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Home > The Doctor's Corner > EMT Discussion Topics > Narcan Update and Enterovirus D68 Virus Outbreak

Narcan Update and Enterovirus D68 Virus Outbreak

September, 2014

Happy Fall, everyone! After taking the summer off from most things EMS related, I am now picking up the pace on the EMS front, getting caught up on issues neglected over the summer, and looking forward to this fall and winter. Hopefully, I will be able to put together regular submissions to be posted to my little EMS blog here, so keep looking for new posts. There are a lot of interesting things going on in Medicine, in general, and EMS, in particular, so we have lots to talk about.

The big news, of course, for any of you providers not aware at this point, is that the State abruptly discontinued the naloxone (Narcan) pilot program that several of our Bayfield County services were involved in. Normally, this would be concerning to stop a study with such short notice. In the case of the Narcan Pilot, however, it is all good news. The Wisconsin legislature passed a law allowing laypersons to be trained to carry and use Narcan. Certainly, if laypersons will be allowed to carry Narcan, then there is no reason that trained EMS professionals should not be allowed to use it so the ongoing study became, essentially, irrelevant and was discontinued. The good news here, of course, is that this means that all services will be allowed to carry and use Narcan and we should plan on having every service carrying Narcan by spring of 2015. Those of you who did not read my previous blog on Narcan (I can’t imagine anyone didn’t) should review that information. There will be more to follow on this whole topic, but this is good news.

I wanted to spend a few paragraphs here discussing the other big Medicine/EMS story out there right now; that being the Enterovirus D68 outbreak that is spreading like wildfire across the central part of the country. While not here yet, it will be, and probably in the very near future.

This particular outbreak has gained a lot (probably too much) attention in the popular press recently because of the number of children that it has affected, and a larger than expected proportion of those children have become quite ill. This all seemed to start in Kansas City – where I went to medical school – and the number of cases there has nearly overwhelmed the primary children’s hospital. That facility, Children’s Mercy, is a large, very good, pediatric specialty center. If they were nearly overwhelmed, then I assure you that a similar situation in this area will be a near-catastrophe…at least from a system management/logistics standpoint.

That said, it is important that you, as the first responding healthcare providers, have a realistic understanding of what enterovirus D68 actually is. The enteroviruses encompass a large number of similar viruses that cycle through the population at various times of the year. These are one of the primary classes of viruses that cause run-of-the-mill upper respiratory tract infections…commonly known as “a cold”. We all get infected with enteroviruses and some us get them multiple times every year. Enterovirus D68 is simply a variant that is, for unknown reasons, causing more virulent illness in certain subsets of the population. While most people, including children, who become infected with D68 will have only mild illness (i.e. a common cold) there are some kids, primarily those who are very young or have underlying lung disease like asthma or – less commonly - cystic fibrosis who are developing acute respiratory failure with this particular virus. Furthermore, as with all variants of the common cold, there is no virus-specific treatment for this and we manage the illness by treating the symptoms with IV fluids, nebulizers, and other more aggressive respiratory treatments in severe cases.

So what should you, as EMS providers, know and do when you respond to a child who is potentially infected with D68? First of all, do what you do best, which is treat the patient and transport them to the hospital. Treat with oxygen therapy and albuterol nebulizers, as indicated. In cases of severe respiratory distress - indicated by hypoxia that does not rapidly resolve with treatment, or by the presence of significant intercostal or supraclavicular retractions – then you should call for an ALS intercept and rapidly transport the patient. Furthermore, keep in mind that this particular virus is most dangerous to very young children and those with underlying lung problems so in the case of a parent who may be hesitant to have their child transported, you should encourage them to allow you to transport the child and/or have the child evaluated by a physician.

What should you not do? First and foremost, please do not add to the hysteria developing around this illness. Despite being a particularly nasty variant, this is simply another enterovirus. It is not the Plague. While you should, as always, use standard precautions, it is not necessary to respond to the scene in an isolation suit, as if you were treating an Ebola patient. This is just another respiratory virus and you should treat these kids as you would any child in respiratory distress, and consider them to be much like a child having an asthma attack.

As this particular pandemic of D68 spreads, I will update posts if there is new or additional information that I receive from the CDC, or others, regarding this illness. In the meantime, stay on alert for these patients and keep up the good work.

Jonathan Shultz, MD Medical Director

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