EMS: Do We Kill Our Patients?

W ar of the Worlds is a familiar novel that has been converted to films, radio dramas, a record album, comic book adaptations and a TV series. The last one I remember watching starred Tom Cruise as Ray Ferrier in 2005, as he and his family battled fictional Martians who landed on earth and exhibited little regard for life as they systemically exterminated humans. Despite the efforts of the military and all of its advanced weapons, the Martians could not be stopped from attempting to annihilate the human race. All the movies, books and even a legendary radio broadcast paint a terrible picture in which there is no stopping the invaders from outer space.

On a side note, the 1938 nationwide CBS radio broadcast of the War of the Worlds by Orson Welles caused panic and hysteria in the United States as the first two-thirds of the 62-minute broadcast were presented as a series of simulated news bulletins. There were no commercials, which further made many in the listening audience truly think truly there was an invasion by the Martians.

Whether it is the novel, the movies or the radio broadcast, the Martians are eventually defeated. Not through massive and overwhelming military force, but by something we cannot see: bacteria, germs and viruses. Humans have immunities to these various bacteria, germs and viruses, but these fictional Martians do not. As a result, all the Martians die off.


Heeding lessons from the past

The use of germ warfare is not isolated to works of fiction. Native Americans were infected with smallpox through contaminated blankets from the British during the siege of Fort Pitt in 1763. Others who did not have immunities died from numerous other diseases that were brought to Native American tribes, including measles, scarlet fever, typhoid, typhus, influenza, pertussis (whooping cough), tuberculosis, cholera, diphtheria, chickenpox and sexually transmitted diseases.

The use of germs is well documented in history as a weapon of war. But we have apparently not learned our lessons well. Or maybe it is because what we cannot see, we have a tendency not to worry about.

Germs are definitely killers. In the United States, the Centers for Disease Control and Prevention (CDC) estimates that roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria, combined cause or contribute to 99,000 deaths each year. That is more people than are killed on highways each year. Think about how many times you’ve heard of someone who came down with a staph infection during a hospital stay.

If you think about it, the back of an ambulance is no different than a small hospital room. Both have a patient and are surrounded by medical equipment.

A few years ago, researchers from Georgetown University tested ambulances in an urban setting and found that nearly half of those tested positive for contamination by Methicillin-resistant Staphylococcus aureus (MRSA), a bacterium responsible for several difficult-to-treat infections in humans. The areas they swabbed were in all the areas, including the stretcher, the patient work area and even the steering wheel. Many feel that the high turnover rate of patients in an urban environment ambulance and the lack of time required to properly sanitize the back of the ambulance results in the high concentration of MRSA the researchers found.

Ambulances have been called the weak link when it comes to fighting bugs that may hide in our vehicles. Many professional organizations that deal with infectious diseases and are aware of how critical a role the back of the ambulance plays in controlling these bugs advocate the proper cleaning and disinfecting.

It does make sense. We are constantly transporting sick patients in the back of our ambulances. Unless ambulances are properly cleaned and disinfected, the patient area is ripe for spreading infection to someone else.

So are we killing the patients we put into the back of our ambulances? I am sure there are some who contract some type of germ in the back of our ambulances. And if they’re immune system is compromised, it makes them even more susceptible.

A clean ambulance is necessary, but in my opinion is difficult to achieve unless you completely sterilize the vehicle. A variety of cleaning products are available. They can be as basic as soap and water all the way up to expensive cleaning products that are sold commercially. Even the highly expensive commercial products still come down to looking like a bleach product with water.

What truly must be spotlessly clean are materials used on a patient, such as a laryngoscope blade. Surface areas are also important, but anything that comes in contact with the patient should have specific attention.

Just because you can’t see it doesn’t mean it can’t kill you or your patient. Special attention to killing germs and proper cleaning will help prevent unnecessary deaths. n