Mom, I Think I'm Really Sick

Attack One responds to a report of a "person ill" in a dormitory at the local university. This is an uncommon call for the crew, as the students generally receive excellent medical care at the Student Health Center, and transportation for students with illnesses or minor injuries is handled by the university transportation system. The evening is quiet in the dorm. A young man is lying quietly, flat on his back, in the small room he shares with another student.

"Headache, nausea, fever..." You've seen a lot of these kinds of calls during this cold winter. Even through your gloves, you appreciate that the young man is febrile. He says he took acetaminophen an hour ago, and has been trying to take fluids but is too nauseated. His symptoms developed about six hours ago. He has no cough, sore throat or earache; no chest or abdominal pain; no vomiting or diarrhea. He tells you others around him have been ill with upper respiratory infections. No recent travel, no rashes. He does have a severe headache, and as you noticed walking in, he had darkened the room because his headache worsens with light. This is the first time he has ever had a severe headache. His neck hurts when he bends it or turns his head.

You are the only crew member to enter the room, and now you're grateful your partner had to lag behind to bring equipment. This young man is quite ill, with a headache, stiff neck and high fever, but without the respiratory symptoms common in winter. Your immediate concern is that he has meningitis, and your bigger concern is whether it's a contagious form of the disease.

You back out into the hallway, letting the patient know you're preparing for his transportation to the hospital. Then you radio your partner.

"Attack One medic to Attack One driver. I have a very ill patient, and we need full personal protective equipment, a mask for the patient and only our oxygen for treatment. Please call the EMS supervisor to the scene to assist with management of this incident."

You ask a passing student to get the dorm supervisor. Before returning to the room to finish your evaluation and prepare the young man for transport, you have to don PPE. Meningitis is spread by respiratory droplets, so your protection will be optimized by wearing a gown, goggles, gloves and an N95 or higher mask, as well as asking the patient to wear a mask over his face and wash his hands.

Once you don your PPE, you're aware that people around you will be concerned for their safety. Dormitories are very tight quarters, usually with shared rest rooms, study areas and dining halls. Contagious diseases are much more easily spread in such an environment. Your concerns need to be immediately shared with the dorm supervisor, and if they're verified, your EMS supervisor is going to need to make some public-health contacts.

The other Attack One crew member arrives, and you both gear up in the hallway. You ask your partner to remain outside the room, and you take one of your plain masks and a bottle of alcohol-based hand cleaner into the room. Your partner offers to brief the resident dorm advisor, keep others out of the room and notify passing students why you're dressed in your protective wear. You would also like to find the patient's roommate, who would have to be considered at higher risk because of the close quarters.

When you re-enter the room, the patient is sitting up on the bedside. He is wearing only a pair of shorts, and you notice some areas on his legs that look like bruises. The patient cannot remember any recent trauma that would have caused these. This prompts you to ask if you could examine him for other rashes. To do so, you will need to have the room lights on. As you flip on the overheads, the patient makes you aware how the light worsens his headache. You ask him to put on the mask and wash his hands with the cleaner. You then examine him further and find a few small bright red spots on his chest. His lower legs have four or five dark-blue to purple splotches that are not tender. You find no ticks or breaks in the skin. His mucous membranes are moist. His chest is clear, and he is not coughing.