{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:12:49Z","timestamp":1790892769578,"version":"4.1.0"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Monkeypox 2022 exhibits unprecedented human-to-human transmission and presents with different clinical features than those observed in prior outbreaks. Previously endemic only to West and Central Africa, the monkeypox virus spread rapidly world-wide following confirmation of a case in the United Kingdom on May 7, 2022 of an individual that had traveled to Nigeria. Detection of cases with no travel history confirms on-going community spread. Emergency Medical Services (EMS) professionals will likely encounter patients suspected or confirmed to have monkeypox, previously a rare disease and therefore unfamiliar to most clinicians. Consequently, it is critical for EMS medical directors to immediately implement policies and procedures for EMS teams \u2013 including emergency medical dispatchers \u2013 to identify potential monkeypox cases. These must include direction on actions EMS professionals should take to protect themselves and others from virus transmission. Monkeypox 2022 may manifest more subtly than it has historically. Presentations include a subclinical prodrome and less dramatic skin lesions \u2013 potentially limited to genital or anal body regions \u2013 which can be easily confused with dermatologic manifestations of common sexually transmitted infections (STIs). While most readily spread by close contact with infectious skin lesions on a patient, it is also transmissible from fomites, such as bed sheets. Additionally, droplet transmission can occur, and the virus can be spread by aerosolization under certain conditions. The long incubation period could have profound negative consequences on EMS staffing if clinicians are exposed to monkeypox. This report summarizes crucial information needed for EMS professionals to understand and manage the monkeypox 2022 outbreak. It presents an innovative Identify-Isolate-Inform (3I) Tool for use by EMS policymakers, educators, and clinicians on the frontlines who may encounter monkeypox patients. Patients are identified as potentially exposed or infected after an initial assessment of risk factors with associated signs and symptoms. Prehospital workers must immediately don personal protective equipment (PPE) and isolate infectious patients. Also, EMS professionals must report exposures to their agency infection control officer and alert health authorities for non-transported patients. Prehospital professionals play a crucial role in emerging and re-emerging infectious disease mitigation. The monkeypox 2022 3I Tool includes knowledge essential for all clinicians, plus specific information to guide critical actions in the prehospital environment.<\/jats:p>","DOI":"10.1017\/s1049023x22001121","type":"journal-article","created":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T10:19:02Z","timestamp":1659608342000},"page":"687-692","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":19,"title":["Monkeypox 2022: A Primer and Identify-Isolate-Inform (3I) Tool for Emergency Medical Services Professionals"],"prefix":"10.1017","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9626-0442","authenticated-orcid":false,"given":"Kristi L.","family":"Koenig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian K.","family":"Be\u00ff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen M.","family":"Marty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"S1049023X22001121_ref11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007791"},{"key":"S1049023X22001121_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2014.03.994"},{"key":"S1049023X22001121_ref22","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2020.1.46120"},{"key":"S1049023X22001121_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.onehlt.2022.100410"},{"key":"S1049023X22001121_ref4","unstructured":"4. Happi, C , Adetifa, I , Mbala, P , et al. Urgent need for a non-discriminatory and non-stigmatizing nomenclature for monkeypox virus. Virological. June 10, 2022. https:\/\/virological.org\/t\/853. Accessed July 12, 2022."},{"key":"S1049023X22001121_ref19","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.3.30188"},{"key":"S1049023X22001121_ref3","unstructured":"3. Genomic epidemiology of monkeypox virus. Nextstrain. Updated July 12, 2022. https:\/\/nextstrain.org\/monkeypox\/hmpxv1. Accessed July 12, 2022."},{"key":"S1049023X22001121_ref20","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2017.10.35983"},{"key":"S1049023X22001121_ref24","unstructured":"24. EMS Response to the Current Outbreak of Monkeypox. National Emerging Special Pathogens Training and Education. May 19, 2022. https:\/\/netec.org\/2022\/05\/19\/ems-response-to-the-current-outbreak-of-monkeypox\/. Accessed July 4, 2022."},{"key":"S1049023X22001121_ref18","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.6.30793"},{"key":"S1049023X22001121_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(22)00354-1"},{"key":"S1049023X22001121_ref5","unstructured":"5. Monkeypox-United Kingdom of Great Britain and Northern Ireland. World Health Organization. July 8, 2022. https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/monkeypox---united-kingdom-of-great-britain-and-northern-ireland. Accessed June 12, 2022."},{"key":"S1049023X22001121_ref17","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2015.7.27915"},{"key":"S1049023X22001121_ref6","unstructured":"6. Mathieu, E , Dattani, S , Ritchie, H , Roser. Monkeypox. Our World in Data. Updated June 12, 2022. https:\/\/ourworldindata.org\/monkeypox. Accessed June 12, 2022."},{"key":"S1049023X22001121_ref8","doi-asserted-by":"publisher","DOI":"10.1086\/505880"},{"key":"S1049023X22001121_ref7","unstructured":"7. Global smallpox eradication (Document EB65.R17). World Health Organization, Executive Board, 65. Published January 25, 1980. https:\/\/apps.who.int\/iris\/handle\/10665\/154647. Accessed June 12, 2022."},{"key":"S1049023X22001121_ref23","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2020.1.46760"},{"key":"S1049023X22001121_ref15","doi-asserted-by":"publisher","DOI":"10.1017\/dmp.2014.125"},{"key":"S1049023X22001121_ref9","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa143"},{"key":"S1049023X22001121_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.onehlt.2022.100410"},{"key":"S1049023X22001121_ref10","doi-asserted-by":"publisher","DOI":"10.1038\/s41564-020-0706-0"},{"key":"S1049023X22001121_ref16","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2015.3.25678"},{"key":"S1049023X22001121_ref21","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2018.11.40023"},{"key":"S1049023X22001121_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jviromet.2012.10.009"},{"key":"S1049023X22001121_ref2","unstructured":"2. Multi-country monkeypox outbreak in non-endemic countries. World Health Organization. May 29, 2022. https:\/\/www.who.int\/emergencies\/disease-outbreak-news\/item\/2022-DON388. Accessed July 3, 2022."}],"container-title":["Prehospital and Disaster Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1049023X22001121","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T12:12:32Z","timestamp":1663071152000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1049023X22001121\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,4]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["S1049023X22001121"],"URL":"https:\/\/doi.org\/10.1017\/s1049023x22001121","relation":{},"ISSN":["1049-023X","1945-1938"],"issn-type":[{"value":"1049-023X","type":"print"},{"value":"1945-1938","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,4]]},"assertion":[{"value":"\u00a9 The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}