Q: How do EMTs protect themselves from being exposed to something contagious when they’re treating someone or riding in an ambulance with a patient that may not know he’s sick, may not admit he’s sick or may not even be conscious to tell the EMT he’s carrying something infectious?

Doug Woods, a field supervisor paramedic at American Ambulance of Visalia gave me the 411.

It comes down to two things: Training and equipment, said Woods, an emergency medical services worker for 10 years.

He said that a lot of the training paramedics get involves how to be safe when confronted by contagious elements. They’re taught to contain any toxic substances like blood or other fluids and protect themselves with gloves, masks, and goggles.

Edward Brown, CSRM, elaborated on the training EMTs get. He’s an alternative risk specialist with Care West Insurance Risk Management, a company that does risk management and insurance for the health care industry. And he did emergency work for 25 years and now trains EMTs to avoid risks and stay safe and healthy.

Brown said EMTs are trained in three types of “interconnected controls,” or ways of reducing the risk of catching an infectious disease. They are personal controls, administrative controls, and engineering controls. The personal controls are the gloves, masks, and goggles that Woods referenced—the barriers that EMTs wear to keep from coming in contact with a potential hazardous germ and letting that germ infect them.

“Treat all blood and body fluid as if it’s infectious” and “if it’s wet and it’s not yours take the precaution” of using the personal controls, Brown said. These are the rules of thumb when treating potentially infectious patients.

EMTs figure out if the patient might have TB or some other contagion through the administrative controls. These controls consist of the training on the symptoms of infectious diseases so that an EMT knows what to look for. The observable symptoms and the patient’s history figure into a simple formula: too many red flags and the EMT uses the personal controls.

When the EMT takes the patient’s history, she’s not just looking for a diagnosis or how best to treat the injury, she’s finding out her risk of catching an infectious disease. She might ask how long the patient has had a persistent cough, if he uses intravenous drugs, or if he has traveled out of the country. She might look for the signs of IV drug use or for bloody sputum. If she sees too many warning signs, she’ll put on additional safety gear, like a high filtration mask, Brown said.

Paramedics “operate under the assumption that people are infected,” Woods said. So they’re as cautious as possible. In addition to the protective gear the EMTs wear, paramedics sometimes will put a mask on a patient if the patient has enough indications that he might have something that could spread through coughing, like tuberculosis.

The third kind of controls—the engineering controls—are built right into the equipment, Brown said. They work at all times. They’re not triggered by an evaluation of any one patient. One engineering control is the high filtration system in ambulances. It circulates the air at regular intervals, taking in new air and blowing out the air that’s been exposed to the patient. This keeps the germs from accumulating in the enclosed ambulance.

I confirmed with Brown that once the airborne pathogens are pushed out into the city’s air, they don’t live very long. They’re pretty much harmless because they can’t live in the air for long enough for someone to pick them up and get sick.

Brown said TB is one of the major diseases EMTs look out for and that Hepatitis B, which is blood borne, is prevalent. He said HIV isn’t as good at staying alive outside of “its element” long enough to infect, but EMTs still take the precautions and treat it as contagious.

Woods says that EMTs see HIV, full-blown AIDS, hepatitis, and bacterial or viral meningitis, in addition to TB. He said that by the time you hear of a new disease in the area, the paramedics have already seen it in their ambulance.

And they’ve been trained to keep themselves safe from it.

The bird flu, Woods said, was the topic of continuing education courses for paramedics. They got an early head’s up so they could protect themselves from being infected by someone they treat.

It’s a good thing, too. Because if the public is hit with an epidemic, the people who treat the sick need to be at their healthy best.

What’s the 411?

The 411 attempts to answer your questions about EMTs, firefighters, police, and the lives and work of these first responders. If you’ve got an infectious inquisitiveness, don’t keep your question to yourself, send it to me at info@valleyresponsemagazine.com.

I’ll delve past the symptoms and into the root cause to cure your curiosity with the answer.

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