You Got a Bloody Right to Say

I'm none too excited to discover coagulated blood on the underside of a gurney while performing rig check - but at least I understand how this can happen. Patients - who tend to have other things to worry about during their trip to the hospital - would surely be appalled to know it's even possible. At best, it conveys a message that care providers are cutting corners. At worst we could be spreading infectious diseases, as these Health Service Journal and BBC articles worry with regards to UK ambulances.



The answer is to clean and disinfect well and often, but we all know the obstacles to this happening: particularly messy or difficult calls, middle of the night calls, frigid Vermont winter calls, calls coming at the end of your 24-hour shift. It isn't surprising we miss a spot now and then. Unless your squad consistently encourages a culture and habit of cleanliness, you aren't cleaning well enough. And not everyone knows how to clean. So here are some guidelines adapted from the NAEMT:



First, make sure you have good ventilation, and be methodical in your cleaning pattern so you reach each spot without overdoing any one place. Always wear gloves, and use eye protection when spraying down equipment. Clean and disinfect thoroughly after every call while at the hospital - not just picking up the garbage, changing the bedding and putting away the equipment, but actually spraying and wiping down surfaces. Use towels to mop up visible fluids. Use Cavicide or bleach solution (depending on your protocols) for gear and surfaces. Spray the entire stretcher including the undersides and wheels, let it sit for a few minutes, and hose it down well. Sweep the floor of the ambulance and then spray with a cleaner and let it sit for a few minutes before mopping out with clean water. Let all equipment, including the cot, dry completely before replacing. Don't forget to disinfect the dashboard and console, radios and telephones by spraying disinfectant on a towel rather than directly on these surfaces.

Many pre-hospital providers, including those who have been at it for many years, were never taught how to disinfect an ambulance, so don't assume just because "no one else is doing it" that it doesn't need to be done. Don't be intimidated - take the lead and make sure your ambulance is a safe environment for you and your patients.

For a thorough description of best practices, including the difference between disinfection and decontamination, see this EMS Responder article.