Ambulances & Vehicle Ops, Patient Care, Trauma

How to Rid Your Rig of a Bedbug Infestation

Issue 5 and Volume 37.

It was one of the creepiest calls paramedic/firefighter Darwin Mace had ever been involved with during his 14 years with Littleton (Colo.) Fire Rescue. What started out as a routine call for abdominal pain turned into something right out of the Twilight Zone.

The tones went off for the address of an office building next to the firehouse. On arrival, his crew found a well-dressed female in her 60s sitting in her cubical complaining of abdominal pain. She was being attended to by coworkers. Mace ordered two sets of vitals, took a 4-lead ECG and obtained her oxygen saturation levels. He reviewed her medical history and performed a focused abdominal exam.

As he concentrated on her treatment plan, he decided to move her to his ambulance to avoid any further embarrassment in front of her coworkers. She was pleasant and talkative as the crew headed to the ambulance for further assessment and pain control. 

“At first, I noticed this small bug on her shirt so I grabbed it and squashed it. I thought it had fallen on her as we moved her to our rig,” he remembers. As he began moving her clothing to attach 12-lead ECG cables, he saw something scurry under the cot sheet. Bugs! Lots of them. At least 20 bugs had fallen out of her left pocket and were looking for hiding places. “This is bizarre,” thought Mace as he examined her other pocket. He found more bugs. Then it dawned on him as he composed himself. They were bedbugs.

He quickly covered her tightly with a blanket, attempting to isolate the pests. He notified the receiving hospital and continued his medical treatment as the bugs wiggled under the covers. 

It wasn’t long before other bedbug incidents started popping up. The next time was a working fire incident—a smoky mattress fire in a basement. Firefighters arrived quickly, knocked the fire down and removed the half-burnt, smoldering mattress from the structure. Embarrassed by the situation, the home owner admitted trying to kill a bedbug infestation using alcohol and a lighter.

Next was the notice from the housing authority that 10 days earlier, the fire department had transported a patient from an apartment so infested with bedbugs that the unit was posted as unfit for human habitation. The tenant was vacated immediately, and their belongings were treated or destroyed. 

What are these pests; where did they come from; and what risks do they pose to first responders? Better yet, how do we stop them from taking up residence in our stations, ambulances, city halls and homes?

Bedbug infestations are on the rise across the nation, and first responders will encounter patients and buildings infested with these creatures. Be aware, be prepared and have a game plan for dealing with bedbugs. 

Bedbug Apocalypse
Bedbugs have made resurgence in the U.S., Canada, Australia and the United Kingdom. These blood-sucking pests were nearly eradicated by the end of World War II by strong pesticides, such as Malathion and Dichlorodiphenyltrichloroethane, known as DDT. The most effective pesticides used to kill and control bedbugs were later banned in the U.S. during the ’70s due to their toxicity, environmental hazards and human risk. Bedbugs are back, and the war against them is being fought in cities around the U.S. 

Experts have been tracking the rapid spread of bedbugs for years. The cause of their exploding population is still somewhat of a mystery, but pest-control specialists believe it’s related to their resistance to weaker modern-day pesticides. Another cause is increased domestic and international travel.

Staying overnight in a bedbug-infested environment can provide a one-way ticket for a hitchhiking bedbug to be transported to another location. Bedbug infestations have been discovered in expensive hotels, apartment buildings, homes, cruise ships, airliners, office buildings, schools, libraries, movie theaters, transportation hubs and fire stations. City leaders are teaming up with bedbug experts to develop effective strategies to combat these pests and stop their rapid spread.

Lack of knowledge of common prevention techniques also aids bedbug tourism. Most people aren’t aware of their comeback or don’t believe they have a bedbug problem. Nobody likes creepy bugs, and people whose homes are infested avoid the topic to escape the scorn and embarrassment associated with having “bugs.”

Creepy Crawlers
The common bedbug (Cimex lectularius) can be found worldwide. They feed exclusively on blood and are usually found close to their blood hosts. They’re nocturnal, becoming active at night. They leave their covert hiding places to feed on blood. Bedbugs are resilient, have a life span of about 10 months and can live up 90 days without a meal.

Under ideal environmental conditions (70–90° F), bedbugs go through five development stages, reaching maturity within a few months. Females lay between one and five eggs a day, usually producing 200–500 offspring during their lifetimes. Their eggs, which are commonly found near their host’s bed, are about 1 mm in length and pearly white. They hatch within three weeks. Newly hatched bedbugs, called nymphs, are translucent and no bigger than the head of a pin. After feeding on blood, they may appear reddish in color. Adult bedbugs are generally brown, a quarter of an inch long and oval with no wings. They don’t fly, but they can move swiftly on horizontal and vertical surfaces. They’re good hitchhikers and can easily latch onto a blanket, sock, shoe lace or bunker coat.

These blood suckers activate when they sense an increase in heat and carbon dioxide (CO2) in the room as their human prey comfortably drifts off to sleep. They inject their victims with an aesthetic and anticoagulant, usually making their bites painless. Bedbug bites frequently appear in rows of three to four bites with red welts, and their effect on people will vary from individual to individual. Itching after a bite can cause redness and skin irritation, and constant scratching may cause open sores, which can lead to skin dermatitis and infection. It’s hard to tell the number of bugs in the environment by the amount of bites on one person. One bug may move around multiple times as they feed or just feed once while others move in for a snack. Although numerous disease pathogens have been discovered in bedbugs, they haven’t shown the ability to transmit and spread disease as other insects do.

Hide & Seek
Bedbug infestations aren’t caused by poor sanitary conditions and aren’t a reflection of a person’s social status or hygiene. These bugs have been found in various setting from upscale mansions to homeless shelters. Infestation begins by bringing an item that has bedbugs or eggs attached to it into an un-infested environment. But poor sanitation and clutter make it more difficult to locate, control and eliminate an infestation after it starts.

Bedbugs play hide and seek well. Most infestations are only discovered after their bites appear on their victims. Human dwellings are a perfect environment for bedbugs to thrive in and provide a reliable and convenient food source—your blood. Their assault isn’t typically limited to the bed or bedroom because they generally disperse throughout the structure via wall cracks, door frames, plumbing areas and electrical outlets. They live and breed in the tiniest cracks and crevices and are often hard to detect with the naked eye. Bedbugs can hide or lay their eggs virtually anywhere. They like cool, secluded spots, such as mattresses, box springs, wooden head boards, picture frames, furniture, carpeting, luggage and clothing. They fasten their rice-like eggs to rough surfaces, which make the eggs difficult to dislodge.

Most people don’t notice the first signs of the presence of bedbugs. Tiny brown or black fecal spots and dots of dried dark blood are common in their habitat area. Cast skins—hollowed out bedbug skins shed during the nymph stage—are another sign your living space has been invaded. In sizeable infestations, a sweet, foul odor may be given off by an oily liquid they emit.

Bedbugs lead a secretive life, and detecting them in the early stages of an infestation, when few bugs are first present, can be challenging. It can also be crucial to preventing a full-scale invasion. Although bedbug detection and monitoring tools have certainly improved over the past 70 years, no detection tool is 100% reliable. Sometimes capturing the bugs or locating their eggs is the only way to be certain of their presence.

Visual inspection can be time consuming and labor intensive, but it’s still the most commonly used and least reliable method of detecting bedbugs. No special equipment is required besides a bright flashlight, a good set of eyes and a strong magnifying lens to help identify eggs or small, freshly hatched nymphs. These cryptic insects like to hide and avoid being seen. Detection devices can be placed under the legs of bed frames and furniture to intercept the bugs as they migrate to their food source. Inexpensive “pitfall” traps capture the bugs after they fall into the trap and they can’t climb out. The traps work 24 hours a day with little maintenance required, other than occasionally emptying out trapped bugs and lubricating the traps with talcum powder. Other active trapping devices use CO2, heat or chemicals to lure the bugs into traps.

K-9 scent detection has become a popular and effective option for detecting low-level infestations. Man’s best friend has been trained to sniff out drugs, explosives, cadavers, mold, termites and cancer—why not bedbugs? Specially trained bedbug dogs can inspect places where humans can’t get too easily or where visual inspection is too tedious and time consuming. A well-trained bedbug detection dog will detect low levels of bugs, even as few as one. Good canines can differentiate active bugs and viable eggs from old infestations with dead bug and empty egg shells. The National Entomology Scent Detection Canine Association supports this emerging science and is working to establish standards for all entomology scent detection canines, handlers and trainers through an accreditation program.

Although bedbug canines are an effective detection tool, they aren’t always 100% accurate. Dogs rely on a “scent picture” to locate the bugs and that may be affected by air movement, wind direction, humidity and temperature. Their effectiveness is directly related to what they can smell. It’s important that a verification system is used to confirm the validity of a dog’s positive “alert” to bedbugs. One method is to have the handler produce physical evidence of the infestation (bugs or eggs) after a positive alert. Another confirmation approach is to use a second canine inspector to positively confirm the first dog’s work before spending money on extermination, which can be complicated and expensive.

Bedbugs: Now What?
They may be small and resilient, but don’t panic. Some feel that if you’re able to see them, they can be killed with a direct spray of 91% alcohol or simply vacuumed up. That may work in some cases, but repeated inspections should be conducted in the following weeks to make sure the dead critter was alone. And you have to carefully secure and dispose of all vacuum bag contents because survivors can escape. 

Most experts will tell you that finding and eradicating an infestation isn’t a simple job. Chances of conquering a large number of bugs yourself are slim and using the wrong pesticides may drive the creepy-crawlies deeper into the structure. So the best thing to do is call in a licensed professional who’s trained in bedbug biology and behavior to give you sound advice.

The three most common methods used to kill bedbugs are cooling, heating and chemicals. The Environmental Protection Agency recommends cold treatments below 0° F (-19° C) for at least four days but using cooling treatments in a large ambulance may be impractical.

Superheating is an effective method to kill bedbugs in all stages of their lives but requires specialized propane or electric heating equipment. Rooms are superheated and monitored until the bug’s thermal death point is reached (near 122° F) and maintained for a minimum of one hour while strong fans circulate the heat. Heating and encapsulating an ambulance, for example, can cost as much as $1,500 per occurrence. More than 300 consumer products currently on the market are registered by the EPA to fight bedbugs. But buyers beware: Before you apply any pesticides, read the label first and follow the directions closely. Using incorrect chemicals in the wrong locations may make you or your patients sick and not fix the problem.

The key to eliminating and preventing bedbugs is to develop an integrated pest management strategy that includes awareness, prevention and education. Many states have formed bedbug task forces, and public safety officials (i.e., police, fire and EMS) should join their collaborative efforts to understand the magnitude of the bug problem in their community and help reduce the risk of exposure for first responders. 

An Ounce of Prevention
Public safety leaders must take proactive steps to keep these bugs out of first responder’s vehicles and station facilities. The consequences of taking these small bugs lightly can have enormous operational implications. Fire stations around the country have been closed for months due to bedbug infestations, which can directly affect service levels and disrupt personnel.

First responders (and their families) rely on their managers to wage a proactive battle against bedbugs before they end up in first responder’s homes.

Have a strategy and follow the following simple prevention techniques:

>> Develop SOPs. These should address transporting patients with bedbugs or from properties with known infestations;

>> Flag all addresses with known infestations. This will give responders early warning of the problem. Don disposable shoe and head covers, gloves and gowns before entering, and avoid pants with cuffs; 

>> Develop a bedbug resources list. Include numbers for immediate inspection, treatment and long-term prevention. Most agencies don’t have the assets to allow an ambulance to sit idle while it waits for bedbug inspection; 

>> Quarantine units, equipment and clothing after exposure.  This can prevent transporting the bugs into your station;

>> Bag and seal uniforms and linens after exposures. Laundering most clothing with hot water and detergent, followed by dry cleaning or drying for at least 20 minutes, should kill all bedbugs;

>> Watch where you place your bags. Leave kits outside a residence known to have bedbugs. Avoid placing medical bags on upholstered furniture, bedding or carpeted floors on all calls, or consider replacing soft medical cases with hard plastic cases;

>> Launder bedding weekly. Clean blankets and bedspreads in sleeping quarters with heat;

>> Provide bedding encasements. Mattress and box springs encasements aid in early detection and can prevent infestations in beds when bedbugs are introduced in the environment;

>> Vacuum and clean surfaces. Vacuums and surface cleaning play a major role in bedbug management. (Remember eggs may not vacuum up easily.) Tightly bag up and dispose of vacuum’s contents immediately after use;

>> Seal personal gear. Keep clothing and gear in tightly sealed plastic containers to avoid transporting the bugs to your home;

>> Eliminate clutter. Cluttered areas can cause a bedbug control program to fail; and

>> Be on alert. Be on bedbug patrol on every call, and have a bedbug code word. 

Sleep Tight
Of all the things first responders have faced over the years, including infectious diseases, flu and terrorism, these small pests pale in comparison. Although they may not make you sick, they will ruin your day. They spread quickly, and killing them can be expensive and time consuming. So start working on an integrated pest management strategy for your organization so that when you lay your head down tonight, you sleep tight. JEMS

Wayne M. Zygowicz, BA, EFO, EMT-P, is the EMS chief for Littleton (Colo.) Fire Rescue. He has been involved in EMS and the fire service for 30 years. He also serves as a member of the JEMS Editorial Board. Contact him at [email protected].

>> Centers for Disease Control and Prevention. (n.d.). Bedbug FAQs. In Centers for Disease Control and Prevention. Retrieved Feb. 2, 2012, from

>> Cooper R. (n.d.). Bedbug 101: Avoiding infestations. In Bed Bug Central. Retrieved Feb. 2, 2012, from

>> Cooper, R. (n.d.). Bedbug 101: Canine scent detection. In Bed Bug Central. Retrieved Feb. 2, 2012, from

>> Cooper, R. (n.d.). Bedbug 101: Identification. In Bed Bug Central. Retrieved Feb. 1, 2012, from

>> Miller DM. (n.d.). Non-chemical bedbug management. In Virginia Department of Agriculture and Consumer Services. Retrieved Feb. 1, 2012, from

>> Porter MF. (n.d.). Bedbugs. In University of Kentucky, College of Agriculture. Retrieved Feb. 1, 2012, from

>> U.S. Environmental Protection Agency. (n.d.). Bedbug information. In Environmental Protection Agency. Retrieved Feb. 1, 2012, from

This article originally appeared in May 2012 JEMS as “What’s Buggin’ EMS: How to rid your rigs of a bedbug.”