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CHAPTER 23 Infectious and communicable diseases
Russell D. MacDonald
Introduction
Emergency medical services (EMS) clinicians are typically the first health care workers to encounter sudden illnesses and other health emergencies in the community, placing them at risk of communicable and infectious diseases. The U.S. Occupational Safety and Health Administration identifies more than 1.2 million community‐based first‐response personnel, including law enforcement, fire, and EMS clinicians, who are at risk for infectious exposure [1].
While infectious and communicable disease preparedness may not have previously been a priority in some EMS agencies, the 2003 severe acute respiratory syndrome (SARS) outbreaks made it one. During the SARS outbreaks in Toronto and Taipei, EMS personnel were exposed to and contracted SARS in significant numbers, resulting in one paramedic fatality. The loss of paramedics available for work due to exposure, quarantine, and illness affected the ability to maintain staffing during the outbreak and highlighted the need for EMS systems to adequately prepare and protect the workforce from potential exposures [2–4].
The 2020 global pandemic due to the novel coronavirus 2019 (SARS‐CoV2 or 2019‐nCoV) highlighted the need for robust EMS infection prevention and control practices to protect personnel and maintain system integrity. Efforts must be multifaceted to account for potential exposures in the workplace from patients, co‐workers, and the public. Additionally, contingency planning must account for the possibility of temporary losses of significant portions of the workforce at times when demands on the EMS system are increased.
EMS Clinician and Patient
An infectious disease results from the invasion of a host by disease producing organisms, such as bacteria, viruses, fungi, or parasites. A communicable (or contagious) disease is one that can be transmitted from one source (i.e., person or animal) to another, by contact with the infected individual or bodily fluids, contact with contaminated surfaces or objects, or ingestion of contaminated food or water, or by contact with disease vectors such as mosquitos, fleas, or mice. Not all infectious diseases are communicable. For example, malaria and schistosomiasis are spread by contact with disease vectors. These are not typically considered to be communicable or contagious diseases because they cannot be spread by direct contact with an infected person. On the other hand, chickenpox is an infectious disease that is also highly communicable, because it can be easily transmitted from one person to another.
The mode of transmission is the mechanism by which an agent is transferred to the host. Modes of transmission include contact transmission (direct, indirect, droplet), airborne, vector‐borne, or common vehicle (food, equipment). Contact transmission is the most common mode of transmission in the EMS setting and can be effectively prevented using routine practices.
Direct contact transmission occurs when there is direct contact between an infected or colonized individual and a susceptible host. Transmission may occur, for example, by biting, kissing, or sexual contact. Indirect contact occurs when there is passive transfer of an infectious agent to a susceptible host through a contaminated intermediate object. This can occur if contaminated hands, equipment, or surfaces are not appropriately washed and decontaminated after patient contacts. Examples of diseases transmitted by direct or indirect contact include human immunodeficiency virus (HIV), hepatitis, and methicillin‐resistant Staphylococcus aureus (MRSA).
Droplet transmission is a form of contact transmission requiring special attention. It refers to large droplets generated from the respiratory tract of a patient when coughing or sneezing, or during invasive airway procedures such as intubation and suctioning. These droplets are propelled and may be deposited on the mucous membranes of the susceptible host. The droplets may also settle in the immediate environment, and the infectious agents may remain viable for prolonged periods, to be later transmitted by indirect contact. Examples of diseases transmitted by droplet transmission include meningitis, influenza, rhinovirus, respiratory syncytial virus, and coronavirus diseases.
Airborne transmission refers to the spread of infectious agents to susceptible hosts through the air. In this case, infectious agents are contained in very small droplets that can remain suspended in the air for prolonged periods. These agents are dispersed widely by air currents and can be inhaled by a susceptible host located at some distance from the source. Examples of airborne
