EMS Fights the Flu – The 2013 influenza epidemic

It’s hitting early, it’s hitting hard, and it’s no joke. This year’s flu season is filling up the nation’s emergency departments, urgent care centers, hospitals, and ambulance run sheets fast. In the US a majority of states are under “widespread” or “intense” flu conditions. No state is currently reporting low levels of flu activity and all states are affected.  According to both Google flu trends and the Centers for Disease Control and Prevention (CDC), the US is right in the throes of an intense and widespread flu season that is sickening many people all over our country. The US flu season generally occurs in winter when people tend to congregate indoors, and this year’s locally cold winter is helping the flu spread quickly.

The “flu” is an abbreviation for the disease “Influenza” which is caused by the various incarnations of the influenza virus. The disease has become such a part of our culture that people call almost any minor illness a touch of the “flu.” People say things like “I have the stomach flu” when they have a case of gastroenteritis, or say that they have the flu when they’re feeling a tad under the weather. This causes a lot of misconceptions about what influenza actually is and can cause us to let our guard down about treating the disease and protecting ourselves from it. Make no mistake that the actual flu is a serious illness that can make even an otherwise healthy person incredibly ill. While the symptoms of the disease themselves can seem relatively minor, the intensity of those symptoms and the complications they can lead to are quite serious and can even be fatal.

Influenza is a viral infection that causes symptoms similar to the common cold. However, the symptoms are markedly more severe with the flu than with a cold. The flu brings intense fever, exhaustion, and severe body aches. Influenza is a respiratory illness though it sometimes brings gastrointestinal symptoms like, nausea, vomiting, and diarrhea. The flu can lead to complications such as dehydration, secondary infections, pneumonia, electrolyte imbalances, cardiac symptoms and exacerbations of asthma and COPD. While most influenza-related fatalities are in vulnerable populations such as the very young, older adults, and in those with compromised immune systems, this is not always the case. In the Spanish Flu pandemic of 1918, the Russian Flu pandemic of 1978, and the possible 2009 H1N1 pandemic, most of the fatalities were in the young adult age range.

While modern medical practices do tend to lessen the impact of a flu pandemic in contemporary times, they are still very worrisome as even seasonal influenza epidemics can overwhelm existing medical facilities and cause an estimated 3,000 to 43,000 deaths in this country each year. The CDC cannot accurately count morbidity and mortality from confirmed influenza infections as medical facilities are only required to report deaths from Influenza or “influenza-like-illnesses” (ILIs) in children, however their estimates over the last decade show an average of 30,000 deaths in the US per year. In comparison, in 2009 the CDC estimates that 17,774 people died from HIV/AIDS.

Influenza has caused pandemics, or global infections, throughout human history. While most countries experience epidemics of influenza at regular intervals, the influenza virus occasionally mutates into a particularly virulent strain and spreads quickly throughout the globe. In the 1918 Spanish Flu pandemic it is estimated that between 1% and 3% of the total global population died with an estimated 600,000 deaths in the United States alone. In more remote areas of the country the mortality count was higher with some villages in Alaska being completely decimated. The “Hong Kong Flu” pandemic in 1968-1969 is said to have killed over one million people worldwide with over 33,000 fatalities in the US. The last official pandemic influenza was in 1978-1979, the “Russian Flu” affected mostly the younger population. In the 21st century, the World Health Organization is attempting to ascertain if the 2009 worldwide outbreak of “H1N1” influenza classifies as a pandemic, with epidemiologists still conducting research. Recently, the CDC has estimated that the 2009 virus killed between 171,000 and 574,000 people worldwide.

Clean your equipment! Don't let your truck be a vector for the spread of disease

The flu is no joke and EMS providers need to practice prevention and infection control. First off, get your flu shot. Ignore the myths about the vaccine and just get it. Immunized healthcare workers are less likely to get sick themselves, are less likely to spread the flu amongst their patients, and are less likely to bring the virus home to their families. EMS providers need to thoroughly clean and sanitize their ambulances and patient care equipment. Hand washing is extremely important, as is the use of proper PPE. All patients exhibiting symptoms of an influenza-like-illness such as a cough, fever, and/or gastrointestinal symptoms should be asked to wear a mask. EMS providers should wear a surgical mask when treating these patients as well. Influenza is spread through droplets that are aerosolized when coughed or sneezed up by an infected person. These droplets settle onto surfaces via gravity and are spread via personal contact or through contact with the droplets while they are airborne. The CDC estimates that the influenza virus can remain viable on external surfaces anywhere from between 2 to 8 hours exposed to the environment. This is more than enough time to cross contaminate your next patient or your coworkers on the next shift. The virus can be killed on surfaces with commonly available disinfectants and regular cleaning and it can be killed on your hands with soap and water or alcohol-based hand sanitizers; However, once a person is infected, the virus cannot be killed with any medical treatment. It can only be slowed down or allowed to run its course.

Protect yourself, protect your patients, and protect your community. Be serious about preventing the spread of the flu. EMS providers are the first line of defense against this insidious disease. Remember that if you are sick, stay home. A person remains infectious for around 7 days after symptoms first appear. Stay home from work until you are at least 24 hours free from fever. Flu prevention is truly an area where EMS is at the intersection of Medicine and Public Health. As with many things, an ounce of prevention can go a long way in the fight against flu.

 

 

 

A comparison of Symptoms between the Common Cold and the Flu

 

Common Cold

Flu

Symptoms

Cold symptoms appear gradually and include sneezing, cough, stuffy nose and sore throat. Fevers are very rare and fatigue is mild. Headaches sometimes occur.

Flu symptoms appear quickly (within 3-6 hrs) and include fever, chills, severe aches and chest discomfort.

Severity:

Usually does not cause severe health problems.

Serious health problems, such as pneumonia, bacterial infections, or hospitalizations can occur.

Fever:

Rare

Usually present

Fatigue:

Mild

Moderate to severe

Chills:

Rare

Common

Sneezing:

Common

Rare

Chest pain:

Mild to moderate

Often severe

Coughing:

Hacking, productive cough

Dry, unproductive cough

Headache:

Rare

Common

Stuffy nose:

Common

Rare

Aches:

Slight, but only headaches

Usual and often severe, affects the entire body.

Sore throat:

Common

Rare

Treatment:

There is no cure for the common cold. Cough syrup and other cold medications are available to ease some of the symptoms and make the patient feel a little better. Tea and nasal drops also sometimes help.

Sometimes antiviral medication helps control the flu but often patients simply wait for their body to fight the virus and overcome the disease. Medication is also available to ease patient comfort.

Duration of illness:

Symptoms typically peak two to three days after infection onset, and usually resolve in seven to ten days.

In children, the cough lasts for more than ten days in 35–40% of the cases and continues for more than 25 days in 10%. Adults usually feel better in seven days.

Seasonal?

Not seasonal (occurs throughout the year)

Seasonal (in winter). In the U.S., flu season is generally October to May and peaks in February.

Vaccine?

No

Yes

Causative Organism:

adenoviruses, coronaviruses, rhinoviruses (most common cause), respiratory syncytial virus, parainfluenza virus, influenza virus

Influenza virus

 

  • Bob

    hey people

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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