TO:                             All E.M.S. Agencies

FROM:                       John Adolf, Deputy Commissioner/EMS

DATE:                       October 17, 2014

SUBJECT:                Commissioner’s Order: Ebola

Howard A. Zucker, MD, New York State Acting Commissioner of Health, has issued a Commissioner’s Order that provides directives to Hospitals, Diagnostic and Treatment Facilities, Emergency Medical Services and Funeral Directors (attached)   The information is also posted on the New York State Department of Health Website at http://www.health.ny.gov/diseases/communicable/ebola/#ems_providers      This directive covers ambulance and advanced life support first response agencies.   We would recommend that all E.M.S. providers consider the recommendations set forth in the Order.   Additionally, first response agencies should be discussing the implications with the local ambulance transport services to coordinate your efforts.

A provision of the Order is to provide points of contact within each of the designated agencies to allow effective communication of up to date information on the topic of Ebola.   I am requesting that Erie County ambulance services and A.L.S. first response agencies identify two (2) points of contact from their respective agency.   Also provide at least two (2) telephone numbers and the email address for the designated individuals.

This information will be collated and utilized to distribute information directly to the agencies.   Please return this information by email to Nancy.Zajdel-Zink@erie.gov or return the information by fax to 716-681-5256.   Additionally, NYS Bureau of E.M.S. has requested that one (1) individual from each ambulance service and advanced life support first response agency acknowledge receipt of this notice by sending an email to Ebola.commissioner.order.acceptance@health.ny.gov confirming that the EMS agency has received the Order, that it agrees to accept service of the Order by electronic delivery and that you have the authority to state that.

The material from the Order that applies to E.M.S. listed below has been excerpted from the Commissioner’s Order.

Purpose

This Attachment to the Order of the Acting Commissioner of Health describes requirements regarding management and treatment of Persons Under Investigation (PUI), Confirmed Cases, and bodies of persons

who have expired from Ebola Virus Disease (EVD). It contains several sections, and multiple sections may apply to your entity. Accordingly, you must review this document in its entirety and identify all requirements that apply. If you have any questions regarding these requirements, please submit your questions by email to Ebola.Preparedness@health.ny.gov.

“Covered Entity” means:

c. Ambulance and advanced life support first response services, licensed pursuant to Article 30 of the PHL; and

“Covered Personnel” means all employees, contractors, students, and all other personnel who may:

a. come into contact with a Patient, or a laboratory specimen from a Patient; or

b. be involved in the cleaning or disinfection of equipment or Patient care areas, including vehicles used to transport Patients.

“Patient” means a Person Under Investigation; a Confirmed Case; or the body of a person who has expired from EVD.

“Person Under Investigation” or “PUI”, means a person who has both consistent symptoms and risk factors as set forth in the Specifications required under the Commissioner’s Order. http://www.health.ny.gov/diseases/communicable/ebola/#commissioner_order

Timetable for Compliance

Any covered entity to which this Order has been served shall immediately begin implementation and compliance with these requirements, with full implementation and compliance to be achieved no later than ten (10) days after receipt of the Order; provided, however, that if there are changes to the information at: Specifications required under the Commissioner’s Order

(http://www.health.ny.gov/diseases/communicable/ebola/#commissioner_order), that will be stated on the web site and Covered Entities will be provided additional time per the web site update to achieve full implementation and compliance with such changes.

All general hospitals, diagnostic and treatment centers, offcampus emergency departments, and ambulance services

The Covered Entities referenced above must:

1. Identify to the NYSDOH at least two lead points of contact for EVD preparedness and response activities, one of whom must be available 24 hours per day, seven days per week.

2. Provide all Covered Personnel with personal protective equipment (PPE) that, at a minimum, meets

the applicable specifications at Specifications required under the Commissioner’s Order

(http://www.health.ny.gov/diseases/communicable/ebola/#commissioner_order).

3. Conduct in‐person training for all Covered Personnel, on donning and removing PPE, including physically practicing donning and removing PPE in the setting that will be used for Patients. A designated trainer with infection control expertise selected by the Covered Entity must be present at the training to assess whether Covered Personnel have initially achieved satisfactory competence. The training used must, at a minimum, meet the applicable specifications at Specifications required under the Commissioner’s Order

(http://www.health.ny.gov/diseases/communicable/ebola/#commissioner_order). The Covered Entity must reassess Covered Personnel every month after initially
achieving satisfactory competence, and must retrain any Covered Personnel who do not demonstrate satisfactory competence upon reassessment. Only staff who have demonstrated satisfactory competence are allowed to provide care to Patients. The Covered Entity must maintain a log that identifies all Covered Personnel who have received training, the dates they obtained satisfactory competence, and dates and results of monthly reassessments.

4. Maintain a log of all personnel coming into contact with a Patient, or a Patient’s area or equipment, regardless of the level of PPE worn at the time of contact. Covered Entities shall measure the temperature twice daily of all personnel who come in contact with a Patient, a Patient’s area or equipment, or obtain the temperatures from off‐duty personnel. The log must describe each person’s measured temperatures and any symptoms. “Contact” for the purposes of this provision is defined as coming in physical contact, entering a patient room, coming within three feet of a Patient, or performing laboratory testing on a specimen from a Patient.

Implement a written protocol to safely contain, store and dispose of regulated medical waste in all settings where Patients will be cared for that is in compliance with the applicable specifications at Specifications required under the Commissioner’s Order

(http://www.health.ny.gov/diseases/communicable/ebola/#commissioner_order).

6. Implement a written protocol to safely clean and disinfect any room, vehicle or equipment with which Patients have come into contact, in accordance with applicable specifications at Specifications required under the Commissioner’s Order

(http://www.health.ny.gov/diseases/communicable/ebola/#commissioner_order).

Maintain a list of all persons who came into contact with a Patient before they were placed in isolation, including direct physical contact or coming within three feet of a Patient. The list shall be provided to the local health department where the hospital is located. The Covered Entity shall monitor the temperature and symptoms of any of its personnel on this list.

6. Immediately notify the local health department or the New York City Department of Health and Mental Hygiene (NYCDOHMH), as applicable, when a PUI is placed in isolation for the medical evaluation of EVD.

7. Conduct drills with personnel on all shifts on the patient registration protocol initially within 5 days of receipt of the Order and then every month, following the initial drill. A written description of the drill, including the items reviewed, number of staff included in the drill, gaps identified, conclusions, and next steps, must be maintained and made available to the New York State Department of Health upon request.

Download Notice of Commissioners Order 10-17-14

John Adolf | Deputy Commissioner

Erie County | Health – EMS

3359 Broadway St., | Cheektowaga, NY 14227

P:(716) 681-6070 | F:(716) 681-5256

John.Adolf@erie.gov | http://www.erie.gov