Food poisoning could be a more harmful sickness than you think. One in six Americans will get sick from food poisoning this year, according to the Centers for Disease Control and Prevention.1 Among those, 128,000 will be hospitalized and 3,000 will die.2
With those statistics, chances are anyone who’s worked in EMS has come across a patient suffering from food poisoning. Symptoms vary, but the telltale signs include nausea, vomiting, diarrhea and abdominal cramping.
What these providers may not have considered is that the two most common causes of foodborne illness, improper preparation and improper storage, are two things of which EMS personnel are frequently guilty. This is in large part due to lack of access to food storage facilities—namely, no fridge in the ambulance.
The first part of the equation, preparing food safely, may not be in your hands. If you’re buying food from a restaurant, then you’re trusting the food preparation staff to keep you safe. But if you’re cooking at home, then you have much more control over how clean and safe your food is.
The four main steps for keeping food safe while cooking are based on preventing bacteria growth and multiplication. They are:
1. Clean everything—except meat. Clean your hands, clean the preparation surface and clean the food itself. Fruits and vegetables should be washed thoroughly before preparing, regardless of whether or not they will be cooked.2 The outside of melons should be rinsed before cutting, as should the outside of onions, to prevent dirt from the outer layer or rind being dragged inside by the knife. The one exception is meat—generally, trying to wash meat causes germs to spread throughout the sink and increases the risk of cross contamination to such an extent that it’s safer to cook it straight from the package than to rinse it.
2. Separate cooked foods from raw meat, poultry, fish and eggs. At the grocery store, place these foods in their own bags and keep them away from fresh fruits and vegetables. Once home, keep them in plastic bags or place them in airtight containers to keep juice from dripping in the refrigerator. When preparing food, never use a cutting board or knife that has been used for meat, poultry or fish to cut something else without washing it first. Once meat, fish, poultry or eggs have been cooked, always place them on a clean plate. Never serve them from the same plate they were stored on raw. 2
3. Cook to a safe temperature. Depending on what you’re cooking, the safe temperature for foods ranges between 145 and 165 degrees F. A detailed chart of safe cooking temperatures for individual foods can be accessed at www.foodsafety.gov. 2
4. Chill. Cool your foods in small batches in a refrigerator less than 40 degrees F, within two hours of preparation. Separating into small containers allows faster cooling. Reducing the amount of time food is sitting at room temperature reduces the amount of time bacteria has to grow and multiply.2 If food isn’t stored at cool enough temperatures, bacteria can multiply more rapidly and there’s a greater chance of becoming sick. Bacteria grow especially quickly between 40 and 140 degrees F, a temperature range known as the “danger zone.”3
• Cleaning foods reduces the amount of bacteria present when you start cooking,
• Separating cooked and raw foods prevents bacteria from raw foods from contaminating cooked foods,
• Cooking to the appropriate temperature kills most bacteria, and
• Chilling quickly and at a cold-enough temperature reduces the ability of bacteria to begin growing again.
Even when everything is prepared properly, however, there’s undoubtedly some bacteria remaining in all food we eat. Generally this isn’t a problem—the human immune system is quite powerful, particularly the part of the immune system contained within the gastrointestinal tract. However, if enough bacteria are present or it’s extra dangerous, the immune system may be overpowered.
Staying Safe on the Job
So in practical terms, what does this mean on the job? If you have prepared everything safely at home, or you purchased safe food from a restaurant and want to save the leftovers, you need to find a way to keep things cold enough to avoid the “danger zone.” You know enough not to bring a bag of raw chicken for lunch and leave it on the dashboard, but what about ham sandwiches from the EMS room or French fries left over from the lunch you didn’t get to eat? What’s safe and what will you regret later?
Prepared foods and cold foods should never be left out at room temperature for more than two hours. Prepared foods include anything that has been cooked: burgers, chicken, French fries, pasta, pizza, casseroles, etc. Cold foods include anything that should be stored in the refrigerator: potato salad, deli meat, dairy products, etc. This also includes foods carefully prepared and chilled at home—they also can’t be left out for more than two hours.
If you want to save food to eat later, you must keep it at the correct temperature. To hold cold, bring a lunchbox or cooler with ice packs and be sure it is tightly closed with all foods completely inside. Avoid opening your cooler too frequently to keep from letting in hot air that can warm up foods. Good foods to carry in a small personal-size coolers include deli meat sandwiches, yogurt, cheese, hard-boiled eggs, salads with dressing, hummus and a variety of dips such as ranch, veggie dip and sour cream. If you are able to stop at your base and want to hold your food hot, keep it in an oven above 140 degrees, which is outside the danger zone. If you don’t have access to an oven, eat within two hours and discard the rest.
The other key element in food safety is time. In general, prepared foods should be kept in the refrigerator for no more than four days. Longer periods can cause enough bacteria to grow to cause illness.4 For a more complete listing of how long individual foods can be stored, view the “Storage Times for Refrigerator and Freezer” section of www.foodsafety.gov.
If these precautionary steps sound impractical, you may be better off choosing foods that don’t require any extra energy for storage. Commercially produced meal replacements such as protein bars generally don’t need to be refrigerated. Uncut fruits and vegetables can also be safely stored at room temperature for the duration of a shift, as long as you aren’t toting along ranch dressing to dip them in. Think apples, oranges, bananas, celery, broccoli and baby carrots. You can also try fruit cups—they’re not just for kids!
Peanut butter is a nice sandwich filler that doesn’t require refrigeration, and can be accompanied by jelly, honey, bananas or even potato chips. Bread products such as crackers and tortillas store safely as well. For room-temperature-safe protein, try nuts, nut butters or protein bars. Of course, you can always pack a bag full of room-temperature-safe snacks to always have on hand, and a small lunchbox or cooler with your cold-food essentials for the day. It’s the best of both worlds, and all stored in a way to keep your food from killing you.
1. Making food safer to eat. (June 2011.) Centers for Disease Control and Prevention. Retrieved on March 18, 2013 from www.cdc.gov/vitalsigns/foodsafety/index.html.
2. Check your steps: four simple steps to food safety. (n.d.) U.S. Department of Health and Human Services. Retrieved on March 18, 2013 from www.foodsafety.gov/keep/basics/.
3. Safe food handling fact sheet. (n.d.) United States Department of Agriculture. Retrieved on July 15, 2013 from http://www.fsis.usda.gov/wps/wcm/connect/8b705ede-f4dc-4b31-a745-836e66eeb0f4/Danger_Zone.pdf?MOD=AJPERES.
4. Storage times for the refrigerator and freezer. (n.d.) U.S. Department of Health and Human Services. Retrieved on March 18, 2013 from www.foodsafety.gov/keep/charts/storagetimes.html.