The following groups are at risk of being infected and contagious:

• Travelers from the Arabian Peninsula
• Close contacts of an ill traveler from the Arabian Peninsula
• People who have been in a health care facility in the Republic of Korea
• Close contacts of a confirmed case of MERS

The MERS 3I Tool

With global travel opportunities, it is essential to assess for risk of exposure to transmissible infectious diseases for all patients presenting to the emergency department. With input from the ACEP Ebola Expert Panel and guidance from the Centers for Disease Control and Prevention, a simple algorithm was developed. This modified 3I tool is intended for use in management of patients under investigation for MERS.

First, an assessment of epidemiologic risk factors, including travel to countries with current cases and contact with patients with confirmed MERS within 14 days, is performed. Patients are then risk-stratified by type of exposure, coupled with symptoms of fever and respiratory illness. If criteria are met for MERS risk, patients must be immediately placed into airborne infection isolation. The final step is for the emergency practitioner to alert hospital infection control and the local public health department. The MERS 3I tool is a new addition to the armamentarium of frontline emergency workers that will facilitate rapid categorization and triggering of appropriate time-sensitive actions for patients presenting to the emergency department at risk for MERS.

References

1. Koenig KL, Schultz CH. The 2014 Ebola virus outbreak and other emerging infectious diseases. Accessed Sept. 1, 2015.
2. Koenig KL, Majestic C, Burns MJ. Ebola virus disease: essential public health principles for clinicians. West J Emerg Med. 2014;15:728-731.
3. Koenig KL. Identify, isolate, inform: a 3-pronged approach to management of public health emergencies. Disaster Med Public Health Prep. 2015;9:86-87.
4. Koenig KL, Burns MJ, Alassaf W. Identify-isolate-inform: a tool for initial detection and management of measles patients in the emergency department. West J Emerg Med. 2015;16:212-219.
5. Augustine JJ. Measles outbreak highlights the need for infectious disease containment protocols in the emergency department. ACEP Now, Feb. 12, 2015.
6. Koenig KL. Identify-isolate-inform: a modified tool for initial detection and management of Middle East respiratory syndrome patients in the emergency department. West J Emerg Med. 4, 2015. [epub ahead of print]

Dr. Koenig is director of the University of California, Irvine Center for Disaster Medical Sciences and professor of emergency medicine and public health at the UC Irvine School of Medicine.