Administration and Leadership, Columns

Pro Bono: Infection Control and Liability in EMS

Issue 11 and Volume 39.

In the good old days, a white glove test was used as measure of cleanliness. For EMS agencies, this meant that if you could put on a white glove and run your hand over the inside of the ambulance and your glove stayed clean, the ambulance was clean.

Today, that glove could still be white after touching anything inside the ambulance and yet the surface could still be contaminated with one of the many infectious diseases prevalent throughout the world today: Ebola, enterovirus, MRSA infections and HIV, just to name a few. In fact, the Centers for Disease Control and Prevention (CDC) recently published its Interim Guidance For EMS Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States.

This guidance reminds EMS providers that control of the deadly infectious diseases of today have effectively put an end to the usefulness of the white glove test—almost. The white glove test is still good for one thing. Take out your organization’s Occupational Safety and Health Administration (OSHA) Compliance Manual. Run your finger over that. If you pick up a layer of dust, then that’s one clue your organization’s infection control practices are woefully out of date and the organization is at risk of liability for its infection control practices.

Seriously though, diseases and the appropriate infection control for these diseases have changed dramatically over the past decade. EMS organizations are familiar with OSHA’s bloodborne pathogens standard and the need to minimize exposure to bloodborne and airborne pathogens. But, to appropriately minimize risks to EMS organizations, the work practice and engineering controls necessary to minimize the infectious disease risks of today are much different than what was sufficient 10 years ago. For this reason, if it’s been five or more years since your organization has reviewed and updated its OSHA compliance policies, then you’ve got your work cut out for you.

Infectious disease prevention for the illnesses of today starts with the PSAPs. If a PSAP doesn’t alert EMS providers to the possibility of an infectious disease at the scene, then the EMS provider could be exposed to the disease before appropriate personal protective equipment (PPE) can be donned. The necessary PPE will vary, depending on the infectious disease. But, if you begin assessing vitals on a patient before becoming aware of the possibility that the patient has symptoms of an infectious disease, then you’ll already be exposed to the infectious disease. That’s why “universal precautions” are so important.

PSAPs should begin by screening callers for symptoms and risk factors for infectious diseases. For example, to screen for Ebola, the CDC’s guidance recommends callers be asked if they or anyone at the scene has: a fever greater than 101.5 degrees F, headaches, muscle pain, vomiting, diarrhea, abdominal pain or unexplained bleeding. If one or more of these symptoms are present, the PSAP should ask additional questions to screen for Ebola risk factors (such as visiting a country within the past three weeks where an Ebola outbreak has occurred).

In addition to wearing appropriate PPE on scene while in contact with the patient, it’s also important to employ thorough hand-washing techniques. Then, it’s important to disinfect all surfaces and the interior of the ambulance.

Overall, the key to minimizing liability when it comes to infection control lies in your organization’s ability to know and employ the proper precautionary techniques when dealing with patients with suspected communicable diseases.