These are uncertain times.
This year had barely started and we have found ourselves in the middle of a pandemic that caught many unprepared. All we can do is keep our heads-up and charge into this straight on like we always do. To help keep our friends in the field safe, and better able to answer questions about the relationship between coronavirus and EMS and a need for increased EMS safety protocols, let’s talk about handwashing and ambulance decontamination.
Handwashing and alcohol-based hand sanitizer
As we know, handwashing is essential to limiting the spread of COVID-19, along with every other infectious disease we encounter.
Often, we think of hand sanitizers as a viable alternative when we don’t have access to soap and water. Hand sanitizer manufacturers have, however, come under scrutiny for these claims. Purell is currently facing not one, but two class action lawsuits. GOJO, the parent company that manufactures Purell, faces accusations of ‘misleading claims’ in regard to the product’s effectiveness.
The complaint accuses the company of making claims that lack scientific evidence, but we should have already been aware of the limitations.
Alcohol-based hand sanitizers undergo testing on inorganic, flat surfaces (i.e. tables). There is no information about how effective it is on organic, round surfaces like you and I. Hand sanitizer does not do you any good if you have obvious organic material on your body. You have to wipe it off and then apply the hand sanitizer and allow it to dry naturally.
Hand sanitizer must also be stored at room temperature, around 73 degrees F, as hotter temperatures degrade the product and render it useless over time. Keep in mind that on an 80-degree F day it is 100 degrees F in an enclosed vehicle. And on a 100-degree F day your car can reach 140 degrees F in 60 minutes.
Finally, alcohol-based hand sanitizer is only meant to buy you some time until you can get to a bathroom and wash your hands with soap and water. Whether you use warm or cold water does not matter, just lather the soap and scrub for at least 20 seconds.
Coronavirus and EMS safety: Cleaning your ambulance post COVID-19 transport
This is obviously a very fluid situation. Because of that, the recommendations may change based on new information becoming available. As of April 6, 2020, the recommended guidelines for decontaminating an ambulance and the equipment are as follows:
- Upon completion of the transport, leave the loading doors open so that the increased air movement can remove lingering particles. The CDC believes that the time it takes to transfer patient care and complete the patient care report (PCR) is sufficient.
- While you are cleaning the ambulance, you should don a disposable gown and gloves as well as some kind of eye/face protection. A face shield, face mask or OSHA compliant goggles all meet this requirement.
- Keep the ambulance doors open while using a chemical cleaning product to ensure adequate ventilation.
- Clean and disinfect all surfaces of the ambulance using an EPA-registered hospital grade disinfectant in accordance with the product instructions. These surfaces include, but are not limited to, the gurney, floors, walls, control panels, radios and other work surfaces.
- Clean and disinfect all reusable patient care equipment prior to using it again.
- Follow your organization’s standard operating procedures (SOPs) when disposing of used personal protective equipment (PPE), medical waste and linens.
If you are exposed to COVID-19 the CDC recommends the following coronavirus EMS safety precautions
- Notification of state and local health authorities.
- Emergency medical service (EMS) agencies develop policies assessing the exposure risk and management of personnel.
- EMS agencies should develop flexible sick-leave policies that are not punitive and consistent with public health recommendations. This is an important recommendation as numerous private agencies use a point system to track excessive absences.
- And finally, exposed EMS providers should notify the appropriate personnel within his/her agency for evaluation and follow-up monitoring.
Ultraviolet Light Decontamination
There is an emerging practice in China that is being used to disinfect public buses. The Shanghai public transportation company, Yanggao, has converted their traditional cleaning chamber to an ultraviolet (UV) light disinfecting chamber.
This change has reduced the cleaning time of the company’s buses from 40 minutes to five minutes.
Not only did the traditional cleaning require two staff members spraying disinfectant, the company also determined that the traditional cleaning method did not adequately clean the hard to reach areas. The UV method requires one staff member to drive the bus into the UV chamber, which contains 210 UV tubes, leave the room and activate the system.
Yanggao has converted both of its bus cleaning chambers to UV chambers. This allows them to decontaminate up to 250 buses per day. If necessary, some EMS agencies may be able to put together a similar UV chamber to disinfect ambulances. You can see a video of the disinfection process by following this hyperlink.
Keep in mind, the CDC recommendations/guidelines can change at any time as they discover new information or more comes out of Europe.
If you would like to learn more about immunology, infectious diseases or personal hygiene you can enroll in the following courses for free:
- ALS L-23 Pediatric Transport, At-risk Populations and Immunology
- L-24 Safety, Wellness and Evidence-based Medicine
- EMT L-1 EMS Culture of Safety, Health, Safety and Vaccinations and At Risk Populations
- BLS L-9 Endocrine System, Immunologic and Infectious Disease
Be safe everyone!