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March 30, 2003 Updated: April 17, 2003 Stephen
M. Apatow
TRIAGE OF PATIENTS WHO MAY HAVE SEVERE ACUTE RESPIRATORY SYNDROME (SARS) Two hospitals in Ontario, Canada have been closed after cases of the disease (SARS) were detected there. More than 1,000 people who worked in or visited the hospitals since mid-March have been ordered to quarantine themselves for 10 days. All Ontario hospital workers are now required to wear masks, gloves, gowns, and protective eyewear to to guard against infection (Canada Says SARS Infections Are Increasing, VOA News, 30 Mar 2003, 00:23 UTC). Steve Urszenyi, Toronto Paramedic in the article "Embedded in the Hot Zone- SARS update" for the EMS News and Information network <http://www.emsnetwork.org/artman/publish/cat_index_10.shtml> shares: " This SARS is not to be taken lightly. You can only imagine the numbers of paramedics now quarantined following the latest news of York Central Hospital being closed. That means that any paramedic that had gone inside that hospital without respiratory protection in the past 2 weeks or so will now be quarantined. Any paramedic who came into contact with the EMS Supervisor will now be quarantined. It's getting to be a bit grim, in terms of available resources." According to the World Health Organization <Biodefense and Epidemiological Tracking: http://www.humanitarian.net/biodefense/sars_biodefense.html>, Canada has 103 cumulative cases/13 deaths in contrast with 199 cases/0 reported deaths in the United States as of 15 April 2003. [ See: Toronto's SARS outbreak may be on verge of breaking out of control: experts, The Canadian Press, Thursday April 16, 2003 - 21:10:10 EST: TORONTO (CP) - The SARS outbreak that has crippled Toronto's health-care system may be on the verge of breaking out, in an uncontrolled fashion, into the community at large, infectious disease experts warned Wednesday. While public health officials leading the fight against SARS warned only that the battle has reached a critical stage, the doctors who advise them were ready to spell out the threat in more graphic and frightening terms. The disease has travelled so far from the original cluster of infection - one expert estimates the city is on the fifth generation of cases - that the risk is mounting daily that people will go undiagnosed and will spread SARS in the community, sparking what are called sporadic cases that experts can't trace.] Efforts to minimize exposure for first responders across the United States has prompted requests for the following guidelines by the Centers for Disease Control: Triage
of Patients Who May Have Severe Acute Respiratory Syndrome:
To
facilitate identification of patients who may have SARS in ambulatory care
settings, targeted screening questions concerning fever, respiratory symptoms,
and recent travel should be included at triage or as soon as possible after
patient arrival; the most recent case definition for SARS, accessible at
A surgical mask should be placed on patients in whom SARS is suspected, and contact (e.g., gloves, gown, and eye protection) and airborne precautions (e.g., an isolation room with negative pressure relative to the surrounding area and use of an N-95 filtering disposable respirator, or respirators of equivalent filtering efficiency, for persons entering the room) should be applied where feasible. Where respirators are not available, healthcare personnel evaluating and caring for suspect SARS patients should wear a surgical mask. Additional guidance regarding SARS infection control in the ambulatory care setting is available at <http://www.cdc.gov/ncidod/sars/infectioncontrol.htm>. For more information, visit this CDC SARS web site: <http://www.cdc.gov/ncidod/sars/>
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