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Prehospital personnel are usually the first health care personnel to encounter sudden illnesses or other health care emergencies in the community setting. Responding to these emergencies puts paramedic personnel at risk because the type, extent, and severity of this illness are not yet known. The Occupational Safety and Health Administration (OSHA) identifies there are more than 1.2 million community-based first-response personnel, including law enforcement, fire, and emergency medical service personnel, who are at risk for infectious exposure.1 This large number highlights the need to protect these personnel against such exposures.


At one time, infectious disease and bioterrorism preparation were not a priority in some EMS agencies. Terrorism events such as the 1995 sarin gas attack on the Tokyo subway, the 2001 World Trade Center in New York City, the 2005 London Underground bombings, and the 2003 severe acute respiratory syndrome (SARS) outbreaks made preparedness a priority. This was especially true in Tokyo where first response personnel were not adequately prepared for acts of terrorism and were exposed to sarin gas,2,3 and as emergency medical personnel responding to patients at the onset of the SARS outbreaks in Toronto4 and Taipei5 were exposed to or contracted SARS in significant numbers, and one paramedic died due to SARS. More importantly, in Toronto, the loss of paramedic availability for work due to exposure, illness, and quarantine impacted the ability to maintain staffing for many weeks during the outbreak.6 These two examples highlight the need for EMS systems to adequately prepare and protect the workforce from potential exposure.




  • Describe the five types of infectious agents.

  • Describe the seven modes of transmission of a contagious disease.

  • Discuss the use of standard prehospital PPE and when additional PPE should be used (eg, respiratory).

  • List common serious contagious and communicable diseases present in the prehospital environment.

  • List appropriate immunizations for prehospital personnel.

  • Describe how needlesticks and known exposures (HIV, hepatitis C, meningitis, TB) are managed.

  • Discuss ways EMS agencies can help prevent, and respond to, certain epidemics (eg, influenza).

  • List potential biological agents that may be released as an act of terrorism.

  • Discuss how the approach to an MCI with a bioterrorism element changes the approach of EMS to the operations.

  • Discuss stock-piling treatments for emergency responders and how to design a response plan to specific bioterrorism threats.


This chapter addresses communicable infectious disease and agents of terrorism in a manner relevant to EMS agencies and their personnel. The chapter is divided in three parts. The first is specific to infectious and communicable disease, describing the basics of communicable disease transmission and prevention, general approach to the patient with a suspected infectious or communicable disease, and specific disease conditions outlined by presenting complaint. The second is specific to agents of bioterrorism, and includes methods for detection and management of those exposed. The second part also includes the fundamentals of ...

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