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Special Pathogen Encounters

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Learning Objectives

  • Identify the different classes of pathogens and treatment methods
  • Identify the steps within the infection cycle
  • Define and give examples of special/high-consequence pathogens (e.g., Ebola and other VHFs, Mpox, MERS, etc.)
  • Pathogen screening and recognition protocols for EMS providers
  • Personal Protective Equipment (PPE): types, donning/doffing procedures
  • Patient transport and ambulance disinfecting procedures
  • Special pathogen notification processes to public health authorities

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Types of Pathogens

Bacteria

  • Description: Single-celled organisms that can cause a variety of diseases in humans and animals.
  • Reservoir: Almost everything, including insects and bodily fluids from humans and animals
  • Types: cocci (spherical), bacilli (rod-shaped), spirilla (spiral), and vibrio (comma-shaped)
  • Treatment: Antibiotics

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Viruses

  • Description: Viruses are microscopic organisms that can infect humans, plants or animals, and require a host cell to replicate itself
  • Reservoir: Almost everything, including insects and bodily fluids from humans and animals
  • Types (based on genetic material):
    • DNA Viruses – Hepatitis B and Adenovirus
    • RNA Viruses – Corona viruses and rotaviruses
    • Retroviruses – HIV
  • Treatment: Antivirals

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Types of Pathogens

Fungi

  • Description: Any of a group of spore-producing organisms feeding on organic matter
  • Reservoir: Various areas on the human body and on the surface area of inanimate objects
  • Types:
    • Superficial fungal infections – Occurs on skin surface (ringworm, oral thrush, and yeast infection)
    • Subcutaneous fungal infections – Occurs under the skin surface causing rashes and ulcers
    • Deep fungal infections – Occurs in lungs, blood, urinary tract or brain (common in the immunocompromised)
  • Treatment: Antifungals

Parasites

  • Description: organisms that live on or inside a host organism and rely on it for survival, often harming the host in the process.
  • Reservoir: Contaminated food, water, insect and other animals.
  • Types:
    • helminths (worms) 🡪Tapeworms, roundworms, hookworms, and whipworms (Localized in the intestines, lungs, liver, and brain)
    • ectoparasites 🡪 Scabies, ticks, lice, and fleas. (Localized on the skin)
    • Protozoa 🡪 Amoebas (localized in the blood, intestines, and other human tissues)
  • Treatment: Antiparasitic medications (Tx depends on the type of parasite)

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Under Constant Attack!!

Pathogens

Immune System

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Infection Cycle

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Prevention Is Key

  1. Donn appropriate PPE when cleaning and during patient contact
  2. Practice good hand-hygiene
  3. Frequently disinfect high-contact surfaces and items

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Trivia:�Studies show the most common reservoir for pathogens are?

Fire-Stash

  • Be sure to clean daily!!
  • Stash-hygiene is key!!

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EMS Infection Prevention Best Practices�

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Designated Infection Control Officer (DICO)

  • What is the role of a DICO?
  • Every EMS provider agency is required to have a DICO
  • Find out who your agency’s DICO is.
  • Reach out to your DICO for any questions regarding infection control/prevention

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2024 Infection Control Assessment and Response (ICAR) �for LA County EMS Providers

  • Assessed providers with the highest call volumes (via interviews with DICO and direct observation on ambulance ride-alongs)
    • 11 providers total participated (7 fire dept. & 4 private ambulance co.)

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  • Summary of findings:
    • Inconsistent annual staff competencies related to infection control practices
    • A lack of infection control audits/feedback being done
    • Performed well on PPE use and safe injectable preparation/administration
    • Low hand hygiene compliance
    • Low compliance with cleaning/disinfecting high touch surfaces

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Special Pathogens

  • Also known as “Emerging Infectious Diseases” (EID) or “High-Consequence Infectious Diseases” (HCIDs)

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  • Definition 🡪 highly transmissible infectious agents that can cause severe illness and are capable of overwhelming healthcare systems.

 

  • They are often novel or reemerging

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Special Pathogen

Country of Origin

Most Recent Confirmed Case in the U.S.

Ebola

DRC & Sudan (West Africa)

September 30, 2014

Marburg

Uganda

None

Lassa Fever

Nigeria (West Africa)

2024

*H5N1 aka “bird flu”

(Currently no human-human transmission detected)

China

February 21, 2025

H1N1 aka “swine flu”

U.S.A.

2009 pandemic

MERS-CoV

aka “MERS”

Saudi Arabia

2014

SARS-CoV-2

aka “Covid-19”

China

January 19, 2020

Monkey Pox

aka “Mpox”

Sierra Leone & Liberia (West Africa)

June 2025

U.S. Timeline of Recent HCID Cases/Outbreaks

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Viral Hemorrhagic Fevers (VHF)

Ebola

Marburg

Lassa Fever

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Viral Hemorrhagic Fevers (VHF)

  • Description: A progressive disease caused by a family of viruses affecting multiple body systems, causing severe illness and death, often associated with uncontrolled bleeding

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  • Symptoms: Abdominal pain, vomiting and diarrhea, Flu-like symptoms and Bleeding from various body orifices

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  • Reservoir: Animals and insects (Zoonotic)

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  • Transmission: Animal and insect bites and contact with droppings. Human bodily fluids (blood, saliva, breast milk, urine, feces, etc.) and dead bodies

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  • Types: Various (e.g., Ebola, Marburg, Lassa fever, Nipah, Hantavirus, Crimean- Congo hemorrhagic fever)

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  • Treatment: Hospitalization at an SPTC and isolation. Antiviral medications and supportive care.

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Orthopoxvirus

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Orthopoxvirus – Mpox clade 2B

  • Description: A highly contagious virus that causes fluid-filled pustules on the skin, concentrated on the extremities, face, and genitals

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  • Symptoms: Fever, headache, muscle aches, back pain, swollen lymph nodes, and a rash that can appear on various parts of the body

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  • Reservoir: Monkeys, rodents, and other small animals

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  • Transmission: Respiratory droplets and fomites. Exposure to infectious lesions and bodily fluids. Sexual contact.

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  • Types: Various types/subtypes categorized by Clade

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  • Treatment: Supportive care, and an antiviral called “TPOXX”

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Novel Influenza Viruses and Coronaviruses

  • Description: Novel influenza viruses and coronaviruses are typically zoonotic (animal-human transmission). A mutation occurs, causing person-person transmission

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  • Symptoms: Fever, chills, body aches, cough, lethargy, and n/v. Severe cases can lead to acute respiratory distress syndrome (ARDS).

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  • Reservoir: Infected Animals, humans, and contact surfaces/areas

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  • Transmission: Airborne and droplets

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  • Types: H5N1(bird flu), swine flu (H1N1), MERS, and SARS (SARS-CoV-1 & SARS-CoV-2 [Covid-19])

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  • Treatment: Supportive care and antivirals

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Screening and Recognition Protocols for EMS�

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System-wide �Notification Memos

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High-Risk Ambulance (HRA)

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  • Driver and patient compartment separated with welded steel
  • Separate high-capacity air conditioning units for driver and patient compartment – will keep personnel in Level C isolation PPE (PAPRs/suits) comfortable
  • Patient compartment has negative pressure, HEPA filters with UV light disinfection for the air intake and exhaust.
  • Tablet mount for receiving facility to monitor patient/team by video
  • Intercom and patient status lights to communicate between driver and patient compartment
  • Molded seats for easy disinfection
  • No shelves/cabinets for easy disinfection
  • SteraMist disinfection system (aerosolized hydrogen peroxide mist)

HRA Features

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Personal Protective Equipment (PPE)

Level 1 – Standard Precautions

  • Used for routine patient care when no special pathogen is suspected.

Level 2 – Contact and Droplet Precautions

  • Used for diseases spread by direct contact or respiratory droplets

Level 3 – Airborne and Enhanced Precautions

  • Used when aerosol-generating procedures may occur

Level 4 – HCID / Special Pathogen PPE

  • Used for confirmed or suspected viral hemorrhagic fever and other HCIDs

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Patient Transport & Ambulance Disinfecting Procedures

  • Confirmed and suspect VHF patients will be transported by HRAs ONLY
  • Place a surgical mask on patient if tolerated
  • Drape the interior of the ambulance prior to transport. Remove draping between patients
  • Manually disinfect the interior of the patient care compartment with an EPA-registered disinfectant. Pay attention to disinfectant contact time for effectiveness
  • Dispose of all waste according to organization protocols as well as local and federal regulations

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  • Universally used for all patient encounters. Gloves and hand hygiene.
  • Protect skin and mucous membranes from infectious drainage, stool, and blood.
  • Impermeable barriers (e.g., gloves, gown, & face shield)
  • Protect mucous membranes and respiratory tract from infectious droplets.
  • Use of surgical mask (for pt/provider) and goggles or face shield
  • Respiratory protection from inhalation of infectious aerosolized agents and suspended droplets.
  • Place surgical mask on pt. Provider use of N95 respirator or PAPR.
  • Implemented until disease-specific guidance is made available.
  • Increased protection of mucous membranes and respiratory tract from infectious droplets and aerosolized agents. (e.g., MERS, Covid-19, H5N1/novel influenza virus, and Mpox).
  • Disposable full body impermeable coveralls with use of N95 respirator or higher. Hooded PAPR preferred.
  • Provide full-body maximum impermeable barrier and highest respiratory protection (e.g., Level C PPE 🡪 SCBA/PAPR) with trained observer. Place mask on pt.
  • Limit pt contact, and avoid AGPs and invasive procedures if possible.
  • CONTACT PH FOR HRA TRANSPORT!

Patient Transport

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Ambulance Disinfecting Procedures

  1. Identify Decontamination Area:

• Select an appropriate site for ambulance decontamination

    • Establish a secure perimeter
    • Define and mark the clean/dirty zone boundary

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2. Disinfection

    • If the interior of the ambulance was draped prior to transport, remove the draping
    • manually disinfect the interior of the patient care compartment with an EPA-registered disinfectant
    • Manually wipe with disinfectant the ambulance’s exterior patient loading doors and handles, and any areas that may have been contaminated
    • HRAs post transport of VHF patients will be taken to LA County EMS DSF for manual decon and SteraMist(aerosolized hydrogen peroxide) spray down. Clearance from LA County EH will occur

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3. After disinfection/decontamination:

    • Dispose of all waste according to organization protocols as well as local and federal regulations infectious substances
    • Once all surfaces have been wiped with disinfectant, then supervised doffing of PPE into a biohazard bags with a trained controller can occur

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Special Pathogen Notification Process to Public Health

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Public Health Alerts & Notifications

LA County Health Alert Network

CA Health Alert Network

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Resources

  • LA County Healthcare Coalition

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  • National Emerging Special Pathogens Training & Education Center (NETEC): EMS Model Procedural Guidelines For Special Pathogens

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References

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