Healthcare leaders are pushing for renewed dedication to patient safety — especially in the fight against HAIs. Creating safe, disinfected patient environments is a key component of infection control and HAI prevention. But the healthcare environment isn’t just the four walls of your hospital — it’s also the emergency vehicles that transport patients to the hospital. 

Patients in emergency medical service (EMS) vehicles are just as vulnerable to MRSA, C. diff, and other HAI-causing pathogens as patients in hospital rooms, and they deserve advanced disinfection, too.

But there are major roadblocks to disinfecting ambulances and other emergency vehicles that require smarter, more efficient solutions. 

Why Is Disinfection in EMS Vehicles So Important? 

While not every patient inside an ambulance is infected with a contagious disease, there is a massive risk for pathogen transfer during each ambulance ride. MRSA, and several other multi-drug resistant organisms, are found on surfaces in EMS vehicles including stretchers, blood pressure cuffs, and monitoring devices.

Ambulance disinfection becomes even more important when you consider the patients they serve. Often, they are in critical, life-threatening conditions, elderly, or very young. These most vulnerable patients could be even further endangered by contact with HAI-causing pathogens, which result in about 72,000 deaths each year in the United States.

EMS professionals are also at risk of exposure, as they come in contact with a variety of patients each day. Most of the time, EMTs have little information about their patients’ pathogenic background. With so much contact with the public, it’s no surprise that there is an increased MRSA colonization rate of 6.4% among paramedics, a significant jump from the 1.5% colonization rate in the general public. Reducing pathogens in the ambulance is key to protecting the EMS professionals who commit their lives to serving the public. 

Challenges to Ambulance Disinfection

EMS vehicles face similar disinfection challenges to hospitals and ORs — challenges that are often exacerbated by the tight space. 

Much like hospital rooms, EMS vehicles are constantly receiving new patients, who introduce the potential for pathogen transmission. Medical researchers are now looking to the EMS vehicle microbiome as a reservoir for pathogen transfer. 

It’s not a simple task to eliminate pathogens in a hospital room, let alone the confined space of an ambulance. The delicate medical equipment could be damaged by harsh chemical disinfectants or by an EMS professional struggling to clean a hard-to-reach area. 

But the EMS team’s worst adversary is time. Calls for help can come in at any moment, maybe even just minutes after transferring a patient to a hospital. Using traditional disinfecting methods, EMS professionals often don’t have time to completely disinfect the vehicle before their next dispatch, leaving several surfaces potentially contaminated. 

How Are EMS Vehicles Disinfected?

The truth is, we don’t really know how most EMS vehicles are disinfected. There is no standard practice among EMS agencies, and practices vary within agencies themselves. 

During major public health crises and pandemics, the CDC publishes guidance for how to disinfect EMS vehicles after transporting patients with suspected or confirmed cases, but there is no standard guide for day-to-day disinfection. 

According to a FEMA study on EMS vehicle safety, 85.9% of respondents disinfected the stretcher between patients, but only 14.1% reported disinfecting the ambulance between cases. The study also revealed the limited infection control training provided to EMS professionals. Most only received 1-5 hours of annual training, and 63% of respondents described their knowledge of C. diff and multi-resistant organisms as “fair” or “poor.” 

It’s clear that EMS professionals want to provide safe environments for their patients and teams alike, but they often aren’t given the time, tools or training to properly disinfect the vehicle. But why? 

Current Infection Control Strategy

EMS agencies vary widely. You have some teams working for the county or city, others working for the hospital, and others still working in the non-profit and for-profit sectors. With so many different leadership styles and goals in place, it’s hard to set a standard for disinfection. 

Although varying in their standards, EMS agencies make attempts to address these challenges by using common hospital disinfection methods. Most EMS teams rely on alcohol or hydrogen peroxide wipes to clean the surfaces of the vehicle, and some have begun to install UVC disinfection systems inside the vehicles. Unfortunately, both of these attempts fall short of providing true advanced disinfection.