Operations, Patient Care

Readers Sound Off About Glove Use After Patient Care

Issue 3 and Volume 40.

Glove Use and Mobile Integrated Healthcare

This month, two readers share their thoughts and experiences about teaching proper glove safety in relation to the December 2014 article, “Gloves On, Gloves Off: Gloves don’t protect if they aren’t removed at the proper times,” by Dennis Edgerly, BS, EMT-P.

Also this month, Facebook readers debate the costs and benefits mobile integrated healthcare has on EMS agencies in response to a story featured in the December 2014 column, “Last Word.” Both letters were edited for space.

Glove Safety

As an EMS “dinosaur” of some 41 years, I date back to the era of the blood-smeared uniform as a “badge of honor,” which I personally never got into. I felt it made me look too sloppy. But I was realist enough, after the fear of the initial AIDS “epidemic,” to pack along several pairs of gloves for myself and for others during my field experiences.

However, as a small aside to your article, it’s not just the possible transfer point of illnesses and disease of the ambulance that concerns me. It isn’t even the ED itself.

In New York City and surrounding areas, in an effort to keep out non-medical personnel, criminals, people from seeking treatment without registering, and visitors after hours, many EDs have installed a keypad on which authorized personnel can tap in a code to unlock and open the door. I believe this extends to most large metropolitan areas around the country.

How often does the maintenance and/or housekeeping staff clean off the keypads? How many EMS crews tap in the code (surprise: it’s usually “9-1-1”) and transfer patient care with their hands still gloved and then, after going back to the ambulance, return inside with no gloves as they, again, tap in the code for access? How many hospital staffers, despite signs asking they not use that door, use it anyway and casually go about their business inside the hospital?

It’s my position that the keypads used to access an ED might just be a likely source of transfer of contagious illness and disease.
What about gloves at that keypad?

Richard C. Berger, EMT-B, FDNY EMS Command (ret.)
Via email

That was a great article in JEMS.  I’ve been yelling about that for years—putting on gloves isn’t a panacea, and constant checking is required to avoid cross-contamination. I always told students that when they saw wet stuff, put on gloves, but not before. Never in the front, never with a pen, never with a radio.

But then I’m obsessed about cleaning up after ourselves, as well. Perhaps that can be your follow-up?

Scot Phelps, JD, MPH, EMT-P, CEM/CBCP/MBCI/MEP
Via email

Is Mobile Integrated Healthcare a Risk for EMS?

On one hand this is great; on the other hand it gives people a non-emergent excuse to call 9-1-1. Why go wait at your doctor’s office for your sore throat when you can call 9-1-1 and get the care brought to you?

Tom G.

This is the wave of the future. But it should be the EDs footing the bill and staffing the rigs. It provides minimal benefit to EMS, but massive benefit in terms of saving time and resources to county hospitals full of underinsured.

Jack S.

How many people call 9-1-1 just for a ride or “to get in the ED faster”? Now if I have a sore throat I can call 9-1-1 for an at-home test, meds and prescriptions. Why bother waiting (and paying) to see my primary care physician? With no insurance reimbursement, how can they sustain this program? 

Only (with) a private ambulance that has to meet response criteria to be paid by a municipality.

James H.

On the original proposal, this is a temporary thing to see what kind of cost savings are available to the department. … This in theory is a great idea. … many who abuse 9-1-1 are unaware of the real usage of 9-1-1 or have no other real options than to call and be transported to the ED.

David W.

Non-emergent 9-1-1 callers rarely have malicious intent, but rather have either a perceived or real medical issue and don’t understand the role of EMS. More common, too, is for them to be from at-risk populations that might not have a primary care provider, insurance, or some other barrier to accessing healthcare.

Labeling all of these people as “just looking for a ride downtown” really detracts from our mission. Yes, some people will abuse it, but that shouldn’t prevent us from providing better care and access to public health.

Steven K.

We just had a patient who drove to the ED but “the back pain was so severe” that she called 9-1-1 asking for [help] to get her out of her car and she was parked in front of the ED entrance patient drop off. Talk about just not caring.Juan M.

You could triage the call. If it sounds non-emergent then you can [pass] it off to a non-emergent system, where they can also explain what 9-1-1 is used for. It also allows you to clean transporting units faster.

Jeffrey S.