Deadly threat of SARS: outbreak in Toronto: the landmark global terrorism conference--the International Joint Operations Command Conference--to be held in Belfast on November 12-13, will focus partly on Emergency Medical Services. This paper previews one of the key presentations, focusing on how Toronto EMS handled the recent outbreak of the lethal SARS disease.(Severe Acute Respiratory Syndrome)

Toronto Emergency Medical Services was involved with this spring's outbreak of Severe Acute Respiratory Syndrome even before SARS had its name. Five months later, the organisation is still dealing with the uncertainties and stress it caused, even as the city's economy and tourism are recovering.

Stopping the spread of SARS both within our community and among our own paramedics, was a huge challenge for Toronto EMS It is a credit to the courage and professionalism of our paramedics, and the rest of our staff, that so few of our people got SARS and that we played such a large role in containing a very serious disease that continues to claim victims in our city.

It all started innocently enough. Toronto EMS paramedics attended the residence of a woman who passed away from an apparent cardiac arrest on March 5, 2003. She turned out to be the original carrier of SARS from Hong Kong to Toronto. A couple of days later, we transported her son to Scarborough Hospital, Grace Division with respiratory problems, where he died shortly thereafter. On March 13, paramedics moved two more respiratory patients from Scarborough Grace to isolation units at other hospitals

Based on descriptions of these patient transports, and on World Health Organisation and Toronto Public Health notifications of an outbreak of atypical pneumonia affecting residents of Hong Kong, China and Vietnam, Dr Martin Friedberg, Medical Advisor, and Peter Macintyre, Manager, Community Safeguard Services, sent out their first memo about 'atypical pneumonia' to all Toronto EMS Staff on March 14. The memo advised paramedics to use standard universal infection control precautions, including wearing N95 respirators, gloves and gowns, and de contaminating vehicles, stretchers and equipment. From that point on, daily updates were emailed to all Toronto EMS staff, posted at stations and recorded on a 1-800 number so staff could get information over the phone In what turned out to be a very prudent move, Toronto EMS Operations Sup port ordered 250,000 N95 respirators and a large supply of disposable gowns and gloves.

Two days later, the WHO identified the out break as 'Severe Acute Respiratory Syndrome'. …

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