How much time do you have to transfer patient care to the receiving facility, complete the Patient Care Report (PCR), clean your ambulance and get back in service?
When I worked for a private company in Las Vegas, crews had 20 minutes for ambulance decontamination. After talking to students within the Distance CME training programs that number seems consistent across the country.
That simply is not enough time to accomplish everything that needs to be done.
Hospitals can hire housekeeping staff and keep the facility on the cool side to slow the spread of infectious diseases. Ambulances, on the other hand, become petri dishes. On an 80-degree F day, it is 100 degrees F inside an enclosed vehicle. On a 100-degree F day, the temperature inside an enclosed vehicle hits 140 degrees F within 60 minutes.
Diseases can thrive within our ambulances.
The current pandemic is starting to put the issue of ambulance decontamination under the spotlight that it needs.
Cleaning gets rid of the visible dirt and, as per the Environmental Protection Agency (EPA), removes only 98% of bacteria and 93% of viruses. We need to be sanitizing and disinfecting our units to ensure optimal ambulance decontamination. Sanitizing and disinfecting introduces a chemical that can kill infectious agents. Known as antimicrobial pesticides, these chemicals can kill 99.999% of germs.
Keep in mind that this is an ongoing process. Just as soon as a clean area is touched by unclean hands, the germs are reintroduced. Crews need enough time to first clean the ambulance and then disinfect it before returning to service after each transport. EMS providers typically carry the supplies necessary to disinfect the ambulance. Thus, this really comes down to the time allotted by an EMS agency.
Ultraviolet (UV) light for ambulance decontamination
After completing a shift or transporting a patient with a known issue like COVID-19, more needs to be done to ensure nothing was missed during the traditional cleaning and disinfecting process. As I mentioned in a previous blog article, Coronavirus and EMS safety: Cleaning your hands and your ambulance, the Shanghai public transportation company, Yanggao, has started using ultraviolet (UV) light disinfection to disinfect their public buses in as short as five and as long as 30 minutes using this process.
UV light radiation produces a wavelength range between 100 and 380 nanometers (nm).
At specific wavelengths the UV light radiation can kill microorganisms by breaking the molecular bonds in the DNA and RNA. Researchers have determined that a wavelength of 254 nm is the most effective. UV can kill the encountered microorganisms; however, some take longer than others. Researchers also determined that crews need to use 30 minutes of pulsed xenon ultraviolet (PX-UV) treatment to reduce the bacteria to acceptable levels.
Ultraviolet C (UVC) is one of three types of UV emitted by the sun and is considered the most dangerous type. The ozone layer stops UVC, so it poses no threat to life on earth. When using UVC lights for ambulance decontamination, setting a time delay and cleaning duration can help prevent injury to personnel. This process would take too long to complete after each call in a high-volume system and would need to be done as part of the end-of-shift duties.
UV disinfection in practice
Thompson Valley Emergency Medical Services, located in Loveland, Co., has been using UV disinfection since 2015. EMS Battalion Chief Tim Zimmerman recently did an interview with the Loveland Reporter-Herald and stated that after the 2014 Ebola outbreak the organization recognized that it needed to upgrade its decontamination equipment in case of future outbreaks. The agency purchased six UVC lights at a cost of $4000 each, one for each station.
Zimmerman stated that crews hang the light in the back of the ambulance for 20 minutes.
Zimmerman also added that they use the UVC lights to clean the stations and decontaminate masks. This allows for reuse due to the ongoing mask shortage.
Cold fogging and microfiber wipe down for ambulance decontamination
The City of Las Vegas Fire & Rescue and the Las Vegas Metropolitan Police Department have started using a company named Summit Restoration to clean and disinfect units. Summit Restoration uses EPA registered cold fog disinfectant and microfiber wipe downs to clean its units. Fogging is a process that requires a machine that can atomize a disinfectant allowing the agent to get into the smaller areas within your ambulance. The service is currently being provided free of charge. The service is not only free of charge to the organizations, but also free to first responders, healthcare workers and active military so that you do not have to worry about transporting a virus home to your family in your personal vehicle.
The company fogs your vehicle with the disinfecting and then wipes the surfaces down with a microfiber towel. They also use microfiber towels, as they are safer for the environment and remove 99% of bacteria from surfaces.