Chapter 2-2 Lecture

Disease Transmission

• Paramedics often treat and transport patients with communicable or infectious diseases.
• Some patients may have an infectious or contagious disease without their knowledge.
• An infectious disease is a medical condition from the growth and spread of harmful organisms.
• A communicable disease spreads from one person or species to another.
• Contagious diseases are infectious, but not all infectious diseases are contagious.
• Pneumonia from pneumococcal bacteria is infectious but not contagious.
• Hepatitis B and COVID-19 are contagious because they transmit from person to person.
• Immunizations, PPE, handwashing, and ambulance disinfection minimize infection risk; also important to inform healthcare providers of potential risks without disclosing sensitive patient information.
• Germs use different mechanisms of transmission.
• Transmission refers to how an infectious agent spreads.
• Infectious diseases transmit via direct/indirect contact, airborne, foodborne, or vector-borne routes.
• Contact transmission involves movement of an organism from one person to another through physical touch.

Direct vs. Indirect Contact Transmission

• Direct contact occurs through touching (e.g., bloodborne pathogens, sexual transmission like HIV).
• Indirect contact spreads infection via contaminated inanimate objects, such as needle sticks.

Airborne Transmission

• Airborne transmission spreads infectious agents through droplets or dust.
• Common cold and COVID-19 spread through coughing and sneezing

Exposure Protocol

• If exposed to a patient's blood or body fluids, the department's infection control plan should be followed.
• Steps: transferring care, washing affected area/rinsing eyes (20 min.), reporting, medical evaluation, immunization boosters, and incident documentation.

PPE and Historical Context

• PPE use wasn't common in early EMS, and being covered in blood/dirt used to be a status symbol.
• Surgeons in the 1800s took pride in messy operating aprons which lead to infections, modern EMS practices evolve rapidly, especially during COVID-19 pandemic.
• CDC's precautions for healthcare workers involve standard precautions, treating all body fluids as potentially infectious.
• Basic measures and immunizations can minimize disease risk.

Immunization Program

• Personal health maintenance includes annual health exams, childhood disease history (chickenpox, MMR, whooping cough needing immunization if not had).

• CDC and OSHA have requirements for bloodborne pathogen protection (e.g., HBV).

• EMS systems should have immunization programs, with updated records.

• Recommended vaccines: tetanus/diphtheria (every 10 yrs.), MMR, flu (yearly), HBV, varicella (if no chickenpox history), and COVID-19.

• TB skin tests are recommended for paramedics, repeated yearly if exposed.

• A positive skin test indicates possible exposure, not active disease, requiring follow-up tests.

• Pertussis (whooping cough) vaccine is suggested.

• Knowing vaccination/disease history reduces risk when transporting patients with communicable diseases

• PPE essentials: gloves, facial protection (masks/eyewear), gowns, N95/N100 respirators.

Infection Control Practices

• Essential practices: wear gloves, wash hands (use lotion), wear eye protection standardly or during suctioning/intubation (face shield best).
• Wear masks to protect from airborne diseases, and gowns when dealing with messy/bloody patients or those with fluid leakage/skin lesions.
• N95/N100 respirators are needed (fit testing offered at some services); e.g., for TB.
• In 2019, there were 10 million new TB cases and it caused 1.4 million deaths globally (WHO).

Ambulance and Equipment Sanitation

• Sanitize patient compartment daily/after calls: cot, bench seats, grab rails, etc.
• Clean cotton mounts weekly or after messy calls, routinely disinfect phones/microphones and pens/stethoscopes after each call.
• Discard single-use equipment in biohazard bags.
• Disinfect equipment after direct patient/body fluid contact with commercial agents or bleach (1:10 ratio, leave wet for 5+ min.).
• Dispose of sharps properly and wear appropriate turnout gear (gloves, helmet, boots).
• Puncture-proof leather gloves (with latex underneath) allow free hand use and protection.
• Wear helmets in fall zones.
• Boots should be water-resistant, well-fitting, flexible; glasses with side shields during care or face shield/goggles during extrication.
• Wear earplugs to prevent hearing loss and sunscreen (SPF 15+) for skin protection.

Body Armor

• EMS responders may wear ballistic/stab-resistant vests for protection in deteriorating scenes.
• National Institute of Justice developed performance/testing requirements for body armor.
• Lighter vests are preferred by EMS/law enforcement.
• Train with vests to ensure ease of use and that body armor is additional protection.

Hostile Situations

• Body armor does not replace scene assessment and avoiding dangerous conditions.
• Dispatch info may indicate potential hostility (e.g., uncooperative patient, verbal threats).
• National Association of EMS Physicians endorsed safety rights for patients/providers (Dec. 2003).
• For hostile situations, stage a safe distance and wait for law enforcement to secure the scene: fights, stabbings, shootings, riots, domestic disturbances, suspicious calls warrant police response.
• Request law enforcement for calls with violent potential.
• Additional training needed to handle hostile situations safely (tactical EMS/rescue task force programs available).
• Never enter a scene first if hostility is known or anticipated, surroundings assessed.

Contact With Hostile Patients

• Identify the fastest exit route; check for weapons.
• Once in contact with a hostile patients, listen more, talk less, don't argue/ridicule, de-escalate emotions, and show empathy/understanding.
• Hostile patients are more dangerous when in their home.
• Cultural awareness aids communication, and all patients must be treated with respect/dignity.

Traffic Incident Safety

• Stay aware, as distractive driving is as problematic as driving under the influence.
• Be aware of other vehicles and onlookers, begin observing a mile before the scene.
• Watch traffic, wind direction, and smoke; plan for lighting/weather.
• Look at vehicle types/obstacles, traffic flow (control if needed).
• Assess incident scope, vehicle types, immediate resource needs, terrain, and fluid drainage.
• Identify final parking/workspace and approach traffic incidents via visual surroundings assessment.
• Become familiar with response area for best/safest route
• Traffic-related programs offer assistance.

Hazard Identification

• Safety of all is the primary concern; identify hazards upon arrival/before leaving the unit.
• Never touch downed power lines; paramedics should mark off a danger zone because dealing with power lines exceeds paramedic scope.
• Energized/live power lines (high voltage) are unpredictable.
• Above/below ground power lines can be hazards at MVCs.
• The zone around downed lines is a danger zone; use utility poles to establish perimeter.

Avoiding Lightning Strikes

• Lightning is a threat through direct hits/ground current.
• Avoid drainage ditches, moist areas, small depressions, wet ropes.
• Rescue operations may be delayed for storm passage, including signs like tingling skin, and hair standing up.
• If a strike is imminent move to lowest area, crouch low, drop metal equipment, and avoid fences/metal.
• Maintaining distance from others, use non-conductive object under feet, and being inside the unit would be the best practice.