I first published this a good number of years ago and thought it may be useful for some of the newer members of the EMS, clinical care, First Responder and Public Safety Communicator community.  Knowing when it is appropriate to don respiratory protection against biological pathogens is often challenging and learning to play “D.O.C.T.O.R.” when interacting with patients might make the task easier and save someone from unnecessary exposure and risk of illness.

Letter Question Interpretation of Results
D Difficulty Breathing

 

 

Is the patient having difficulty breathing?

 Difficulty breathing typically indicates higher patient acuity which is always wise to ascertain prior to arrival.  New or worsening dyspnea raises the index of suspicion for utilization of appropriate respiratory and droplet protective equipment if a traumatic origin is ruled out.  Respiratory distress brought on by illness may be the result of an organism residing in the respiratory tract which translates to aerosolzation of organism via coughing or sneezing.  This places the care-giver at high risk for inoculation via the respiratory or mucus membrane route. Treatment may demand aggressive airway and/or ventilatory support, which places the care-giver at grave risk for inoculation, demanding appropriate respiratory and droplet protective equipment to be worn.
O Occupation

 

What is the patient’s occupation?

 Certain occupations lend themselves to placing the employee at higher risk for disease exposure.  The zoonotic feature of many organisms suggests wearing of appropriate respiratory and droplet protective equipment when caring for anyone ill who works around animals (e.g. zoo, veterinarian office, wildlife park), or a patient who has been around an ill animal.  In addition, laboratory workers, personnel who may work in parks or urban settings around bird excrement, as well as workers disposing of road-killed animal carcasses are at higher risk.
C Contact history

 

Has the patient been in contact with anyone else sick?

 If your patient has had contact with other persons or animals (see occupation) ill within the past two weeks, you should adopt a more aggressive posture of appropriate respiratory and droplet protective equipment.  One or more patients ill at a site (ensure hazardous materials event is ruled out first) are highly indicative of a contagious organism that requires protection against.
T Temperature

 

Does the patient have a fever?

 Patients exhibiting a fever suggest an infection until ruled out.  Since the exact cause of the infection can not readily or reliably be assessed early in the patient contact, the care giver should adopt appropriate respiratory and droplet protective equipment.  If there are other close contacts of the patient on scene, it may be wise to assess them for subtle signs and symptoms of illness as well.
O Out of Country

 

Has the patient been out of the country recently?

 Patients, who in the previous two weeks have traveled outside the country, or to an area inside the country where the care giver knows an endemic disease of interest resides, may pose a higher risk of danger to the care-giver and they should adopt the appropriate respiratory and droplet protective equipment.
R Rash

 

Does the patient have a rash?

 Rashes are suggestive of a need to adopt a more aggressive stance of respiratory and droplet protective equipment.  Fever and rash, as a syndrome, is often the result of an infectious disease.