When EMTs or Paramedics wear mask or not?

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Dear Dr. Ichikawa,
   
  It has always been protocol to wear a mask when dealing with a respiratory disease. If our patient is for example, a known TB patient, or some other type of illness, paramedics were and are very likely to wear a mask.  As well, any other respiratory illness such as influenza would require a mask , although many medics did not wear them in the past. I myself am guilty of this.  Most of us felt as though we are healthy individuals that can fight off infection.  As mentioned by others, wearing a mask does at times make the patient feel uncomfortable, especially when dealing with a pediatric patient.  However, during SARS, young and healthy individuals were infected and spent time recovering in hospital.  There were no deaths of paramedics to be best of my knowledge, but speaking to medics that did become infected with the virus, they stated that it was the worst feeling that had ever experienced.  It has opened up our eyes in health care that there are "bugs" out there that can cause
 serious health problems for young and healthy people. 
   
  Also, when dealing with workers compensation, a paramedic may not be compensated if he/she did not follow procedure with regards to PPE. Unfortunately in health care, as you yourself obviously know, one of the greatest risks to providers is the "unseen" threat.  If a fire fighter gets burned at work, it is known where it happened, and he/she will be compensated for lost time. If a police officer gets shot, the same applies. If a paramedic catches a virus and is hospitalized a few days later, it is difficult to prove that the paramedic contracted the illness while at work, and the paramedic may not be compensated for lost wages, as the worker's compensation board may say that the paramedic may have caught the virus on their own time.  
   
  With regards to trauma, to the best of my knowledge, protocols have not changed. Although there is always the possibility that a trauma patient has a serious respiratory illness, it is less likely.  It is the standard over here to wear an N95 mask for an unconscious patient, regardless of whether it is a trauma or not. The face shields that I was referring to are the ones with the head band, attached to a piece of plastic that covers the face from the forehead down to past the nose.  A lot of medics will remove their face shields once the patient has been successfully intubated, but will continue to wear their mask and safety goggles. 
   
  I hope I have answered your questions. 
   
  Sincerely,
   
  Marty Munro
  

little_karuka at nifty.ne.jp wrote:
  
On Wed, 23 Nov 2005 17:52:16 -0800
Ashton Treadway wrote:

Thank you Dr.Treadway

> One note: when I said "standard face shield", I meant a standard
> surgical mask, not a HEPA/NIOSH mask.

I agree your comments.


Dear Mr.Munro

> As you probably know, we in Toronto experienced SARS a few years ago, 
> and since then, precautions involving PPE have changed. 
> We are supposed to wear full PPE including mask, gown, gloves and goggles 
> whenever dealing with an unconscious patient. 

May I ask you the "change" ,before and after of SARS.
I mean I want to know the same question for Dr.Treadway, 
'in the field'.
Thank you

Takao Ichikawa
Japan

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