It’s Not Too Late for a Review of the Flu

If you ride a 9-1-1 truck in the winter, many of your calls are for a “sick person.” According to the CDC, flu season tends to peak at the end of January and into February. Symptoms can range from mild to severe. This article will outline the signs, symptoms, and treatments for flu patients as well as precautions providers can use to limit or reduce their exposure to these germs.

What Is the Flu?

Flu is short for influenza, a viral infection typically acquired through one’s mucous membranes. While there are four flu viruses (A, B, C, and D), the most common for 2020 are A and B. Per the CDC, influenza A is the only one that can cause a pandemic because it spreads so efficiently and changes rapidly. These A viruses are often classified into subgroups called clades based upon their gene sequence.

Influenza B moves more slowly and changes its properties more slowly than A. Influenza C typically is a mild form and not very contagious, and D primarily affects livestock and other animals and isn’t known to infect humans.

According to the CDC, every year millions of Americans get the flu, hundreds of thousands are hospitalized, and tens of thousands die from the flu or flu-related viruses.

The flu virus is airborne and transmitted via droplets. These droplets can be introduced to the body via the mouth, nose, or eyes when an infected person coughs, sneezes, or speaks. The virus can live for several hours on surfaces as well, so while less likely, it is still possible to contract the virus when you touch a contaminated surface like a table, doorknob, phone, keyboard, or steering wheel and then touch your eyes, nose, mouth, or face.

Signs and Symptoms

As part of your assessment, note the following symptoms in a patient whose symptoms suggest flu:

• Nasal congestion;
• General body weakness;
• Cough (productive or nonproductive);
• Headache;
• Chills;
• Muscle aches and stiffness.

A fever is often but not always present with influenza. Patients may simply feel feverish while maintaining a normal body temperature, especially if they’ve had the influenza vaccine. Respirations may be shallow or labored, and pulse rate might be slightly elevated. The patient might experience some mild hypotension, especially if they’re not hydrating well. Unless there is a preexisting condition, their EKG would be unchanged. SpO₂ might be slightly lower based upon congestion or breathing difficulty.

Gastroenteritis, more commonly known as the stomach flu, isn’t the flu. Symptoms of nausea, diarrhea, cramping, and dehydration are not caused by the influenza virus. It is still highly contagious, so employ universal precautions.

EMS Treatment

From an EMS perspective, unless the patient is having significant shortness of breath or exacerbation of an existing medical condition, a call for the flu is typically a BLS response. Clearly crews should employ universal precautions and utilize PPE, including eye protection and masks, to avoid the spread of the virus. Place a mask on the patient as well.

If the patient is receiving oxygen via a nonrebreather mask due to low SpO₂ and/or associated breathing difficulty, be sure all crew members are wearing masks, as the blow-by oxygen can easily spread the virus around the ambulance cabin. Keep the patient warm and in a position of comfort. Transport to an emergency department and monitor during transport; consider suggesting an urgent care facility if the patient’s symptoms are not severe.

Precautions

To decrease the chance of getting influenza (or any flulike virus), take the following precautions:

• Wash your hands frequently with warm water and soap or use a waterless alcohol-based hand sanitizer until a sink hand-washing opportunity is available. Do not eat or drink after patient contact until your hands have been washed.
• If you have to sneeze or cough, cover your mouth and do so inside your elbow.
• Wear your PPE on calls, including gloves, eye protection, and mask.
• Launder your uniform after each shift.
• Wipe down surfaces in your vehicle at the start of each shift and after every call with a germicidal or bleach-based wipe. Include personal equipment such as laptops and pens as well as commonly touched items like stethoscopes, door handles, clipboards, and radios. The New Jersey Office of EMS recently released these disinfection guidelines to all providers in the state.
• Get plenty of rest and stay hydrated.
• Get an annual influenza vaccine.

Getting Your Flu Shot

The influenza vaccine is created each year based upon predictions of which flu viruses will emerge. It’s typically effective against types A or B. The vaccine will not prevent C, D, or other viruses (like coronavirus) that can mimic flulike symptoms. Vaccines are given from October to March and can be given via intramuscular injection or nasal inhalation, depending on age of the patient and physician preference.

The vaccine is now commonly given at physicians’ offices, urgent care clinics, and pharmacies across the country. It is covered by most insurance programs. Some senior citizens will get vaccines for both A and B.

The vaccine causes antibodies to develop and normally requires about two weeks to take effect. It is recommended that everyone six months and older get a flu shot every year. While it is possible to get the flu even if you have been vaccinated, the risk is significantly diminished, and the effects might be reduced. This can prevent the need for hospitalization, especially among people with diabetes and chronic lung disease. The only people who should not get a flu shot are infants younger than six months, people with life-threatening allergy to the ingredients in the vaccine, such as gelatin, antibiotics, or eggs, and those with Guillain-Barré syndrome.

COVID-19: A New Threat?

Over the past weeks, the so-called novel corononavirus, now known as COVID-19, has been making headlines and causing concern. Globally there are now more than 103,000 confirmed cases and have been more than 3,500 deaths.

According to the CDC, “Coronaviruses are a large family of viruses, some causing illness in people and others, that circulate among animals, including camels, cats, and bats.” Based upon early information, the CDC believes the virus is being spread via person to person, rather than from animal to person, but it unclear how easily it is being spread.

Find current CDC COVID-19 guidance for EMS and 9-1-1 here; find the latest from the World Health Organization here.

Resources

Arriola C, Garg S, Anderson EJ, et al. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clin Infect Dis, 2017 Oct 15; 65(8): 1,289–97.

Centers for Disease Control and Prevention. Types of influenza viruses, www.cdc.gov/flu/about/viruses/types.htm.

Mayo Clinic Health System. Facts about flu, www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/facts-about-flu.

New Jersey Department of Health. EMS Toolbox, Ebola/Infectious Disease Planning, https://www.nj.gov/health/ems/ems-toolbox/.

Barry A. Bachenheimer, EdD, FF/EMT, is a frequent contributor to EMS World. He is a career educator and university professor with more than 33 years in EMS and fire suppression. He is currently an EMT with the South Orange (N.J.) Rescue Squad, a firefighter with the Roseland (N.J.) Fire Department, and an instructor at the National Center for Homeland Security and Preparedness in New York. Reach him at bbachenheimer@albany.edu.