New York State Department of Health
	Bureau of Emergency Medical Services
	IMPORTANT ADVISORY AND UPDATE

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Subject: Severe Acute Respiratory Syndrome (SARS) March 20, 2003

The New York State Department of Health, Bureau of Emergency Medical Services (NYSDOH/BEMS) is providing this information and these recommendations to all EMS services and providers. In the event you come into contact with a suspected SARS patient, we want you to be informed and careful. While there is no information currently that suggests that there is a significant risk of SARS in New York State, it is important that EMS be prepared for this possibility.

CASE PRESENTATION: The CDC has developed the following case definition for severe acute respiratory syndrome (SARS). A person with onset of illness after February 1, 2003 with: high fever (>38 degree C or 100.4 degree F) AND one or more respiratory signs or symptoms, including cough, shortness of breath, difficulty breathing and hypoxia. AND either: recent travel to areas reporting transmission of SARS (including Hong Kong, Guangdong Province in the People's Republic of China, Singapore, Hanoi, Vietnam, and Toronto, Canada) within 10 days of symptom onset. OR close contact with a person who is under investigation or suspected of having SARS. Close contact includes having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with suspected SARS.

EMS providers should ask patients presenting with fever and respiratory symptoms about recent travel to Asia or Toronto, Canada, or close contact with a person with suspected SARS.

All EMS agencies and personnel should immediately implement the following recommendations:

• Patients presenting with fever and respiratory syndromes should immediately be asked about travel to affected areas or in close contact with individuals who have traveled in the affected areas in the 10 days prior to illness.
• Patients that confirm recent travel to Asia or close contact with a SARS case, have developed fever and acute respiratory disease syndrome should be transported to a hospital. EMS personnel should notify the hospital prior to arrival of the suspected case of SARS and the possible need for an airborne infection isolation room and proper precautions.
• A surgical or non-rebreathing oxygen mask with 10 to 15 LPM flow should be placed on the patient if not contraindicated.
• All EMS personnel in contact with the patient should:

-Take airborne isolation precautions. (e.g. wear a fit tested N-95 respirator).
-Practice Standard Body Substance Isolation (BSI)* and personal protection equipment (PPE) precautions (e.g. use of gown and gloves for contract with the patient or their environment).
-Wear eye protection for all patient contacts.
-Practice good personal hygiene precautions (e.g., hand washing).
-Follow post response vehicle cleanup policies and procedures.

* The current terminology from the CDC for BSI is Standard Precautions.

NOTE: Please refer to BEMS Policy Statement 03-02, EMS Response Planning to a Suspected Biological/Infectious Disease Incident for additional recommendations.

TREATMENT: EMS personnel should follow state and regional protocols for the treatment of respiratory illness.
ADDITIONAL INFORMATION: For additional information on this evolving outbreak, please check the following sites:
DOH WEB site	www.health.state.ny.us
EMS Provider WEB site	www.health.state.ny.us/nysdoh/ems/main.htm
Centers for Disease Control and Prevention	www.cdc.gov
World Health Organization	www/who.int/en/

Updates on this SAR, as well as the CDC and WHO alerts, will be posted on the NYSDOH's Health Alert Network (HAN): https//commerce.health.state.ny.us/hpn

Information in this alert was adapted from the CDC's Health Alerts (CDCHAN-000118; CDCHAN-00019),CDC's Updated Interim Domestic Infection Control Guidance in the Health Care and Community Setting for Patients with Suspected SARS, the World Health Organization Severe Acute Respiratory Syndrome (SARS) multi-country outbreak – Update,3, and the New York City Department of Health and Mental Hygiene's 2003 Health Alert #8.