The role of EMS systems in public health emergencies.
BACKGROUND
Until now, the public health response to the threat of an epidemic has involved coordination of efforts between federal agencies, local health departments, and individual hospitals, with no defined role for prehospital emergency medical services (EMS) providers.


METHODS
Representatives from the local health department, hospital consortium, and prehospital EMS providers developed an interim plan for dealing with an epidemic alert. The plan allowed for the prehospital use of appropriate isolation procedures, prophylaxis of personnel, and predesignation of receiving hospitals for patients suspected of having infection. Additionally, a dual notification system utilizing an EMS physician and a representative from the Office of Infectious Diseases from the hospital group was implemented to ensure that all potential cases were captured. Initially, the plan was employed only for those cases arising from the Centers for Disease Control and Prevention (CDC)/Public Health Service (PHS) quarantine unit at the airport, but its use later was expanded to include all potential cases within the 9-1-1 system.


RESULTS
In the two test situations in which it was employed, the plan incorporating the prehospital EMS sector worked well and extended the "surveillance net" further into the community. During the Pneumonic Plague alert, EMS responded to the quarantine facilities at the airport five times and transported two patients to isolation facilities. Two additional patients were identified and transported to isolation facilities from calls within the 9-1-1 system. In all four isolated cases, Pneumonic Plague was ruled out. During the Ebola alert, no potential cases were identified.


CONCLUSIONS
The incorporation of the prehospital sector into an already existing framework for public health emergencies (i.e., epidemics), enhances the reach of the public safety surveillance net and ensure that proper isolation is continued from identification of a possible case to arrive at a definitive treatment facility.
McIntosh
B A
BA
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York 11219, USA.
Hinds
P
P
Giordano
L M
LM
D004196:Disease Outbreaks / Q000517:prevention & control*; D004632:Emergency Medical Services / Q000458:organization & administration*; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control; D006801:Humans; D009519:New York City / Q000453:epidemiology; D010930:Plague / Q000517:prevention & control