Do you jump right into your car, drive home and stop in your kitchen for a drink before changing after a work shift?
Ever think about what you’re potentially bringing home with you ... that you leave on the countertop ... that your toddler might be crawling in ... that your bare feet might be stepping on?
While every scene that we enter isn’t ridden with biohazards, pathogens and methyl-ethyl contaminates, we certainly aren’t immune from encountering and bringing them home with us.
Consider this:
You respond to the scene of a bicycle accident. Your patient went head-over-heels over the handlebars of his bicycle and received some road rash as a result. Adding in an open ulna/radius fracture with some bleeding, your scene looks a whole lot worse than it really is. You approach your patient and accidentally step into a puddle of blood. Now, you track that blood into your ambulance ... the hospital ... your station ... your car ... your home.
Could this have been prevented, avoided or mitigated?
Aside from conscious and careful movement on scene, sometimes getting a little dirty is a consequence of our job. Staying dirty, however, is a decision.
While dried blood on your boots may not seem like a significant hazard – at least it’s one that can be washed off – exposure to substances and pathogens like C. diff, methamphetamines, fentanyl, MRSA or even bed bugs can be an entirely different story.
What can we do about exposure?
Reduce your exposure time
Limit your on-scene time within any hazardous area, as well as the number of personnel that may become exposed to any potential hazard.
If you do become exposed to an unhealthy substance, decontaminate yourself as soon as is practical.
Keep your distance from contaminates
Avoiding a hazardous area is the best idea ... on paper.
In many of these situations, we unknowingly walk into a dirty zone or encounter a contaminated patient. Providing a barrier of protection between yourself and your patient may be your best option.
Think back to your primary skills testing, when you walked into the skills station with your hands in the air, nervously reciting “BSI, scene safe.” Those words are supposed to mean something, and here’s where they apply.
Double-gloving, face shields, safety glasses, protective aprons, arm sleeves, boot protectors and particulate masks should all be staple items on your ambulance. Knowing where they are and how to rapidly access them should be a priority.
Clean early, clean often
Decon doesn’t not always involve a Level-A wet-down decon line. Sometimes, it may be as simple as washing your arms with soap and water on scene. Appropriate commercial wipes, cleaning solutions or detergents should be available in your ambulance.
For those times where on-scene decon is needed, consider available options and who is properly trained to institute them. Do you have access to a portable shower with hot water, or are you only relying on fire engine hydrant or tank water (which is cold, by the way) to gross decon anyone that is contaminated?
If you need to change your clothes, do it sooner rather than later. Bag your clothes, change into a new uniform set or into scrubs, and wash your clothes at a station, if possible. If this isn’t an option, then turn to your supervisory staff to reference appropriate off-site cleaning options. As a final thought, bringing contaminated (or potentially contaminated) clothing home to launder should not be an option, as a cleaning solution should be available through your agency’s decontamination and exposure plans.
It’s also important to wipe down your cot at the beginning of your shift and after each patient use. Consider the crevices, the seat belts, the mattress and the rest of your ambulance. Using appropriate cleaning solutions is an important component of proper decontamination.
“A clean squad is a happy squad” should be your motto for every shift. What’s important, moreover, is that you’re using the right cleaning solution for the right dirty job.
