International Association of Fire Fighters

1. International Association of Fire Fighters This presentation was created by the IAFF’s Department of Education. It is adapted from an online learning module, which is available at www.IAFF.org.

2. Getting Started • After participating in this presentation, you will be able to: • Identify the characteristics of the Avian Flu. • Describe how to protect yourself against influenza. • Assist your department in developing a plan for a potential pandemic in your community.

3. What is the Avian flu? (Click) The Avian flu is a strain of the flu that is carried by birds. A new strain, the H5N1 virus, is being passed to humans through the handling of birds. If it begins to jump from human to human, a potential flu pandemic could arise. A pandemic is a global outbreak of a disease, while an epidemic affects a region. Health officials believe that the Avian flu could become pandemic. Compared with the seasonal flu, which usually affects the very young and the very old, kills only about 35,000 people annually in the United States and can be vaccinated against, we have no immunity or vaccine for the pandemic flu, which has the potential to kill.

4. Why should I be concerned? No vaccine for H5N1 virus While we have some immunity to the seasonal flu, when it comes to the H5N1 virus our immune system is a blank slate. Until we know the specifics of the virus, we cannot create a vaccine. If a pandemic arises it will take months to produce and distribute the vaccine. Highly Infections if it were to transfer from human to human Influenza is highly infectious and is easily transmitted by body fluids through the eyes, nose and mouth. The Avian Flu’s incubation period, or time between exposure and symptoms, is 2-8 days, while the seasonal flu’s 2-3 days. Those with the virus may not know they have it. Kills the young and healthy Because we have no immunity to a new influenza virus, the H5N1 would affect any age group. During past flu pandemics, those in their 20s and 30s, who had strong immune systems, fell victim to the virus. Kills 50% of those it infects Half of those who have been infected with the H5N1 virus, through the handling of poultry, have died. Visit the World Health Organization’s website on the resources page for the most current information on Avian flu deaths.

5. Has this ever happened before? In 1918, the Spanish flu pandemic hit the world and became one of the worst pandemics in history. It is estimated that approximately 20 to 40 percent of the worldwide population became ill and that over 50 million people died. During a period of the pandemic, influenza killed more people in 24 weeks than AIDS has killed in 24 years. There were other influenza pandemics in the 20th century: During the Asian Flu, the virus H2N2 started in China in February 1957, by June 1957 it spread to U.S. and caused 70,000 deaths in U.S. During the Hong Kong Flu the virus H3N2 started in Hong Kong in early 1968.  Later in the year, it spread to the U.S. and caused 34,000 deaths.

6. Part 2: Planning for Response • Disasters and emergencies are dealt with locally, so each local fire and • emergency medical department must collaborate with its local • government, public health department, and community stakeholders to • devise a plan of action. • A lesson learned from the recent Katrina/Rita disasters is that • preparation for emergencies requires advanced planning if the response • is to be effective and efficient

7. Predicting Pandemic Effects on Response System • Your department must discuss the potential affects of pandemic on your • response system. • What might be some potential effects to discuss? (click) • A few important elements to consider: • Dispatching increased call volumes at the 911 call center • Adding units for transport (in addition to daily calls) • Potentially losing one third of your force (due to illness and quarantine) • Facing shortages in the stock of protective gear

8. Building Relationships • Have you met with your health department or local hospital about a potential • Avian flu pandemic? • Setting up a meeting to discuss the Avian flu with local health officials is • an essential step in planning for a pandemic. Meeting with your health • department, risk management agency, and hospitals before an outbreak • begins is key. As new information arises, you should continue to discuss the • challenges you will encounter before a pandemic hits and how you can work • together.

9. Safety Officers You will explore a scenario of an influenza pandemic that hits your community. You must decide the shift safety officer’s role throughout the scenario. January 20: A flu pandemic is announced as a potential threat to world health. What should the shift safety officer do? a. Stockpile disposable masks for the department b. Provide training and education about pandemic c.Implement a strategic departmental plan for the influenza pandemic See notes for answer

10. Safety Officers April 23: A flu pandemic has reached your region. What should the shift safety officer do? a. Meet with hospital officials to discuss the pandemic. b. Focus only on pandemic response. c. Make sure everyone is using the correct fit of disposable masks and ensure supplies are available for use. See notes for answer

11. Safety Officers April 24: 13:00 A call goes out to a possible flu patient. 14:00 The call comes back from a scene, where the victim had respiratory problems. The call responders bring equipment from call to wash their equipment in the firehouse sink. What should the shift safety officer do? a. The safety officer should stop them and remind them to decontaminate equipment in the designated location in firehouse. b. The safety officer quarantines the entire shift and reports the incident to the health center. c. Mandate SCBA masks be worn for the EMS for this shift See notes for answer

12. Fit Testing Fit testing is another step you can take now to prepare for a pandemic flu. Have you been fit tested for a disposable mask? If you do not have a fit test, you are poorly prepared to respond. Fit testing is an easy step you can take now to ensure your safety at any emergency scene. In order for you achieve the maximum amount of protection when using a mask, you will need to be fit tested by your department. This determines the correct size based on the seal of the mask. Never reuse a disposable mask.

13. Fit Testing Fit Testing Process: 1. Don a hood while the fit test facilitator sprays a fit-test agent, either a bitter substance called Bitrex or Saccharin, into the hood for you to taste and smell. 2. Don a disposable mask, while the testing agent is sprayed again. Do you smell or taste the agent? 3. If you taste or smell the agent, you will test another disposable mask type or another size until you find the correct fit. 4. You will receive a card with your fit testing results for you to carry on the job.

14. Making a Plan Your department will need to create policies on the minimum equipment to use during response to an influenza patient. Your safety officer will enforce these policies. The IAFF’s Pandemic Influenza Checklist is available to assist your department.

15. Part 3: Prevention on the Scene • During a threat of the H5N1 virus, treat any case of the influenza as if it were the Avian flu. • Characteristic Signs and Symptoms: • Persistent fever, usually high fever • Diarrhea and vomiting • Chills • Productive or dry cough • Shortness of breath • Eye infections • Fatigue • Muscle aches • Acute encephalitis (less common)

16. Standard Precautions • It is important to refresh your knowledge of universal precautions in case of a pandemic. • The next few slides will go over important precautions you can take to protect yourself on the scene: • Respiratory Protection • Hand Care • Eye Care • Patient Transport • Patient Care • Decontaminating Equipment • Vaccinations

17. Respiratory Protection You must wear a protective mask to help prevent contracting the flu virus. Which mask would you choose to protect yourself from contracting a deadly flu virus? Surgical mask N-95 P-100 See next slide for solutions. See notes for more information.

18. Respiratory Protection Explained The IAFF recommends, as a minimum, the P-100 with an exhalation valve. The P-100 filters 99.9% of particles and is oil proof. The mask is effective only if it fits correctly. If you were exposed to the flu virus and your mask does not fit, you will be exposed to the virus, become ill, and further take that virus back to your entire shift. The CDC recommends, as a minimum the N-95, which filters 95% of particles. The N-95 disposable mask is only effective if you have been fit tested to determine size. If you were exposed to the flu virus and your mask does not fit, you may take that virus back to your entire shift. A surgical mask will not protect you. Surgical masks are intended to protect a patient from the health care provider. They are not NIOSH approve for worker protection. There is no effective seal with this mask and the flu virus will be easily breathed in.

19. Hand Care True or False: If you wear gloves, you do not have to wash your hands. (click) False. Hand washing is one of the most important methods of preventing contraction of the flu—even if you were wearing gloves, you must still wash your hands. In addition to proper hand washing, wear disposable medical gloves, certified to NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, prior to making any patient contact. Keep waterless hand cleaner in your EMS bag. Immediately after activities involving contact with patient body fluids, gloves should be removed and discarded and hands should be cleaned. Gloves must never be washed or reused.

20. Eye Care True or False: Wearing eyeglasses provides sufficient protection. (click) False. Eye glasses do not cover tear ducts where fluids could enter. Don protective eyewear, certified to NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, in situations where bodily fluids may be splashed. Do not rub eyes before or after using eyewear or after handling patients or equipment.

21. Patient Transport You can reduce your risk of contracting the flu during transport: (click) Do not allow air to re-circulate within the vehicle, especially do not use the recirculation control on the vehicles heating/air conditioning system. Respirators should notbe removed to eat or drink while in the transport vehicle. The patient should wear a surgical mask to reduce droplet production, if tolerated. Oxygen delivery with simple and non-rebreather facemasks may be used for patient oxygen support during transport.

22. Eye Care True or False: Wearing eyeglasses provides sufficient protection. (click) False. Eye glasses do not cover tear ducts where fluids could enter. Don protective eyewear, certified to NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, in situations where bodily fluids may be splashed. Do not rub eyes before or after using eyewear or after handling patients or equipment.

23. Decontaminating Equipment True or False: Use bleach to get rid of any virus that has touched PPE. (click) • False. Do not use bleach on PPE, it degrades equipment. • Follow manufacture and departmental guidelines for • decontamination. Dispose of disposable respirators, • respirator filters, gloves and other disposable equipment/supplies used at the scene as bio-hazardous waste. • For decontamination of non-disposable equipment, follow manufacturer and departmental standard operating procedures. • If the turnout gear is visibly contaminated by bodily fluid, it should be placed in a biohazard bag at the scene and washed following prescribed laundry procedures. • Always refer to your department's Standard Operation Procedure.

24. Vaccine and Treatment There is no vaccine for this virus yet. If the H5N1 virus becomes a pandemic it may mutate, causing delays in the creation and distribution of a vaccine. Regardless of an influenza pandemic event, all first responders should receive influenza vaccine each year to protect themselves, their families and the public they serve from the seasonal influenza outbreak. There are four antiviral medications are approved by the U.S. Food and Drug Administration (FDA) for treatment and or prevention of seasonal influenza – Tamiflu (oseltamivir), Relenza (zanamivir), Symmetrel (amantadine), and Flumadine (rimantadine).   While they may decrease the severity and duration of the illness, there is no definitive treatment for influenza. Treatment of infected persons does not prevent further spread of infection, but it may reduce their degree of contagion. 

25. Resources • www.iaff.org • Visit the IAFF’s website for learning tools and information for first responders. A more detailed resource page is available at http://www.iaff.org/academy/online/modules/avian/resources.shtm • www.pandemicflu.gov United States Official U.S. Government website on Pandemic and Avian Influenza • http://www.nfpa.org • National Fire Prevention Association’s standards: • NFPA 1600 Standard on Disaster/Emergency Management and Business Continuity Programs • NFPA 1500 Standard on FD Occupational Safety and Health Program • NFPA 1521 Standard for Fire Department Safety Officer • NFPA 1561 Standard on Emergency Services Incident Management System • NFPA 1581 Fire Department Infection Control Program • NFPA 1999 Standard on Protective Clothing for Emergency Medical Operations