Provision of Hepatitis A Vaccine by Paramedics During Noncritical Patient Interactions: Lessons Learned

Background: Hepatitis A cases have been regularly increasing in Florida since 2016, after remaining relatively stable for several years. Between January 1, 2019, and October 19, 2019, 2,847 cases of hepatitis were reported to the Florida Department of Health, including 2,209 hospitalizations and 41 deaths due to infection with hepatitis A1. At least 93% of these cases was acquired within the state of Florida.1 During this outbreak, Pasco County clearly emerged as a focal point for new cases. As of week 42 of 2019, Pasco County was the second-highest county for new cases (n = 484) and the leading county for deaths due to hepatitis A infection (n = 8). Risk factors identified from hepatitis A cases reported between January 1, 2019, and October 19, 2019, included any drug use (57%), injection drug use (37%), noninjection drug use (35%), homelessness (22%), and being a man who had sexual intercourse with other men (MSM, 4%).1 Moreover, 33% of newly reported cases were interviewed and denied risk factors; 1 (20%) had recently been incarcerated or was currently incarcerated.1 Individuals with these risk factors are often individuals who also require emergency medical services (EMS). On August 1, 2019, a public health emergency (PHE) was issued for the entire state of Florida. The existence of a PHE allows for paramedics to administer vaccine (with the approval of the fire rescue medical director). Pasco County Fire Rescue routinely operates 28 advanced life support (ALS) ambulances with either a crew of 2 paramedics or a paramedic/EMT pair. On October 7, 2019, the Pasco County Board of County Commissioners (BCC) approved a Memorandum of Understanding between the Florida Department of Health in Pasco County, the Pasco County Fire Rescue Medical Director, and the BCC for ALS crews to provide hepatitis A vaccination to noncritical (ie, basic life support) patients during routine contact. This effort appears to be the first within the of Florida. Pasco County Fire Rescue (PCFR) began stocking hepatitis A vaccine on January 1, 2020 and ceased participation in the program on March 1, 2020. During the window of participation, PCFR responded to approximately 6,570 calls in which the patient would have been non-critical and eligible for hepatitis A vaccination. Twelve hepatitis A vaccinations (0.18%) were administered. Crews verbalized concerns about adding vaccination to their job description, feelings of being overwhelmed with existing emergency medical services (EMS) responsibilities, apathy regarding the potential benefit of provision of vaccine, and perception that successful participation in a vaccine campaign would lead to additional community paramedicine responsibilities. The vaccine program was terminated early due to the significant demands on EMS as SARS-CoV2 impacted Pasco County. This trial highlights the need for crew investments and buy-in for future partial or full community paramedicine initiatives.1. Florida Department of Health, Hepatitis A Surveillance State Report, Week 42.Funding: NoneDisclosures: None

Boots and Bugs: The Beginning of an Intervention for Firefighters

Background: Multiple studies have demonstrated that pathogens are present in both apparatus and stations within the fire service. Pasco County Fire Rescue’s (PCFR’s) 500+ firefighters routinely wear boots to trauma scenes and into patient’s residences and then into the dormitory and living areas of the fire stations. Pasco County Fire Rescue (PCFR) recently participated in a larger effort to identify the bacteria, yeast, and mold that firefighters, emergency medical technicians, and paramedics are exposed to on apparatuses and the station living environment during a typical shift. During these efforts to swab multiple touch points within apparatus (ambulances and engines) and common areas of the stations, firefighters’ boots were identified as a significant source of bacterial contamination. Methods: Swabs of 191 surfaces in 23 vehicles and 5 fire stations were collected, including 3 swabs from the bottom of firefighter boots. Results: Firefighter boots had the highest bacterial CFUs of all locations swabbed, with >900,000 and 378,000 CFUs per boot. Disinfection with a quaternary ammonium product sprayed through an electrostatic sprayer system effectively reduced the bacterial contamination on boots. Conclusions: PCFR recognizes firefighter boots as a critical vector of contamination between the environment encountered on emergency medical calls and the fire station environment and, as a result, has started a preliminary education campaign for agency firefighters regarding the need for regular boot disinfection. These efforts include regular submissions to the biweekly employee newsletter, as well as reminders on interoffice mailing envelopes (see example below) in hopes of increasing informal, self-directed boot cleaning and disinfection efforts. The next steps include verifying the effectiveness of specific disinfectant cleaners on boots; addressing logistical and practical barriers to routine cleaning and disinfection of boots; and developing, implementing, and evaluating a protocol for regular boot cleaning and disinfection.Funding: NoneDisclosures: None

Recreational Harvest of the Florida Bay Scallop: Pasco County

This useful brochure written by Brittany Hall-Scharf and published by the UF/IFAS Extension Florida Sea Grant College Program includes a full-color map identifying access routes to the boat ramps and marinas in Pasco County, plus the latest information on scallops and scalloping, the recommended equipment you will want to bring, and a few tasty recipes for preparing Florida’s best summertime catch. https://edis.ifas.ufl.edu/sg157

Floating wetland islands as a method of nitrogen mass reduction: results of a 1 year test

Floating wetland islands (FWIs) were tested in Pasco County, Florida, as a method of reducing total nitrogen (TN) in reclaimed water during reservoir storage. The Pasco County Master Reuse System (PCMRS) is a regional reclaimed-water transmission and distribution system providing wastewater effluent disposal for the county. Total daily mass loading from reclaimed water is limited by nitrogen content in the PCMRS watershed. To test TN reduction efficacy, 20 FWIs were constructed, installed, and monitored in a lined pond receiving PCMRS reclaimed water. In total, 149 m2 of FWIs were installed, distributed as a connected network covering 1,122 m2, or 7% of pond area. Pond hydraulic residence time averaged 15.7 days. Treatment performance was assessed during three consecutive periods: establishment (first 6 months of grow-in), performance (8 months immediately following grow-in), and control (3 months after the FWIs were removed from the pond). The FWIs enhanced pond nitrogen removal capacity by 32%. The primary effect of the FWIs was to decrease organic nitrogen in the pond outflow. By evaluating the difference between the performance and control periods, an incremental TN removal rate for the FWIs was calculated to be 4.2 kg N/m2 FWI per year.

Bridging the Communication Gap in Hospice and Palliative Care for Hispanics and Latinos

The Hispanic and Latino populations have increased nationwide. Hispanics are now the largest minority group in the United States. This increase in population will have an impact on all service areas, including hospice and palliative care. The goal as service providers is to remove barriers to care in order to increase opportunities for all the people residing in the communities. This project addresses the impact of the Hispanic and Latino populations in Pasco County, Florida, and the need to develop Latino outreach programs that will inform, educate, and provide culturally sensitive services which will decrease the barriers of communication and accessibility for Hispanics and Latinos who are in need of hospice and palliative care. The new outreach program, named Nuestro, which means “ours” in Spanish, is designed with this purpose in mind. The project's goal was to increase service by 200%; the outcome after 2 years was an increase of services by 900%.