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Apr 26, 2009

NAEMT has issued the following member alert regarding the recent swine flu outbreak.

Confirmed cases of swine flu have been documented in people in the U.S. and Mexico, and the spread to other countries is being monitored. Because there is the possibility that this disease could be a pandemic, and to help you protect yourselves when treating patients, NAEMT is providing you with links to the most current information provided to date from government agencies monitoring the outbreak.

What is swine flu?
Swine flu is a respiratory disease of pigs caused by type A influenza that regularly causes outbreaks of influenza among pigs and has been documented to occasionally infect humans. Cases of human-to-human spread of swine flu viruses also have been documented and are now being suspected. The current virus contains a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere.At this time, the CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine and the seasonal influenza vaccine does not provide protection.

For more information, please view the following CDC materials and resources:

Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts

CDC Swine Flu Investigation Update Web page (All new guidance will be posted here)

What should I do if I suspect swine flu in a patient?
Clinicians should consider swine influenza infection in the differential diagnosis of patients with febrile respiratory illness and who 1) live in San Diego or Imperial counties, California, or Guadalupe County, Texas, or traveled to these counties or 2) who traveled recently to Mexico or were in contact with persons who had febrile respiratory illness and were in one of the three U.S. counties or Mexico during the seven days preceding their illness onset.

When EMS personnel are taking a patient history, it is suggested that a question be included about the patient’s travel history, such as: “Have you recently traveled outside the U.S. or have you had a house guest who has?”

Patients who meet the above criteria should be tested for influenza, and specimens positive for influenza should be sent to public health laboratories for further characterization. Clinicians who suspect swine influenza virus infections in humans should obtain a nasopharyngeal swab from the patient, place the swab in a viral transport medium, refrigerate the specimen, and then contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.

The ill person should wear a surgical mask when outside of the patient room, and should be encouraged to wash hands frequently and follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons. Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management of swine influenza. More information can be found at

Those with febrile respiratory illness should stay home from work or school to avoid spreading infections (including influenza and other respiratory illnesses) to others in their communities. In addition, frequent hand washing can lessen the spread of respiratory illness.

Personnel providing care to or collecting clinical specimens from suspected or confirmed cases should wear disposable non-sterile gloves, gowns, and eye protection (e.g., goggles) to prevent eye exposure.

Clinical guidance on laboratory safety, case definitions and infection control, and information for the public, are available at:

Swine Influenza A (H1N1) Virus Biosafety Guidelines for Laboratory Workers:
Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection in a Healthcare Setting:
Interim Guidance on Case Definitions for Swine Influenza A (H1N1) Human Case Investigations:

How can I protect myself?
Those personnel engaged in aerosol generating activities such as collecting clinical specimens, endotracheal intubation, nebulizer treatment, bronchoscopy, and resuscitation involving emergency intubation or cardiac pulmonary resuscitation for suspected or confirmed swine influenza A (H1N1) cases should wear a fit-tested disposable N95 respirator. At this time, it’s also recommended that those providing direct patient care for suspected or confirmed swine influenza A (H1N1) also should wear the respirator when entering the patients’ rooms.

Respirator use should be in the context of a complete respiratory protection program in accordance with Occupational Safety and Health Administration (OSHA) regulations. Information on respiratory protection programs and fit test procedures can be accessed at Staff should be medically cleared, fit-tested, and trained for respirator use, including: proper fit-testing and use of respirators, safe removal and disposal, and medical contraindications to respirator use. Additional information on N95 respirators and other types of respirators may be found at:, and at

For more information about swine flu, visit or call 1-800-CDC-INFO (1-800-232-4636).

Department of Homeland Security Secretary Janet Napolitano has declared a national public health emergency in response to the recent outbreak of swine flu. To read the Secretary's latest press briefing on this subject, click here.


The Centers of Disease Control and Prevention is the U.S. government's source for the last information on this outbreak. Click here for the CDC's latest information on swine flu.


The U.S. Department of Transportation's EMS Pandemic Influzena Guidelines for Statewide Adoption and Preparing for Pandemic Influenza: Recommendations for Protocol Development and 9-1-1 Personnel and Public Safety Answering Points (PSAPs) are available online at (Click here). State and local EMS agencies should review these documents for additional useful information.