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Arrive to a local care home. Worker meets you outside and says "We are on lockdown because we have Norovirus infected tenants inside".

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Upon arrival

1. Find out how many patients are symptomatic and what their symptoms are. Request additional units as needed.

2. Make use of Complete BSI equipment including gown before entering the facility.

3.Patient Evaluation. Patient Hx. Onset? Symptoms? Vital signs? Signs of dehydration?

4. Ascertain BGL and treat if needed.

5. Check SPO2 and administer O2 accordingly.

6. Start IV with Nacl .09% for fluid replacement. Hartman's solution might be an appropriate alternative.

7. Cardiac monitoring.

8. Administer anti-emetic.

7. Advise Hospital of arrival of patient with probable Norovirus.

8. Transport.

Norovirus is pretty contagious but not deadly. The age of the patient greatly increases the gravity of her infection. Precautions should be taken to avoid contamination since the incubation period can be up to 48 hours to avoid giving family and friends the squirts (southern technical term). :)

Edited by DFIB

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A quick microbiology review tells us that Norovirus is spread by aerosol droplets so on goes the N95 Daffy Duck special

Is Nana one the infected peoples?

How long has she been vomiting? Hours? days? What's her history like? Any hepatic problems, ulcers, AAAs, diabetes, gallstones, abdo surgery etc?

What started it? Has she eaten anything different?

What have her symptoms been? What has she been vomiting up i.e. normal stomach contents, chunky bits or nasty, foul smelling malena?

During the time she has been vomiting has she been holding down fluids and if so, can we have a look at her fluid chart (if she has one)

How crook does Nana seem to be?

Physical exam? Hydration status, abdominal examination, general impression?

I'm thinking we'll put in a drip give her a litre of fluid and take her to the hospital, with appropriate notification if she has the norovirus

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Honestly, the best place for all these patients unless some of them are critical is where they are.

Why bring a bunch of norovirus patients into a fresh breeding ground, mainly a hospital.

Norovirus is pretty darned contagious and a hospital with it's already immunocompromised patients and many visitors who are immunocompromised but do not know it yet, can be a breeding ground of well you guessed it, contagion.

you have a contained area of infection that can be easily contained and quarantined.

Supplies can be brought in, additional public health staff can be brought in and can treat the sick and the nursing home is pretty much a city unto itself.

Depending on how bad the outbreak is Nana may just have to be left at the home and treated there.

But we don't live in a society where we will do anything like this so let's just take nana to the hospital and spread the infection.

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Oh Jesus. I lived this scenario back in August and nearly got fired for telling EMS the above requested information of number of patients, how sick, onset of cases over time, etc. (My former administrator was a nutter butter who didn't understand medicine very well.) I now work somewhere else, in case anyone's curious...

So, waiting for the info that others have requested... I would add, any indicators that anyone's aspirated, and are there any folks with moderate-to-severe dementia who are infected...

Wendy

CO EMT-B

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Easy there DFib, finished the scenario without even meeting your patient ;)

OK Gown and mask on. BTW is that N95 or surgical?

The staff member leads you into a room down the hall where you find an elderly although not frail looking lady whom is sitting in a chair with her head tilted back (lookoing at ceiling). There is vomit free flowing out of her mouth, and she is coughing/gagging/snoring/vomiting.

Staff states she has no PmHx, and only a bottle of Prednisone and eye drops are found in the room.

She was out for a meal one hour ago, and was just found like this.

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Yeah, @ DFIB, you've based your treatment so far on the stated diagnosis of someone that you don't know, and who might be, in fact, is likely, wrong.

What the hell?? :-)

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Easy there DFib, finished the scenario without even meeting your patient ;)

Figgured it couldn't hurt. It would not be the first time you start a scenario and disappear without concluding but I am all ears now. I am interested in seeing how it will turn out different.

Edited by DFIB

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Figgured it couldn't hurt. It would not be the first time you start a scenario and disappear without concluding

Reference?

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It will be probably be easier to take it back than to look it up. Let me see if I can find it but I am cool and down with the gagging elderly lady.

I retract from lazyness. No problems.

Edited by DFIB

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