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Viral Hemorrhagic Fevers (VHFs) are severe illnesses caused by a range of viruses, some of which have high fatality rates. Although cases are rare in the United States, these viruses are becoming more prevalent internationally. Examples of VHFs include Marburg virus disease (MVD), with a fatality rate averaging around 50% (ranging from 24% to 88%), Lassa fever, with a hospital fatality rate of 15% to 20% (and as high as 50% in pandemic settings), Ebola virus disease (EVD), and Crimean-Congo hemorrhagic fever (CCHF). The recent national attention surrounding a fatal Lassa fever case in Iowa underscores the importance for EMS clinicians to stay informed about VHFs.
The National Highway Traffic Safety Administration (NHTSA) Office of EMS strongly encourages EMS clinicians to familiarize themselves with VHFs, including where they occur, how they spread, what questions to ask patients, and how to protect themselves. The National Emerging Special Pathogens Training & Education Center (NETEC) provides guidance for the management of VHFs and has recently updated the MVD NETEC guidelines for EMS clinicians, in October 2024 to align with current CDC recommendations. These guidelines for EMS clinicians emphasize the "Identify, Isolate, and Inform" paradigm, previously used for diseases like Ebola and mpox.
Emergency responders are encouraged to learn the signs and symptoms of VHFs and to assess patients with travel-related questions when appropriate. While most EMS clinicians in the United States are unlikely to encounter a VHF case during routine operations, international outbreaks heighten the risk of encountering an infected patient who may have traveled from an affected region. EMS agencies serving areas with international ports of entry should be especially vigilant.
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