The importance of ambulances being decontaminated is critical in pandemics. The COVID-19 pandemic has stressed “gaps” in EMS protocols, particularly regarding disinfecting the ambulance. Less than 50% of respondents in a 2018 EMS1 poll said the patient care section was decontaminated after each call or transport. In the middle of this coronavirus pandemic, it is essential to disinfect each time thoroughly.
From November 10, 2020, more than 10,430,000 million people in the U.S. had tested positive for the virus, and over 245,000 — including EMS providers and other first responders — had died from the illness. With an approximate reproductive number (R0) of 2.5, which means each infected individual is very likely to infect two or three more without intervention, EMS providers must take precautions to protect themselves, in addition to future patients, to prevent spreading the highly infectious virus.
Follow These Guidelines To Achieve Decontaminated Ambulances
Here are four steps to efficiently disinfecting the ambulance after having a patient with COVID-19, according to guidelines published by the CDC in July 2020:
1. Set And Follow A Consistent Procedure
An April 2020 survey of EMS providers throughout the U.S. demonstrated that inconsistent protocols might be leading to the spread of this virus. The CDC advises that EMS agencies set environmental cleaning and disinfection processes and ensure they are followed consistently and adequately. Including the use of chemical disinfectants with sufficient ventilation. Doors should stay open when cleaning the vehicle to permit air exchange.
Standard operating processes for decontaminating the patient care compartment between every individual must include thorough cleaning and disinfecting of all reusable patient-care equipment and surfaces that may have come in contact with the individual or been contaminated during the call (monitors, floors, stretcher, walls, etc.).
It is important to remember that pathogens and contaminants can quickly make their way to the front seat, so both compartments should be cleaned and decontaminated often as a key health and safety measure. Make sure to use an EPA-registered hospital-grade disinfectant based on the product label, which has shown effectiveness against viruses like the coronavirus that causes COVID-19.
2. Wear PPE
Providers must wear full PPE from start to finish on any call where COVID-19 is suspected. The proposed COVID-19 PPE set comprises an N95 mask, disposable gown, eye protection, gloves, and face shield. Providers should retain the complete PPE ensemble when disinfecting the patient care cell, as various disinfectants can irritate eyes, skin, and mucous membranes.
Be sure all employees know how to correctly doff and include contaminated gear. Remove the gloves and gown, then facial protection. Put all PPE in a red biohazard case, close and dispose of the dirty gear in a suitable receptacle. Make sure to wash your hands early and often in this procedure.
3. Provide Ventilation
Light and air can be crucial allies in the battle against airborne virus particles. The CDC guidelines suggest leaving the ambulance’s back doors open after transporting the individual to allow enough airflow to remove potentially infectious particles. The time to complete the patient’s transfer to the receiving facility and complete all documentation must provide adequate air exchange.
But airborne particles are just a fraction of this threat. Airing out the patient care compartment doesn’t address surface contamination, which requires a broad-spectrum disinfectant.
4. Use An Approved Disinfectant
It is important to choose your disinfectant carefully. Not all cleaning goods are acceptable for this purpose. Like bleach, some can create noxious fumes or damage tools, and many aren’t successful in destroying infectious pathogens such as the coronavirus.
Decontaminate And Clean The Ambulance Properly
The ambulance is a vital vehicle to give emergency medical help in pre-hospital care scenarios. That is the vehicle on which paramedics and EMT’s annual save millions of people around the world. However, as they propagate to save people’s lives, they’re well aware of how important it is to decontaminate and clean the ambulance, especially in virus outbreaks.
Medical professionals know very well. How to offer services to patients; at precisely the same time, they need to look after their ambulance. Does an ambulance transport people to medical centers, but it also must allow medical care on board. That’s why it’s extremely important to decontaminate and clean the ambulance, to be able to ensure safety to both professionals and patients.
1. Before Cleaning The Inside…Beware Of The Outside!
The first recommendation is to clean the exterior. Use sponges soaked with water and soap, then brush, to cover the whole body of the ambulance. Ensure the tires are free of dirt and sand. In case they must be cleaned, you can use an extra cleaner, like a degreaser. Don’t be scared of energetically cleaning the tires, scrubbing with a brush. Good behavior is to wash the tires every time the body of the ambulance is washed.
2. Decontaminate And Clean The Ambulance: Within The Cab
In the ambulance’s cab, you have to be sure that both seats and the floor are decontaminated and cleaned. You can see they are externally clean, but you know it does not necessarily mean they are decontaminated and cleaned. Wipeout both the flooring and chairs with a cleaner and wear gloves to perform this operation.
Always have a garbage bag with you, so you can get rid of used disposable tools and other items.
Concerning the console’s decontamination, use a disinfectant but be careful: don’t spray the disinfectant right on the dashboard, console, radio, or other electronics equipment. Instead, spray directly on the rag and wipe it down. Your focus must go especially to door handles and radio mic. They’re the most touched by paramedics and EMTs. They talk on to the radio microphones, that is why it is so important to clean them.
Take into consideration the right cleaning of the stretchers, which regularly transport patients. They deserve maximum cleaning. Stretcher linens must be fresh and clean after every dispatch, in the event of patient transportation. No patient should ever be set on used linens. Make sure also that stretcher straps are cleaned properly after every use.
Then, wipe the mattress down and remove it from the frame to ensure you are cleaning it completely. Wipe down the handrails and the frame of the cot, even the undercarriage. If in plexiglass, ambulance door glasses must be cleaned using a glass cleaner, not a disinfectant.
After that, assess the harps container. If it is close to being full, change it immediately, or be sure that you change it after your next trip to the hospital.
3. Last But Not Least: Decontaminate And Clean Out The Ambulance Floor And Things
Decontaminate and clean the ambulance on the ground by sweeping out debris or dirt. Spray the floor with disinfectant and allow it to sit for a couple of minutes. Then mop with clean water.
Be careful when you clean the Monitor or Defibrillator. Be sure you wipe down the guide wires, the pulse ox probe, and the surface of the monitor. Clean out the Oxygen caddy, wipe down the regulator, head blocks, the backboards, stethoscope bell, and the BB cuff, earpieces, and let them dry before putting back on the ambulance.
These are routine measures to clean an ambulance and its equipment. However, if you’re facing a specific illness or virus affecting a particular region of your nation, you have to take additional behavior. Nowadays, we are all leaving with SARSCOV2. It is an enemy hard to defeat. That is why it’s quite important to focus on decontamination.
4. Suspected Virus Individual: SARSCOV2 And Ebola
The CDC (Centers for Disease Control And Prevention) describes how to decontaminate and clean the ambulance in the event of virus influenced patient transport, especially for Ebola patients. This practice is done for a 3-person team. Two individuals will be donned in PPE and do the decontamination. A third individual, not donned in PPE, will be available to document the decontamination and for additional help.
- Select an appropriate site for ambulance decontamination: Protect the car and the staff from weather elements.
- Establish a safe perimeter for the safety of the public and decontamination personnel.
- Climate control is helpful.
- Define and indicate hot, warm, and cold zones of contamination around the ambulance that require PPE to input.
- Restrict the number of individuals exposed to potentially contaminated substances
- All waste, such as drapes, PPE, and wipes, should be considered Category A infectious substance and must be packed appropriately for disposal.
- PPE should be donned and doffed based on organizational items.
- PPE selection must consider worker protection for biological exposures and possible chemical exposures depending on the disinfectant used.
- Disinfect the exterior of any prepositioned but fresh medical equipment (still within the protective bags they were put in) and move it to the warm zone. If the equipment was taken out from a protective bag in transition, analyze the equipment to determine whether it could be properly disinfected and decontaminated or disposed of.
- Any parts that are visibly infected with the patient’s body fluids should be disinfected first using an approved EPA-registered disinfectant for the proper contact time before soaking up the fluid with absorbent substances.
- If the inside of the ambulance was draped Before transport, Eliminate the draping by rolling down the drapes outside in, from the ceiling to the floor of this unit, starting in the front to the back of the compartment and moving to the back.
- Roll flooring drapes from front to the rear of the compartment, rolling drapes out in.
- To facilitate packaging and transportation, drapes can be cut into segments. All drape materials must be in segments that are small enough to ease the addition of the biohazard cases into an autoclave or Category A infectious material packaging for disposal.
- Two individuals in PPE should manually disinfect this patient care compartment’s interior with specific detail for high-touch surfaces like door handles and measures using care to limit mechanically generated aerosols and utilizing the surface wipe method to disinfect.
- Disinfect the interior as a team to speak to each other through the process and expedite the decontamination procedure.
- Once the manual inside wipes down has been finished, collect and pack all waste as Category A waste.
- Gently wipe down the ambulance’s outside patient loading doors and handles, and any areas that might have been infected, with disinfectant. The outside of the ambulance doesn’t want a complete disinfectant wipe down.
- When the exterior of all surfaces (such as waste bags) have been cleaned with disinfectant, then Doffing can happen.
- A third person who has been in the cold zone should oversee Doffing, which should be performed according to organization doffing protocols.
- Dispose of waste based on organization protocols, too, as local and national regulations for Category A infectious substances.
- Further cleaning methods may also be used. While not needed, this may give the public and personnel additional assurance before returning the vehicle to support. Ultraviolet germicidal irradiation, hydrogen peroxide vapor, or chlorine dioxide gas may be used for an extra disinfection step. But these shouldn’t replace manual disinfection, as their effectiveness from organisms in body fluids hasn’t been fully established, and these methods may need PPE and specialized equipment.
- The decontaminated ambulances can then be returned to service.