Earlier this week, the World Health Organization raised the Pandemic Alert Level to Phase 4, sending the world's media and medical communities into a frenzy of worry and action. Phase 4 alerts are issued whenever human to human transmission is confirmed for an animal or human-animal influenza or virus, and the transmission is suspected of being capable of causing "community level outbreaks." With 100 confirmed U.S. cases - including 1 death - in several states and communities (as of the writing of this article) the implications for EMS providers cannot be overlooked.

Editor's Note: Since the writing of this article on April 29, the WHO has raised the worldwide pandemic alert level to Phase 5, indicating a "strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short." The CDC reported a total of 109 confirmed cases and one death as of April 30. For updates visit cdc.gov/swineflu.

In addition, this "Swine Flu" is not the same Swine Flu that has broken out several times in the past, although the viruses are being compared in the media. This new virus, which also incorporates human and avian virus elements, is now officially and more appropriately known as influenza A (H1N1).

Symptoms of an H1N1 infection are identical to that of influenza. The symptoms include lethargy, high fever (greater than 102°F), weakness, sore throat, runny nose, coughing, loss of appetite, nausea, and vomiting. In severe cases, patients can develop shortness of breath progressing to respiratory distress, dehydration, cyanosis, mental status changes, and severe anxiety and agitation.

Influenza A (H1N1), like other influenza viruses, is airborne and can be spread through direct contact as well. Close proximity with infected swine or individuals can cause transmission. Typically human-to-human transmissions occur when an infected individual coughs or sneezes, or when an infected individual touches something (rails of a cot) with the virus and then another individual touches the same surface before it is cleaned. Airborne transmission often occurs when individuals are within "close contact," which O.S.H.A. defines as 6 feet, but the World Health Organization defines as 1 meter - just over 3 feet. Once infected, the incubation period is as short as 24 hours, or up to a week depending on the source.