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(See endnote 39)

Emergency medical services systems personnel respond to situations where the individuals may either be highly infectious from a variety of diseases or may be highly susceptible to disease because of existing chronic health conditions, age, medications being taken, being debilitated, or severe trauma from motor vehicle accidents, falls, cuts, burns, gunshot wounds, domestic violence, or other kinds of violence. The personnel arrive at the scene of numerous high-risk situations and may be exposed to a variety of diseases without even knowing it. The individuals responding may vary from paid to unpaid, from highly experienced to people with little experience, and they may be paramedics, emergency medical technicians, police, firefighters, and others. The amount of knowledge about infection prevention may vary from none to fairly intensive training. In any case, the patients typically end up at a hospital and may either be at risk themselves, put the first responders at risk, and/or put the hospital at risk of serious infections.

The personnel not only have exposure to a variety of infectious or contagious diseases but also to body fluids, sharps which are contaminated and may cause immediate problems to personnel if they penetrate their skin, high-risk procedures such as intubation, starting IVs, bandaging injured people, poorly lit work areas, hazardous work areas with fires or hazardous materials, patients who become violent, etc.

The totality of first responders may be exposed to cutaneous anthrax, hepatitis B, hepatitis C, human immunodeficiency virus (HIV), viral hemorrhagic fevers, measles, tuberculosis, chickenpox, diphtheria, influenza, meningitis of various forms, mumps, whooping cough, MRSA, SARS, etc.

Best Practices for Preventing Infections from Emergency Medical Services System Practices

  • • Vaccinate all emergency medical services personnel with all appropriate vaccines to immunize them against possible contamination and disease from patients they are treating or transporting. The vaccines should include but not be limited to hepatitis B, influenza, measles, mumps, rubella, and varicella zoster.
  • • Provide to all personnel with intensive and continuous training in infection prevention and control including, but not limited to, proper hand washing (this is of greatest significance), use of gloves, proper use of respiratory devices and outer gowns when necessary, covering of exposed skin, proper use of eye shields if necessary, techniques of disinfection of equipment and all surfaces within the vehicle, etc.
  • • Conduct all cleaning and disinfecting within the vehicle before leaving the facility to which you have brought a patient.
  • • Remove all disposable contaminated items in a waterproof bag labeled biohazard.
  • • Remove all linens carefully and place in a waterproof bag marked contaminated laundry.
  • • Place all needles and sharps in a special waterproof solid box for later disposal.
  • • Instruct all patients to cover their mouth and nose when sneezing or coughing and dispose of tissues in a no-touch receptacle. They should wear a surgical mask if they are in an infectious stage and dispose of it properly when it becomes wet. Patients need to wash their hands thoroughly before doing any routine type of lifestyle work.
  • • Clean and disinfect all high touch areas that are close to the patient after each patient.
  • • If the patient had a communicable or highly infectious disease, totally decontaminate the vehicle before using it for other patients.
  • • Report all potential infection problems to healthcare personnel when bringing patients into a facility.
  • • For large quantities of blood or other bodily fluids, wear proper personal protective equipment, use super absorbent pads and dispose of them in biohazard bags, use disinfectants over the entire area, and if necessary rinse the area with small quantities of water. Bodily fluids include semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva, and anything contaminated with blood, tissue, or organs.
  • • If blood or body fluids come in contact with the emergency medical services personnel’s intact skin, wash the area thoroughly for at least 15 seconds, examine the skin to make sure there are no breaks or chapped areas, and then disinfect the skin carefully with appropriate skin disinfectants. Non-intact skin should follow the previous care system and then have the appropriate antibiotics applied and supplied orally if directed by medical care personnel.
  • • Clean and decontaminate or dispose of all equipment used on patients. (See the section on “Equipment” later in this chapter.)
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