1. health and fitness

POLK COUNTY EMERGENCY MANAGEMENT
INCIDENT ACTION PLAN
12/22/2014 06:00 to 03/31/2015 06:00
Ebola 2014
For Additional Information Contact:
A.J.Mumm, Director
PolkCounty EMA
515-286-2107
[email protected]
POLK COUNTY EMERGENCY MANAGEMENT
Proudly serving the communities of:
Alleman,Altoona, Ankeny, Bondurant, Clive, Des Moines, Elkhart, Grimes, Johnston,Mitchellville, Pleasant Hill, Polk City, Polk
County, Runnells, Urbandale, WestDes Moines, and Windsor Heights
Page 1 of 28
Page 1
INCIDENT OBJECTIVES
1. Incident Name
2. Date Prepared
3. Time Prepared
Ebola 2014
4. Operational Period
12/22/2014 06:00 - 03/31/2015 06:00
5. General Control Objectives for the Incident (include alternatives)
THIS INCIDENT ACTION PLAN SHALL REMAIN IN EFFECT UNTIL:
- THE CURRENT EBOLA SITUATION HAS ENDED; OR
- UNTIL A CONFIRMED CASE OF EBOLA IS IDENTIFIED IN POLK COUNTY, AT WHICH TIME A NEW IAP WILL BE ISSUED THAT WILL COVER
DECONTAMINATION, TREATMENT AND OTHER TOPICS.
- Minimize the risk of contraction of the Ebola virus for emergency responders and health care providers
- Gain and maintain situational awareness through information from the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC)
and Iowa Department of Public Health (IDPH).
-Coordinate with IDPH regarding messaging and communications.
-Ensure partners and the public have current information to guide decision-making regarding their health safety
-Strengthen preparedness in Polk County for the early recognition, detection, and control of an Ebola exposure.
-To ensure responders are prepared with the appropriate PPE and proper guidance on Donning and Doffing.
6. Weather Forecast For Period
Weather Forecast information may be obtained at http://www.crh.noaa.gov/dmx
7. General Safety Message
Maintain appropriate communication between the 9-1-1 centers, first responders, hospitals, Iowa Department of Public Health and Polk County Public Health
regarding suspected individuals with symptoms of Ebola.
All responders should be wearing the appropriate personal protective equipment during a response that involves a suspected case of Ebola.
Review and become familiar with discipline specific guidance included in each ICS 204 and the PPE information included within this Incident Action Plan.
8. Attachments (mark if attached)
X
Organization List - ICS 203
X
Div. Assignment Lists - ICS 204
Medical Plan - ICS 206
Communications Plan - ICS 205
Prepared by (Planning Section Chief)
ICS 202
Approved by (Incident Commander)
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Page
2
ORGANIZATION ASSIGNMENT LIST
1. Incident Name:
2. Date
3. Time
4. Operational Period
Ebola 2014
12/22/2014 06:00 - 03/31/2015 06:00
5. EOC Director & Staff
9. Operations Section:
EOC Director
Rick Kozin
Chief
Deputy EOC Director
AJ Mumm
Deputy
Nola Aigner
Branch:
Scott Slater
Safety Officer
PIO/JIC Officer
Policy Officer
Infrastructure Support
Branch Director
Branch Deputy Director
Transportation Group
6. Agency Representatives:
Agency
Name
Communication Group
Public Works/Eng Group
7. Planning Section:
Chief
Kari Lebeda Townsend
Deputy
Franny Medeiros/Samantha Brear
Situation Unit
Juan Cadenillas
Info/Intel Unit
Branch:
Emergency Services
Branch Director
Branch Deputy Director
Firefighting
Resources Unit
Public Hlth & Med Services 1
Documentation Unit
Hazardous Materials
Demob Unit
Law Enforcement & Security
Recovery/Mitigation Unit
Public Hlth & Med Services 2
Technical Specialists
Public Hlth & Med Services 3
Technical Specialists
8. Logistics Section:
10. Finance Section:
Chief
Chief
Deputy
Deputy
Service Branch
Time Unit
Comms Unit
Procurement Unit
Medical Unit
Compensation/Claims Unit
Food Unit
Cost Unit
11. Information and Intelligence Section:
Support Branch
Facilities Unit
Supply Unit
Prepared by:
Ground Support Unit
Page 3 of 28
Page
8
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Transportation Group
Infrastructure Support
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
The federal government is working closely with states, and states in turn with local public health agencies, to track travelers returning from Ebola-affected West
African countries. All of these travelers are routed to one of five screening airports that have CDC Federal quarantine stations for Ebola-Atlanta, New York
Liberty, Dulles, John F. Kennedy International Airport or Chicago O'Hare International Airport. This guidance does not apply to Des Moines International Airport
as they were not included in the list of the five airports above.
•Well travelers are allowed to go on to their final destination.
•The CDC then notifies the receiving state of that traveler’s final destination.
•If, for instance, the final destination is Iowa, IDPH contacts local public health officials to conduct a risk assessment of the individual and issue appropriate
health orders.
8. Special Instructions
Appropriate information is relayed from CDC to each applicable state public health department through EPI-X, a national notification system used by all states
and the CDC to communicate health information on a regular basis.IDPH will notify the PCHD regarding travelers with a destination of Polk County for
appropriate monitoring. Travelers who have been in an affected country (Guinea, Liberia or Sierra Leone) in the previous 21 days with fever of 100.4 or higher
with or without Ebola symptoms will be deferred and not allowed to continue to travel. Travelers who have been in an affected country (Guinea, Liberia, Mali or
Sierra Leone) in the previous 21 days no known exposure will receive instructions on self-monitoring and a CARE Kit (with digital thermometer, thermometer
directions, health advisory, symptom card, symptom log, reminder card, list of state health department phone numbers).
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 4 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
20
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Communication Group
Infrastructure Support
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
It is important for PSAPs to question callers and determine if anyone at the incident possibly has Ebola. This shall be communicated immediately to Polk
County Public Health/Iowa Department of Public Health so that they can call the individual and verify symptoms.
8. Special Instructions
Self-Monitor/Quarantine –Becomes Symptomatic and Calls 9-1-1:
Dispatch/PSAP is screening all Ebola-like complaints for travel to Liberia, Sierra Leone or Guinea in the
last 21 days.
Dispatch/PSAP notifies LPH/IDPH prior to local 911 EMS Dispatch.
IDPH calls the individual and verifies symptoms.
IDPH Epidemiologist consults Infectious Disease and Critical Care Physicians to determine most
appropriate facility to transfer patient dependent upon clinical presentation.
IDPH calls Pre-designated EMS Transport Service to transport to accepting facility.
Tier 2/3 hospital in the state follows established protocols to accept, isolate and screen/treat for
Ebola.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 5 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
9
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Public Works/Eng Group
Infrastructure Support
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
Waste Management:
CDC guidance indicates that sanitary sewers are acceptable for patient bodily fluids. Royce Hammitt, the Wastewater Reclamation Authority Operations
Manager said that they will follow the CDC guidelines.
8. Special Instructions
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Royce Hammit
(515) 323-8001
Cell/Pager
515-208-0641
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 6 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
21
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Firefighting
Emergency Services
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
If PSAP call takers advise that the person is suspected of having Ebola this shall be communicated immediately to Polk County Public Health/Iowa Department
of Public Health so that they can call the individual and verify symptoms.
8. Special Instructions
Based on the presence of symptoms and risk factors, put on or continue to wear appropriate PPE and follow the scene safety guidelines for suspected case of
Ebola. The patient should be placed in a gown, mask and gloves according to the same PPE recommendations.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 7 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
10
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Public Hlth & Med Services 1
Emergency Services
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
X
Public Health
7. Work Assignments
Medical Supplies Management & Distribution Task Force - Check local inventory of PPE for adequate supplies
Mass Prophylaxis Task Force - At this time, no vaccination is available for the Ebola Virus. Polk County Health Department has a Mass Prophylaxis plan should
a vaccine become available.
Medical Surge Task Force - Individual hospitals maintain medical surge plans that may be implemented as needed
Isolation & Quarantine Task Force - Polk County Health Department has an Isolation & Quarantine plan that may be implemented if necessary
Laboratory Testing Task Force - Iowa Department of Public Health and Polk County Public Health will coordinate any lab testing of suspected Ebola cases with
the State Hygienic Lab.
Fatality Management Task Force - Polk County Emergency Management and the Polk County Medical Examiner have a fatality management plan that may be
implemented as needed
Disaster Mental Health Task Force - Polk County Emergency Management has a Disaster Mental Health plan that may be implemented as needed
Environmental Health Task Force - Polk County Emergency Management has a Environmental Health plan that may be implemented as needed
Responder Safety & Health Task Force - Maintain coordination and communication on safety and health issues between agencies and departments
8. Special Instructions
Epidemiological Surveillance & Investigations - If patient meets clinical and exposure criteria for high or low risk Contact IDPH immediately at 800-362-2736 or
515-323-4360. If patient meets the clinical and “no known exposure” criteria, order appropriate testing which may include continued use of infection control
measures until cause identified; Rule out more common infections, including influenza, malaria, and diarrheal pathogens; If no cause is identified and Ebola
infection is suspected, contact IDPH at 800-362-2736 or 515-323-4360 to discuss Ebola testing.
Use a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant with a label claim for a non-enveloped virus (e.g., norovirus, rotavirus,
adenovirus, poliovirus) to disinfect environmental surfaces in rooms of patients with suspected or confirmed Ebola virus infection. Although there are no
products with specific label claims against the Ebola virus, enveloped viruses such as Ebola are susceptible to a broad range of hospital disinfectants used to
disinfect hard, non-porous surfaces. In contrast, non-enveloped viruses are more resistant to disinfectants. As a precaution, selection of a disinfectant product
with a higher potency than what is normally required for an enveloped virus is being recommended at this time. EPA-registered hospital disinfectants with label
claims against non-enveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus) are broadly antiviral and capable of inactivating both enveloped and
non-enveloped viruses.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 8 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
11
1. Incident Name
2. Operational Period (Date/Time)
Ebola 2014
From: 12/22/2014 06:00
3. Branch
4. Division/Group
Emergency Services
Public Hlth & Med Services 1
5. Strike Team / Task Force/Resource (Identifier)
6. Leader
ASSIGNMENT LIST ATTACHMENT
ICS 204a-CG
To: 03/31/2015 06:00
7. Assignment Location
Public Health
8. Work Assignment Special Instructions, Special Equipment/Supplies Needed for Assignment, Special Environmental
Considerations, Special Site Specific Safety Considerations
Clinical presentation and level of exposure are taken into account when determining appropriate public health actions for individuals with potential Ebola
exposure, as follows.
Mandatory Quarantine: Asymptomatic individuals with High Risk or Some Risk of exposure will be placed under a mandatory quarantine through an order
issued by the Iowa Department of Public Health and monitored by the Polk County Health Department.
1) Self-Monitor body temp twice a day, track and report, once daily observed by public health official during the 21 day incubation period.
2) Instructed to stay at home and avoid congregate situations
3) Informed to call IDPH if fever, nausea, vomiting, or malaise DO NOT CALL 911
4) Individual never becomes ill
5) Individual released from self-monitor
Symptomatic individuals with High Risk or Some Risk of exposure will be placed under a mandatory quarantine order within the pre-designated hospitals by
the Iowa Department of Public Health.
Self-Monitoring: Asymptomatic individuals with Low (But Not Zero) risk of exposure will be required to self-monitor for fever and symptoms under a mandatory
order to Submit to Self-Monitor issued by the Iowa Department of Public Health and monitored by the Polk County Health Department.
1) Self-Monitor body temp twice a day, track and report during the 21 day incubation period.
2) Informed to call IDPH if fever, nausea, vomiting, or malaise DO NOT CALL 911
3) Individual never becomes ill
4) Individual released from self-monitor
Individuals do not have movement restrictions as with quarantine but must refrain from using mass transportation, including airplanes, trains, cruise ships, or
busses for long distance travel, unless they receive written permission from the Iowa Department of Public Health/CDC prior to engaging in such travel.
If an individual under health orders were to develop symptoms of Ebola, IDPH would be notified and IDPH would coordinate transportation with a pre-identified
EMS to a designated screening facility. This will ensure that no exposure to unprotected and unprepared healthcare workers occurs.
Approved Site Safety Plan Located at:
9. Other Attachments (as needed)
Map/Chart
10. Prepared by:
Weather Forecast/Tides/Currents
Date/Time
ASSIGNMENT LIST ATTACHMENT
11. Reviewed by (PSC):
Page 9 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
ICS 204a-CG (Rev 04/04)
Page
12
Potential Outcomes of Self.pdf
Potential Outcomes of Self-Monitoring/Home Quarantine Individuals that Become
Symptomatic
The medical treatment aspects of the Ebola response structure (CONOPS) is different than how
individuals typically access the healthcare system. If an individual that has traveled to West Africa in the
past 21 days and has been under health monitoring or quarantine orders, that individual will have been
educated on the response and treatment structure that has been developed to limit the spread of Ebola.
These individuals are instructed NOT to utilize the EMS service from their community (911) and NOT to
utilize a community hospital or clinic.
Public health Officials will communicate with these individuals to ensure it is understood where and why
they are being transferred to an Ebola Tier 2 or Tier 3 facility. It is believed that with this clear
communication, individuals will be compliant and cooperative. However, IDPH has the legal authority
through the health orders to determine and require the individual to be transported to a Tier 2 or Tier 3
facility that can safely screen for suspected Ebola and treat confirmed cases of Ebola.
Self-Monitor/Quarantine-Becomes Symptomatic
1) Self-Monitor body temp twice a day, track and report
2) Informed to call IDPH if fever, nausea, vomiting or malaise DO NOT CALL 911
3) Individual becomes symptomatic-fever, nausea, vomiting malaise
4) Immediately notifies IDPH
5) IDPH Epidemiologist consults Infectious Disease and Critical Care Physicians to determine most
appropriate facility to transfer patient dependent upon clinical presentation.
6) IDPH calls Pre-designated EMS Transport Service to transport to accepting facility
7) Tier 2/3 hospital in the state follows established protocols to accept, isolate and screen/treat for
Ebola.
Self-Monitor/Quarantine –Becomes Symptomatic
1) Self-Monitors body temperature twice a day.
2) Individual becomes symptomatic-fever, nausea, vomiting or malaise.
3) Calls 911.
4) Dispatch/PSAP is screening all Ebola-like complaints for travel to Liberia, Sierra Leone or Guinea in the
last 21 days.
5) Dispatch/PSAP notifies LPH/IDPH prior to local 911 EMS Dispatch.
6) IDPH calls the individual and verifies symptoms.
Page 10 of 28
Page 13
7) IDPH Epidemiologist consults Infectious Disease and Critical Care Physicians to determine most
appropriate facility to transfer patient dependent upon clinical presentation.
8) IDPH calls Pre-designated EMS Transport Service to transport to accepting facility.
9) Tier 2/3 hospital in the state follows established protocols to accept, isolate and screen/treat for
Ebola.
Self- Monitor/Quarantine –Becomes Symptomatic
1) Self-Monitors body temperature twice a day.
2) Individual becomes symptomatic-fever, nausea, vomiting or malaise.
3) Calls 911.
4) Dispatch/PSAP does not screen for travel and dispatches EMS 911 to the home.
5) Local 911 EMS screens for travel to Liberia, Sierra Leone or Guinea in the last 21 days and verifies
symptoms consistent with Ebola.
6) Local 911 EMS Service notifies LPH/IDPH.
7) Local 911 EMS assesses the individual and isolates the individual providing oral fluid until Predesignated EMS Transport Service arrives.
8) IDPH/LPH stays in contact with individual to assess physical condition until Pre-designated EMS
transport agency arrives.
9) IDPH Epidemiologist consults Infectious Disease and Critical Care Physicians to determine most
appropriate facility to transfer patient dependent upon clinical presentation.
10) IDPH calls Pre-designated EMS Transport Service to transport to accepting facility.
11) Tier 2/3 hospital in the state follows established protocols to accept, isolate and screen/treat for
Ebola.
Page 11 of 28
Potential Outcomes of
Page
Self.pdf
14
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Public Hlth & Med Services 2
Emergency Services
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
X
Emergency Medical Services
7. Work Assignments
Self- Monitor/Quarantine –Becomes Symptomatic:
In the event that an individual calls 9-1-1 and the PSAP's do not screen for travel and dispatches EMS 911 to the home.
Local 911 EMS should screen for travel to Liberia, Sierra Leone or Guinea in the last 21 days and verifies symptoms consistent with Ebola.
Local 911 EMS Service should then notify Polk County Public Health/Iowa Department of Public Health.
Local 911 EMS assesses the individual and isolates the individual providing oral fluid until Predesignated EMS Transport Service arrives.
IDPH/LPH stays in contact with individual to assess physical condition until Pre-designated EMS transport agency arrives.
IDPH Epidemiologist consults Infectious Disease and Critical Care Physicians to determine most appropriate facility to transfer patient dependent upon clinical
presentation.
IDPH calls Pre-designated EMS Transport Service to transport to accepting facility.
Tier 2/3 hospital in the state follows established protocols to accept, isolate and screen/treat for Ebola.
8. Special Instructions
EMS providers who have agreed to be designated as transporters are Area Ambulance, Cedar Rapids; Medic EMS, Davenport; and Iowa EMS Alliance (West
DSM EMS), West Des Moines.
During patient assessment and management, EMS personnel shall consider the symptoms and risk factors of Ebola:
- All patients shall be assessed for symptoms of Ebola (fever of greater than 100.4 degrees Fahrenheit, and additional symptoms such as severe headache,
muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage). If the patient has symptoms of Ebola, then ask the patient about risk factors
within the past 3 weeks before the onset of symptoms.
- Based on the presence of symptoms and risk factors, put on or continue to wear appropriate PPE and follow the scene
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 12 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
18
1. Incident Name
2. Operational Period (Date/Time)
Ebola 2014
From: 12/22/2014 06:00
3. Branch
4. Division/Group
Emergency Services
Public Hlth & Med Services 2
5. Strike Team / Task Force/Resource (Identifier)
6. Leader
ASSIGNMENT LIST ATTACHMENT
ICS 204a-CG
To: 03/31/2015 06:00
7. Assignment Location
Emergency Medical Services
8. Work Assignment Special Instructions, Special Equipment/Supplies Needed for Assignment, Special Environmental
Considerations, Special Site Specific Safety Considerations
IDPH will coordinate the movement of all suspect and confirmed cases of Ebola including transfers from home or between medical facilities. If the patient is
being transferred from home, IDPH will notify the pre-designated EMS agency and provide the following information:
•Patient’s full name
•Patient’s physical location (home address)
•Current medical status
•Facility the patient is to be transferred to including hospital contact information for providing patient report prior to arrival.
•Directions for entering the receiving facility (appropriate doors to minimize exposures to the patient)
If the patient is being transferred from one medical facility to another medical facility, IDPH will notify the pre-designated EMS agency and provide the following
information:
•Patient’s full name
•Patient’s physical location
•Hospital address
•Patient room number/location
•Directions for entering the facility to ensure an egress that minimizes exposures.
•Current medical status
•Facility the patient is to be transferred to including hospital contact information for providing patient report prior to arrival.
•Directions for entering the receiving facility (appropriate doors to minimize exposures to the patient).
EMS crews should wear properly fitting PPE as identified in CDC guidance included at the end of this IAP.
Approved Site Safety Plan Located at:
9. Other Attachments (as needed)
Map/Chart
10. Prepared by:
Weather Forecast/Tides/Currents
Date/Time
ASSIGNMENT LIST ATTACHMENT
11. Reviewed by (PSC):
Page 13 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
ICS 204a-CG (Rev 04/04)
Page
19
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Public Hlth & Med Services 3
Emergency Services
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
Hospitals/Clinics
7. Work Assignments
The University of Iowa Hospitals and Clinics in Iowa City has agreed to serve as an Ebola treatment facility. Mercy Medical Center – Des Moines and UnityPoint
Health – Iowa Methodist Medical Center, Des Moines have agreed to be screening facilities for an Ebola patient. Broadlawns, Mercy and Methodist are tier 3.
Lutheran and the western hospitals are tier 4.
The hospitals above will be identified and defined utilizing the following Tier structure:
Tier 1-Biocontainment Treatment Centers in the United States.
Tier 2-Hospitals in Iowa Capable of Providing Definitive Treatment for a Confirmed Case of Ebola.
Tier 3-Hospitals in Iowa Capable of Providing Rule out/ Rule in Testing and Short Term Treatment for a Suspected Case of Ebola.
Tier 4-Any Hospital, Ambulatory, Urgent Care or Clinic in Iowa Capable of Verbally Screening and Temporary Isolation of Suspected Case of Ebola.
Please see attached regarding the facility expectations.
8. Special Instructions
•Tier 2 and 3 hospitals must have dedicated treatment and PPE donning and doffing areas, highly skilled and trained staff, appropriate equipment and excellent
infection control procedures to isolate, conduct screen/rule out laboratory testing, and provide supportive care.
•Tier 1 and 2 hospitals may need to provide care for confirmed cases for up to 1 month.
•Tier 3 hospitals may have to care for suspected cases for up to five days before Ebola can be confirmed and transport arranged.
•Tier 4 facilities will demonstrate the ability to verbally screen acutely ill patients for health history and travel to identify, isolate and provide minimal temporary
care (3-6 hours) to any suspected Ebola patient. Tier 4 Facility will immediately coordinate with IDPH and will not provide invasive treatment or laboratory
testing.
•Hospitals may advance to higher Tier level dependent on capability and as demand dictates.
•A minimum of 7 beds will be available in the state for Ebola patients. Two Tier 2 beds and five Tier 3 beds. These hospitals will be distributed throughout the
state according to geographic location, risk and population.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 14 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
22
FacilityExpectations.pdf
Ebola Tier 4 Facility Expectations
IDPH is monitoring all West African travelers that have identified Iowa as a final destination for travel. These
monitored individuals have specific instructions to notify IDPH if signs of illness appear, and are instructed not
to self-deploy to a clinic or hospital. However unlikely, it is possible for individuals that meet risk criteria to
present to a hospital or clinic. As such, all hospitals and outpatient/ambulatory care settings in Iowa must
verbally screen for travel to West Africa, identify individuals at risk for Ebola, isolate, safely assess, and notify
IDPH immediately. IDPH will work with the pre-designated EMS and Tier 4 facilities to ensure the patient is
transferred within 3-6 hours.
The following provides a basic overview of actions to be taken if an individual presents to a Tier 4 facility:
1) The patient is verbally screened positive for travel to Liberia, Sierra Leone or Guinea in the last 21 days and
is displaying symptoms consistent with Ebola
2) Staff shall immediately isolate the patient with access to a private bathroom or covered commode and oral
hydration.
3) Tier 4 staff will designate a separate area for patient family. Family will only be allowed in the isolation area
with the patient if special circumstances exist (child, or other special needs), PPE will be provided to family
members.
4) Tier 4 staff will ensure the least possible number of exposures to other patients or staff.
5) Notify the Iowa Department of Public Health immediately.
6) Staff shall utilize the appropriate PPE for contact isolation to provide a basic assessment and stabilization
for the patient.
7) Staff shall not draw blood for laboratory testing.
8) Staff shall not perform invasive or aerosolizing procedures.
9) Provide oral hydration as tolerated.
10) IDPH Epidemiologist consults Infectious Disease and Critical Care Physicians to determine most
appropriate facility to transfer patient dependent upon clinical presentation.
11) IDPH will contact the Pre-designated EMS transport service to move the patient to the appropriate Tier 2
or Tier 3 facility.
12) IDPH will provide the name and contact information of the facility that will be accepting the patient
including the contact information for the accepting physician to the Tier 4 staff.
13) Tier 4 staff will provide a patient report to the receiving medical physician.
14) Tier 4 staff will monitor and provide supportive care for the patient until the pre-designated ambulance
arrives for transport.
15) Tier 4 staff will provide the transporting ambulance staff a patient report and all patient records that are to
be transferred with the patient.
16) The facility will manage all medical waste per CDC guidance.
17) The facility will clean durable equipment per CDC guidance.
Ebola Tier 2 and Tier 3 Facility Expectations
A limited number of hospitals in Iowa have been identified to be Ebola Tier 2 Tier 3 Facilities. All these facilities
must have plans in place to address the following domains See Attachment 2:
 Staffing of Ebola Patient Care Team
 Patient Transport from Point of Entry to Designated Ebola Treatment Area
 Patient Placement
 Personal Protective Equipment and Procedures for Donning and Doffing
 Monitoring Healthcare Personnel and Managing Exposures
 Laboratory Safety
 Environmental Infection Control and Equipment Reprocessing
 Management of Waste
 Communications
 Management of the Deceased
Tier 2 and Tier 3 Facilities have the ability to isolate individuals suspected to have Ebola. These facilities will
provide supportive care for patients while completing testing to confirm a diagnosis. If the individual is
Page 15 of 28
Page 23
confirmed to have another disease such as malaria, a Tier 3 facility will provide care for that patient until ready
for discharge or transfer to another appropriate facility. If the patient is confirmed to have Ebola, the patient will
be transferred to Tier 2 or Tier 1 Facility depending upon availability and patient care needs. It could take up to
five days for a patient to be confirmed to have Ebola.
Tier 2 Facilities will additionally accommodate the following:
 Provide definitive care for Ebola patients including providing prolonged intensive care support.
 Provide the staff resources, isolation equipment and PPE needed to support care for the duration of the
patient’s illness (potentially several weeks).
 Ability to care for very special needs Ebola patients such as children or pregnant women
 CDC has developed the Rapid Ebola Preparedness Tool for hospitals to assess readiness for
becoming a Tier 2 Facility or a Tier 3 Facility. If an individual is confirmed to have Ebola, CDC will
deploy a Rapid Response Team to assist the Treatment facility. (See Attachment 2) Rapid Ebola
Preparedness (REP) Tool for Hospitals Designated to Receive Suspected or Confirmed Ebola Virus
Disease (Ebola) Patients for additional information.
 If an individual develops symptoms consistent with Ebola, IDPH will consider the following when
determining a hospital destination:
 Timing of the symptom presentation
 Developing several Ebola symptoms in the 3-8 day range of monitoring is more indicative of Ebola than
developing a severe headache with no fever on day 19 of monitoring.
 Severity and progression of symptoms
 Proximity of medical facility and length of transport
 Bed availability at potential receiving facilities
 Mechanisms to limit healthcare workers exposure to suspected or confirmed cases
 Co-morbidity determinations for specialized care
Healthcare workers that provide care to an individual that becomes ill and is confirmed to have Ebola will
undergo health monitoring for 21 days following the last day the healthcare professional provided care. The
healthcare providers will be assessed for risk associated with developing Ebola. IDPH will coordinate
monitoring of healthcare providers based on CDC guidance.
Page 16 of 28
FacilityExpectations.pdf
Page 24
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Hazardous Materials
Emergency Services
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
The Ebola virus is a Category A infectious substance regulated by the U.S. Department of Transportation’s (DOT) Hazardous Materials Regulations (HMR, 49
C.F.R., Parts 171-180). Any item transported for disposal that is contaminated or suspected of being contaminated with a Category A infectious substance must
be packaged and transported in accordance with the HMR. This includes medical equipment, sharps, linens, and used health care products (such as soiled
absorbent pads or dressings, kidney-shaped emesis pans, portable toilets, used Personal Protection Equipment [e.g., gowns, masks, gloves, goggles, face
shields, respirators, booties] or byproducts of cleaning) contaminated or suspected of being contaminated with a Category A infectious substance.
8. Special Instructions
- Personnel performing cleaning and disinfection should wear the recommended PPE outlined at the end of this IAP.
- Patient-care surfaces (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces) are likely to become
contaminated and should be cleaned and disinfected after transport. A blood spill or spill of other body fluid or substance (e.g., feces or vomit) should be
managed through removal of bulk spill matter, cleaning the site, and then disinfecting the site. For large spills, a chemical disinfectant with sufficient potency is
needed to overcome the tendency of proteins in blood and other body substances to neutralize the disinfectant’s active ingredient.
- An EPA-registered hospital disinfectant with label claims for viruses that share some technical similarities to Ebola (such as, norovirus, rotavirus, adenovirus,
poliovirus) and instructions for cleaning and decontaminating surfaces or objects soiled with blood or body fluids should be used according to those instructions.
After the bulk waste is wiped up, the surface should be disinfected as described in the bullet above. Contaminated reusable patient care equipment should be
placed in biohazard bags and labeled for cleaning and disinfection according to agency policies. Reusable equipment should be cleaned and disinfected
according to manufacturer's instructions by trained personnel wearing correct PPE. Avoid contamination of reusable porous surfaces that cannot be made
single use.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 17 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
15
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Law Enforcement & Security
Emergency Services
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
If PSAP call takers advise that the person is suspected of having Ebola this shall be communicated immediately to Polk County Public Health/Iowa Department
of Public Health so that they can call the individual and verify symptoms.
8. Special Instructions
If you observe a person you suspect may be ill, you will ask if they, or someone at the incident, have fever of greater than 100.4 degrees Fahrenheit, and if they
have additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding.
- If a patients is reporting symptoms of Ebola, they shall be questioned for risk factors within the past 3 weeks before onset of symptoms. Risk factors include:
Contact with blood or body fluids of a patient known to have or suspected to have Ebola;
- Residence in–or travel to–a country where an Ebola outbreak is occurring; or direct handling of bats or nonhuman primates from disease-endemic areas.
- Based on the presence of symptoms and risk factors, put on or continue to wear appropriate PPE and follow the scene safety guidelines for suspected case of
Ebola. The patient should be placed in a gown, mask and gloves according to the same PPE recommendations.
- Polk County Public Health and Iowa Department of Public Health should be notified of a suspected case so that their procedures can be followed.
- If there are no risk factors, proceed with normal law enforcement duties.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 18 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
16
1. Incident Name
2. Operational Period (Date/Time)
From: 12/22/2014 06:00
Ebola 2014
3. Branch
4. Division/Group/Staging
Public Information
Command Staff
Name
5. Operations Personnel
Operations Section Chief:
To: 03/31/2015 06:00
Assignment List
ICS 204-CG
Affiliation
Contact # (s)
Scott Slater
Branch Director:
Division/Group Supervisor/STAM:
“X” indicates 204a attachment with additional instructions
6. Resources Assigned
Strike Team/Task Force/Resource
Identifier
Leader
Contact Info. #
# Of
Persons
Reporting Info/Notes/Remarks
7. Work Assignments
Coordination between IDPH and Polk County Public Health. Public Health will send out relevant information to their partners as necessary.
Press conferences, Flash Reports, Situation Reports, Facebook and Twitter updates will be used for public information.
8. Special Instructions
Once there is a suspected case a Joint Information Center shall be established at Polk County Emergency Management Agency within the hour. The Joint
Information Center shall include representatives from Polk County Public Health, Iowa Department of Public Health, Polk County Emergency Management and
the EMS Agency and Hospital involved in the suspected case. The lead Public Information Officer will come from the Polk County Health Department.
For additional information on Joint Information Center procedures, please log into DLAN and click on Documentation>Reference Library>Polk County
Comprehensive Emergency Plan>ESF#15 Public Information.
9. Communications (radio and/or phone contact numbers needed for this assignment)
Name/Function
Radio: Freq./System/Channel Phone
Cell/Pager
Emergency Communications
Medical
Evacuation
10. Prepared by:
ASSIGNMENT LIST
Date/Time
Other
11. Reviewed by (PSC):
Page 19 of 28
Date/Time
12. Reviewed by (OSC):
Date/Time
Page
ICS 204-CG (Rev 04/04)
17
1. Incident Name
2. Operational Period (Date / Time)
Ebola 2014
From: 12/22/2014 06:00
COMMUNICATIONS LIST
To: 03/31/2015 06:00
ICS 205A-CG
3. Basic Local Communications Information
Assignment
Name
Method(s) of contact (radio frequency, phone, pager, cell #(s), etc.)
Johnston Schools
Susanne Richardson
[email protected]/971-1312
Johnston Schools
Susan Krebs
[email protected]
Unity Point RN Epidemiologist
Carrie OBrien
515-241-6826
Polk County Health Department
Scott Slater
286-3752
Polk County Board of Superviso
Sarah Boese
664-7869
Polk County Medical Exam.
Amanda Luick
201-2275
Broadlawns
Karen Nichols
988-4160
DSM Schools
Amanda Lewis
451-3336
Pine Ridge Farms
Nicole Sams
608-3289
DMACC
Sandra Foster
964-6352
Iowa DPS
Alex Murphy
443-3014
Fraser Ambulance
James Morgan
460-8883
Mary Greeley Medical Center
Chris Perrin
[email protected]
Clive Fire Department
Brian Helland
[email protected]
Unity Point
Julie Gibbons
241-5434
Unity Point
Kevin Daniels
241-8622
IDPH
Chris Galeazzi
[email protected]
IDPH
Anne Garvey
[email protected]
DSM Register
Tony Lays
Safe Guard Iowa Partnership
Jesse Truax
[email protected]
Safe Guard Iowa Partnership
Jami Haberl
[email protected]
Ankeny PD
Makai Echer
[email protected]
DMACC
Ned Miller
[email protected]
Unity Point
Scott Draper
[email protected]
Polk Co Court Administrator
Anne Sheeley
286-3184
Polk Co Public Works
Bob Rice
286-3705
Polk City PD
Dustin Bjornn
984-6565
Polk Co Medical Examiner
Dr. Schmunk
710-2852
Broadlawns ED
Steve Carter
282-2253
Des Moines Fire Dept
Dale Bunting
283-4929
4. Prepared by: (Communications Unit)
Date / Time
COMMUNICATIONS LIST
ICS 205a-CG (Rev. 07/04)
Page 20 of 28
Page
25
1. Incident Name
2. Operational Period (Date / Time)
Ebola 2014
From: 12/22/2014 06:00
COMMUNICATIONS LIST
To: 03/31/2015 06:00
ICS 205A-CG
3. Basic Local Communications Information
Assignment
Name
Method(s) of contact (radio frequency, phone, pager, cell #(s), etc.)
Polk County Attorney
Ralph Marasco
[email protected]
DSM Public Schools
Marci Cordaro
242-7618
Polk County Sheriff Office
Tim Krum
208-4872
Westcom
Rob Dehnert
[email protected]
Ankeny PD
Brian Huggins
289-5258
DSM Airport FD
Kevin Gill
573-424-1523
Drake University
Becky Anderson
210-1293
Urbandale FD
Scott Lyon
278-4172
Des Moines Fire
Jim Fox
283-4273
Des Moines Fire
Tony Sposeto
283-4172
Windsor Heights Fire
Christopher Criss
778-2772
MWA
Scott Nelson
710-1403
Polk County Health Depart
Rick Kozin
[email protected]
Pleasant Hill Fire
Jamie Xayavong
[email protected]
MidAmerican
Carol Ralston
[email protected]
Mercy Hospital
Brenda McGraw
[email protected]
Mercy Hospital
Jan Tippett
[email protected]
Mercy Hospital
Gregg Lagan
[email protected]
Iowa Homeland Security
Steve Warren
[email protected]
Warren County EM
Troy Bass
[email protected]
Unity Point
Katherine Hill
[email protected]
Newton Fire
Rex H.
rexhnewtongov.org
Newton Fire
Joe Coen
[email protected]
Iowa Health Association
Art Spies
[email protected]
Iowa Air National Guard
Cameron Stufflebeam
[email protected]
Meredith Corporation
Katherine Reardon
[email protected]
Polk County Sheriff Comm
John Smith
[email protected]
Polk County Sheriff Office
John Taylor
[email protected]
West Des Moines EMS
Mark Mc Culloch
Mark [email protected]
West Des Moines EMS
David Edgar
[email protected]
Iowa Telecom
Pam Boat
[email protected]
4. Prepared by: (Communications Unit)
Date / Time
COMMUNICATIONS LIST
ICS 205a-CG (Rev. 07/04)
Page 21 of 28
Page
26
1. Incident Name
2. Operational Period (Date / Time)
Ebola 2014
From: 12/22/2014 06:00
COMMUNICATIONS LIST
To: 03/31/2015 06:00
ICS 205A-CG
3. Basic Local Communications Information
Assignment
Name
Method(s) of contact (radio frequency, phone, pager, cell #(s), etc.)
Marge Zondervain
[email protected]
Altoona Fire
Doug Richardson
[email protected]
Polk County Sheriff Office
Vic Munoz
[email protected]
Sean McAndrew
[email protected]
Tristan Johnson
[email protected]
VA
Angela Blankership
[email protected]
VA
Rebecca Jordan
[email protected]
Marion County Public Health
Kim Dorn
[email protected]
Marion County
Kim Pettyjohn
[email protected]
Polk County Sheriff Office
Mike Reasoner
[email protected]
VA
Corey Bakaler
[email protected]
Urbandale Schools
Dan Stein
[email protected]
Altoona Fire Department
Jerry Whetstone
[email protected]
Justine Wyma
[email protected]
PC Sheriffs office
Kevin Schneider
[email protected]
Story County Hospital
Jeff Gilchrist
[email protected]
Marion County Public Health
Teresa H.
[email protected] 641-828-2238
Des Moines PD
Gaylord Houston
[email protected]
Wellmark
Chris George
[email protected]
Ankeny Fire
Frank Prowant
[email protected]
Ankeny Fire
Dan Schellhase
[email protected]
Dallas County EA
Barry Halling
[email protected]
Dean MCGhee
[email protected]
Johnston Schools
Josh Morgan
[email protected]
United Way 211
Tim Schuh
[email protected]
Des Moines Schools
Marci Cordaro
[email protected]
Broadlawns
Jacalyn Bell
[email protected]
Dept Public Safety
Alex Murphy
[email protected]
Ankeny Schools
Chad Bentzinger
[email protected]
LEPC Chair
Mary Jo Press
[email protected]
4. Prepared by: (Communications Unit)
Date / Time
COMMUNICATIONS LIST
ICS 205a-CG (Rev. 07/04)
Page 22 of 28
Page
27
1. Incident Name
2. Operational Period (Date / Time)
Ebola 2014
From: 12/22/2014 06:00
COMMUNICATIONS LIST
To: 03/31/2015 06:00
ICS 205A-CG
3. Basic Local Communications Information
Assignment
Name
Method(s) of contact (radio frequency, phone, pager, cell #(s), etc.)
Des Moines Police Comm
Sandy Morris
[email protected]
Community Family Youth Svcs
Betty Devine
[email protected]
American Red Cross
Joe Solem
[email protected]
Des Moines Water Works
John Linns
[email protected]
4. Prepared by: (Communications Unit)
Date / Time
COMMUNICATIONS LIST
ICS 205a-CG (Rev. 07/04)
Page 23 of 28
Page
28
Guidance on PPE.pdf
CDC Guidance on Personal Protective Equipment To Be Used by Healthcare Workers
During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Recommended Personal Protective Equipment





PAPR or N95 Respirator. If a NIOSH-certified PAPR and a NIOSH-certified fit-tested
disposable N95 respirator is used in facility protocols, ensure compliance with all
elements of the OSHA Respiratory Protection Standard, 29 CFR 1910.134, including fit
testing, medical evaluation, and training of the healthcare worker.
o N95 Respirator: Single-use (disposable) N95 respirator in combination with
single-use (disposable) surgical hood extending to shoulders and single-use
(disposable) full face shield.** If N95 respirators are used instead of PAPRs,
careful observation is required to ensure healthcare workers are not inadvertently
touching their faces under the face shield during patient care.
o PAPR: A PAPR with a full face shield, helmet, or headpiece. Any reusable
helmet or headpiece must be covered with a single-use (disposable) hood that
extends to the shoulders and fully covers the neck and is compatible with the
selected PAPR. The facility should follow manufacturer’s instructions for
decontamination of all reusable components and, based upon those instructions,
develop facility protocols that include the designation of responsible personnel
who assure that the equipment is appropriately reprocessed and that batteries are
fully charged before reuse.
 A PAPR with a self-contained filter and blower unit integrated inside the
helmet is preferred.
 A PAPR with external belt-mounted blower unit requires adjustment of
the sequence for donning and doffing, as described below.
Single-use (disposable) fluid-resistant or impermeable gown that extends to at least midcalf or coverall without integrated hood. Coveralls with or without integrated socks are
acceptable.
Consideration should be given to selecting gowns or coveralls with thumb hooks to
secure sleeves over inner glove. If gowns or coveralls with thumb hooks are not
available, personnel may consider taping the sleeve of the gown or coverall over the inner
glove to prevent potential skin exposure from separation between sleeve and inner glove
during activity. However, if taping is used, care must be taken to remove tape gently.
Experience in some facilities suggests that taping may increase risk by making the
doffing process more difficult and cumbersome.
Single-use (disposable) nitrile examination gloves with extended cuffs. Two pairs of
gloves should be worn. At a minimum, outer gloves should have extended cuffs.
Single-use (disposable), fluid-resistant or impermeable boot covers that extend to at least
mid-calf or single-use (disposable) shoe covers. Boot and shoe covers should allow for
ease of movement and not present a slip hazard to the worker.
o Single-use (disposable) fluid-resistant or impermeable shoe covers are acceptable
only if they will be used in combination with a coverall with integrated socks.
Single-use (disposable), fluid-resistant or impermeable apron that covers the torso to the
level of the mid-calf should be used if Ebola patients have vomiting or diarrhea. An apron
provides additional protection against exposure of the front of the body to body fluids or
Page 24 of 28
Page 3

excrement. If a PAPR will be worn, consider selecting an apron that ties behind the neck
to facilitate easier removal during the doffing procedure.
The CDC is also recommending an apron if vomiting, diarrhea occur.
For additional details including preparing for Donning and Doffing please go to this link:
http://www.cdc.gov/vhf/ebola/hcp/procedures-for-ppe.html
Page 25 of 28
Guidance on PPE.pdf
Page 4
Evaluating Returned Travelers.pdf
Evaluating Returned Travelers
High Risk





Percutaneous (e.g., needle stick) or muscous membrane exposure to blood or body fluids of
known and symptomatic Ebola-infected patients
Exposure to the blood and body fluids (including by not limited to feces, saliva, sweat, urine,
vomit, and semen) of a person with Ebola while the person was symptomatic without
appropriate personal protective equipment (PPE)
Processing blood or body fluids of a person with Ebola while the person was symptomatic
without appropriate PPE or standard biosafety precautions
Direct contact with a dead body without appropriate PPE in a country with widespread Ebola
virus transmission
Having lived the immediate household and provided direct care to a person with Ebola while the
person was symptomatic
Some Risk


In countries with widespread Ebola virus transmission: direct contact while using appropriate
PPE with a person with Ebola while the person was symptomatic
Close contact in households, healthcare facilities, or community settings with a person with
Ebola while the person was symptomatic
Low (But Not Zero) Risk




Having been in a country with widespread Ebola virus transmission within the past 21 days and
having no known exposures
Having brief direct contact (e.g., shaking hands), while not wearing appropriate PPE, with a
person with Ebola while the person was in the early stage of the disease
Brief proximity, such as being in the same room for a brief period of time, with a person with
Ebola while the person was symptomatic
Traveled on an aircraft with a person with Ebola while the person was symptomatic
No Identified Risk




Contact with an asymptomatic person who had contact with a person with Ebola
Contact with a person with Ebola before that person developed symptoms
Having been in a country with widespread Ebola virus transmission more than 21 days
previously
Having been in a country without widespread Ebola virus transmission and not having any other
exposures as defined above
Page 26 of 28
Page 6
ExposureLevels.pdf
Page 27 of 28
Page 7
214.pdf
Page 28 of 28
Page 5