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The risk of communicable disease is not as apparent as other physical risks, such as road traffic, power lines, firearms, or chemical agents. EMS personnel must use the same heightened level of suspicion and precaution whenever approaching a patient. All personnel must take appropriate precautions when a patient presents with any signs or symptoms potentially due to an infectious or communicable disease. All EMS and first responder agencies must provide appropriate training that prepares personnel to identify at‐risk patients and to use personal protective equipment (PPE). Table 23.1 outlines suggested PPE based on procedure or intervention. Table 23.2 provides suggested precautions based on the suspected infection.

Appropriate use of PPE is tantamount to implementation of isolation as it might be described in a hospital setting. One important principal difference is that the patient’s location is far less static. Thus, it is important that personnel, EMS and hospital alike, soon to come in proximity to the patient, have enough forewarning to enable them similarly to prepare with appropriate PPE. Further, in the case of a receiving hospital, advance notice may facilitate preparation of an optimal isolated receiving area for an infectious patient.

The risk assessment begins with information from the public safety answering point, prior to making patient contact. Call‐taking procedures should include basic screening to identify potential communicable disease threats. The screening can identify patients with symptoms of fever, chills, cough, shortness of breath, or diarrhea. The call‐taker can also determine if the patient location, such as nursing home, group home, or other institutional setting, poses a potential risk to the responding personnel. This information appropriately conveyed to EMS clinicians helps them prepare and determine what precautions are necessary before they make patient contact.

When patient contact is made, personnel should continue to determine if the patient has a potential risk for a communicable disease. A brief history and physical examination can help raise suspicion. The following screening questions may help identify a patient with a communicable disease:

 Do you have a new or worsening cough or shortness of breath?

 Do you have a fever, shakes, or chills?

 Do you have a sore throat, runny nose, or nasal congestion?

 Do you have nausea, vomiting, or diarrhea?

 Do you have a headache or muscle pains?

 Have you had an abnormal temperature (above 38 degrees C)?

 Have you been in close contact with anyone who is ill or known to have a communicable disease?

 Have you been in contact with anyone who has traveled to an area affected by a communicable disease outbreak?

A screening physical examination will also identify obvious signs of a communicable disease. This may include a rash, skin lesions, or draining wounds.