title: Loss of paramedic availability in an urban emergency medical services system during a severe acute respiratory syndrome outbreak.
abstract: OBJECTIVE
  To describe the loss of paramedic availability to Toronto Emergency Medical Services during a biphasic (SARS-1 and SARS-2) outbreak of severe acute respiratory syndrome (SARS).
  
  
  METHODS
  During the SARS outbreak, a dedicated paramedic surveillance and quarantine program was developed. The authors determined the number of paramedics on quarantine each day, the type of quarantine (either home quarantine [HQ] or work quarantine [WQ]), and the development of SARS-like symptoms.
  
  
  RESULTS
  During the SARS outbreak, there were five cases of probable SARS and three cases of suspect SARS. SARS-1 lasted 30 days, during which 234 paramedics were placed on HQ. The total number of HQ days was 1,615. During the five peak days of SARS-1, the total number of HQ days was 664. SARS-2 lasted 18 days, during which 292 paramedics were placed on either HQ or WQ, for a combined number of quarantine days of 1,637. During the five peak days of SARS-2, the combined number of quarantine days was 910. Of these, paramedics were available for duty on 708 days (78%) due to the WQ program. The primary reason for quarantine was unprotected exposure to a health care institution experiencing a SARS outbreak. Under quarantine, SARS-like symptoms developed in 68 paramedics, including cough (53 [78%]), myalgia (33 [48%]), fatigue (30 [44%]), headache (29 [43%]), fever (11 [16%]), and shortness of breath (7 [10%]).
  
  
  CONCLUSIONS
  Paramedics were among the health care workers who developed SARS. During SARS-2, WQ optimized the number of days on which paramedics were available for duty. Many paramedics developed SARS-like symptoms without being diagnosed as having SARS. A dedicated paramedic surveillance and quarantine program provided a useful means to manage the paramedic resource during the SARS outbreak.
authors.affiliation: Division of Prehospital Care, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. rverbeek@basehospital.on.ca
authors.forename: P Richard
authors.initials: PR
authors.lastname: Verbeek
authors.forename: Ian W
authors.initials: IW
authors.lastname: McClelland
authors.forename: Alexis C
authors.initials: AC
authors.lastname: Silverman
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Burgess
mesh_terms: D000041:Absenteeism; D004196:Disease Outbreaks; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000706:statistics & numerical data*; D016273:Occupational Exposure / Q000009:adverse effects; D009864:Ontario / Q000453:epidemiology; D045169:Severe Acute Respiratory Syndrome / Q000453:epidemiology* / Q000503:physiopathology / Q000635:transmission; D013997:Time Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*