Paul Pepe, MD, MPH, FAEMS,MCCM
Global Coordinator, Metropolitan EMS Medical Directors Alliance
University of Texas Health Sciences, Houston, Texas, USA
Dallas, Texas
Disclosure information not submitted.
Peter Antevy, MD
Medical Director
City of Coral Springs, Parkland and Davie Fire Rescue Departments
Broward County, Florida, United States
Disclosure information not submitted.
Steven Rios, MD
Study Coordinator
Coral Springs Parkland Fire Department
Coral Springs, Florida, United States
Disclosure information not submitted.
Leslie Leal, DO
Senior Resident in Pediatrics
DiMaggio Children's Hospital
Hollywood, Florida, United States
Disclosure information not submitted.
Juan Cardona, EMT-P, BS, MFA
EMS Division Chief and Infection Control Officer
Coral Springs Parkland Fire Department
Coral Springs, Florida, United States
Disclosure information not submitted.
Michael McNally, MS, EMT-P
Fire Chief
Coral Springs Parkland Fire Department
Coral Springs, Florida, United States
Disclosure information not submitted.
James Roach, DO
Medical Director
Cleveland Clinic of Florida Emergency Department and Broward Sheriff's Office
Fort Lauderdale, Florida, United States
Disclosure information not submitted.
Remle Crowe, PhD
National Research Scientist
ESO
Austin, Texas, United States
Disclosure information not submitted.
Title: Controlling Potentially-Infectious Fugitive Bio-Aerosol Emissions During Nebulizer Treatments
Introduction: Nebulizer treatments can create aerosolized spread of highly-contagious airborne viruses (eg, COVID-19). With increased risk of aerosolized spread within confined ambulance compartments, this study specifically evaluated a specially-designed nebulizer mask modified with expiratory-port filters and a sealing faceplate to minimize fugitive bio-aerosol emissions (FBAE).
Methods: As FBAE carrying contagious viruses typically range from 0.5 to 1.5 micron (μ), a 6-port (0.3–10μ) Kanomax 3889 particle measurement (PM) counter was placed 78 cm from each of 15 rotating adult volunteers (non-patients; beardless; 7 women, 8 men; ages 18-59 yrs) sitting upright in one of 3 rotating fleet ambulances using the EMS agency’s usual jet-nebulizers on day 1 with either a conventional mask (CM) or an aerosol-controlling mask (ACM). Each person returned on another day using the other mask as indicated. Ambient ambulance PMs (PMamb) were sampled before subjects entered. After re-closing the door and waiting 5 mins, a pre-nebulization PM (preNeb-PM) was made. Jet-nebulizers (using H2O solutions) were then applied (either by CM or ACM) for 5 min followed by post-neb PMs (Post1) and 2 successive PMs (Post2/Post 3), all 5 mins apart, with masks remaining in place.
Results: After “treatment”, mean 1μ CM PMs (Post1CM) were 152.2-fold larger (p=0.001) than mean 1μ ACM PMs (Post1ACM), remaining 49.6-fold (p=0.005) and 7.2-fold (p=0.006) larger at Post2 and Post3 readings. PMamb and preNeb-PM were all similar (NSD) for both ACM and CM across all PM sizes (0.5, 1.0, 3.0 μ) including 1μ ACM preNeb-PMs of 6,977/cf vs. 5.683/cf for CM preNeb-PMs (NSD). While mean 1μ Post1ACM readings decreased (-31.7%) from ACM pre-Neb-PM (6,977 to 4,662/cf; p=0.002), the 1μ Post1CM readings rose 14,500.1% (5,683 to 700,549.93/cf; p=0.002) with corresponding elevations for 0.5μ (p=0.001) and 3μ (p=0.002) particles using CM. Of additional note, ACMs were uniformly well-tolerated over the 15 mins being worn.
Conclusion: Compared to conventional methods, a modified mask system designed specifically to limit aerosolization of inhaled solutions did provide profound control of fugitive aerosolized particle emissions during nebulizer applications. The findings indicate a much safer approach to treating COVID-19 patients and all others requiring nebulization.