quick to increase its pandemic alert levels to the second-highest level possible. Both the WHO and the CDC have provided daily online updates and guidelines, keeping the flow of information accurate and accessible. The media both informed and frightened the public while government officials debated travel restrictions, school closures and the canceling of public events. However, when the flu failed to meet expectations, there was less relief than public backlash over the "hype" and "fear-mongering."

     -Heather Caspi, EMSResponder.com

WHAT EMS PROVIDERS NEED TO KNOW ABOUT SWINE FLU

     Symptoms of an H1N1 infection are identical to that of influenza, notes EMS Magazine contributor Kevin Thomas Collopy. "They include lethargy, fever, weakness, sore throat, runny nose, coughing, loss of appetite, nausea and vomiting. In severe cases, patients can develop shortness of breath progressing to respiratory distress, dehydration, cyanosis, mental status changes and severe anxiety and agitation."

Transmission

     Like other influenza viruses, H1N1 is airborne and can also be spread through direct contact, Collopy says. "Typically human-to-human transmissions occur when an infected individual coughs or sneezes, or when an infected individual touches something (e.g., rails of a cot) with the virus and then another individual touches the same surface before it is cleaned. The incubation period is as short as 24 hours, or up to a week depending on the source."

EMS Management of Influenza A (H1N1)

     Management is symptom-based, Collopy notes. "Treat suspected dehydration with IV fluids and shortness of breath as needed. Protect the critical systems. After a physician evaluation, patients can be treated with antiviral drugs. Antibiotics are ineffective, as are previous influenza and H1N1 inoculations.

Antiviral Resistance

     According to the CDC, this virus is sensitive to the neuraminidase inhibitor antiviral medications, zanamivir and oseltamivir, and resistant to the adamantane antiviral medications, amantadine and rimantadine. Recommendations for use of antivirals may change as data become available, and clinical judgment is an important factor in treatment decisions.

Key Differences

     There are some differences between the H1N1 flu and the common flu that are of concern, according to Katherine West, infection control expert and EMS Magazine advisory board member.

     For one, "It is a new virus - components of three viruses have merged to form this new virus," she says. "There is therefore no basis for comparison to previous outbreaks of the 'swine flu,' because they are not the same virus."

     Also, this flu has been hitting a population with an average age of 16. "Usually flu hits the very young and the very old, so this is different," West says. In addition, "It's the end of the flu season that this is occurring, so that's an interesting fact."

Special Considerations

     All of our experts had some common advice for healthcare providers: get a travel history from suspected patients; take extra effort to follow standard infection control measures; and keep perspective.

     For official tracking and federal interim guidelines, visit www.cdc.gov/h1n1. For news coverage and related resources, visit www.emsresponder.com/swineflu.