Illness Protocols

I recently attended a meeting hosted by John Collins from the regional nps/phs office. This meeting was attended by Park Service staff as well as representatives from the various groups of river users. The main agenda of this meeting was to discuss last summer's illnesses on the river and what we can do to help prevent future illness.
In the last several months this situation has been discussed with other phs officers and people from Center for Disease Control (cdc). It has been postulated that these illnesses were probably caused by a Norwalk type virus. Because of inadequate reporting procedures and subsequent ineffective response to the illnesses that occurred last summer, we do not have any laboratory sample analysis. Therefore, we can not be absolutely sure what really caused these illnesses.
This brought up several problems with the present procedures regarding the handling of illness on the river and the reporting of these illnesses. I have been appointed as the new nps Illness Reporting Coordinator. It will be my job to work out the problems we have had in the past regarding illness reporting. I have overhauled the reporting form that was developed by the State of Arizona after the 1994 group of illnesses. I have also developed a set of instructions to be included with the form. In that way everyone will know how, when, and to whom an illness report is to be made. I will be distributing the new form and instruction sheet to all river users before the start of the main 2001 river season.
Since the most likely source of last summer's illness was the river water, proper treatment of river water for consumption was discussed at length at this meeting. Bacteria and protozoa are generally two microns or larger and are easily filtered out by the filters commonly used on the river. Viruses, on the other hand, are in the range of 0.025 to 0.25 microns in size. Since the vast majority of them are not filtered out, treatment with chlorine or iodine is essential to making river

water safe to drink. Both steps are essential, since some protozoa are easily filtered but are not affected by chlorine while viruses are not filtered out but are easily deactivated by chlorine. Even though harmful viruses may not always be present in the river system, they are present often enough to warrant absolute adherence to a filtration plus disinfection protocol for treating river water. Proper hand washing has also been discussed. Hand washing is a very essential procedure to help prevent initial illness or the spread of illness on river trips. The use of the alcohol based hand sanitizers is being encouraged whenever there is not a hand wash station set up. It takes about 30 minutes for a sanitizer to effectively treat river water. Therefore, at lunch stops, it is recommended that people use soap and river water to prewash hands followed by the use of the alcohol hand sanitizer. This is also recommended for food handlers at camp when hand washing is needed before the 30 minute set up time for a hand wash station. We would also encourage to have the hand sanitizer available at hiking or “pit” stops to be used as needed.
As mentioned earlier, I should have the illness form and instruction sheet out by the first part of February. I will also be working on some instructional materials on water treatment, hand washing and food safety. Hopefully these will be out very soon as well. I will be attending the spring gts meeting and will be meeting with the outfitters before the season gets under way.
People becoming ill on the river is a very serious situation. Not only is it a potentially life threatening problem, but it also seriously affects the whole river experience for everyone involved. Hopefully, with education and cooperation, we can cut down on the prevalence of illnesses on the river. I hope all of you have a very happy and safe year. I look forward to meeting as many of you as possible either on the river or wherever.
Jim Nothnagel