Are Bed Bugs Biting Your Wallet?

Bed Bug media hype has spurned considerable action in the travel industry, hospitals, prisons, homes and (of course) fire stations. These pesky little critters have developed resistance to many pesticides (which may account for the recent increase in infestations), are particularly good a hiding, but remain visible to the naked eye. That’s right; you can see them! What you might not see so clearly are the unscrupulous profiteers hoping to drain your wallet with ridiculously expensive equipment and supplies. They’re out there, and some fire departments have already been bitten.

Noted Fire Service and EMS infection control expert Katherine West points out that a comprehensive bed bug control program involves minimal cost. The Centers for Disease Control (CDC) and the Environmental Protection Agency (EPA) have outlined a simple yet comprehensive strategy of prevention and control.

Preventitive efforts include:
– remove clutter in sleeping areas
– seal cracks and crevices
– wash linen after each use in hot (> 120 degrees F) water and dry in a hot dryer
– vacuum beds and quarters frequently and discard vacuum bag after each use
– use mattress covers
– roll linen off beds (instead of pulling)

Control measures during an infestation include:
– spray surfaces with 91% isopropyl alcohol (kills on contact)
– ventilate areas after spraying
– allow surfaces to dry before placing clean linens/sleeping
– steam cleaning surfaces may be effective (done every 5-10 days until resolved)

Kathy West points out that 91% isopropyl alcohol is available at most drug stores for less than $2 per bottle. Departments may wish to spray surfaces prophylactically (as a preventative measure). For infestations, departments may wish to consider contracting with a pest control company. There is absolutely no reason to purchase expensive cleaning equipment, solutions, or supplies. There is also no reason under the sun to burn or discard linens and bedding items. Prevention is a responsibility we all share.

These same measures are equally effective for EMS cots, stretchers, equipment, and bags brought into homes and businesses. Changing linens after each use, vacuuming and spraying surfaces of equipment and bags with 91% isopropyl alcohol are wise prevention strategies. Like fire gear, EMS linens, bags, and equipment should never be carried into crew quarters.

Bed bugs infestations are increasing in every area of the world. Like any other health concern, an informed and common sense approach will protect your members, their families, and your community. There is no reason to waste money, time, or energy on expensive and unproven solutions when practical, inexpensive prevention and control stragies are readily available.

Reference: Joint Statement on Bed Bug Control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA), www.cdc.gov/nceh/ehs/Publications/Bed_Bugs_CDC-EPA_Statement.htm.

Mike McEvoy
EMS Editor
Fire Engineering

Hold CPR: Get an Ambulance and Helicopter

Time is ticking away. You might want to put down those few hundred pages of Emergency Cardiac Care Guidelines 2010 and pick up a copy of the draft NFPA 1917 Standard for Automotive Ambulances. “Doesn’t affect me,” you say? I’d bet otherwise; if you ride a bus, aid car, rescue, box, ambulance, or whatever else you call that patient care and transport vehicle on wheels, this standard affects you. Once finalized in 2013, the feds will drop their KKK purchasing spec which is probably the guideline you currently live under. Have a look and see; comments are due back to NFPA no later than December 15, 2010.

While you’re in a reading mode, you might want to take a look at the proposed FAA Rules for Air Ambulances. These sweeping new regulations also affect you. Comments are due back to the FAA no later than January 10, 2011.

When you’re done studying the NFPA Ambulance Standards and the FAA Air Medical Rules, you can get back to your November 2010 issue of Circulation. Those CPR changes are going to take some time to make it out into the textbooks and teaching materials. While you’re at it, take a peek at our growing FireEMS page on the Fire Engineering website. We’re focused on keeping you up to date with the latest FireEMS news and information you need to stay on the leading edge of patient care!

Mike McEvoy
FireEMS Editor
Fire Engineering

Don’t Forget EMS!

Last week’s announcement by the US Transportation Secretary that traffic fatalities have reached the lowest levels in 60 years overlooked an important contributor: EMS. NHTSA Administrator David Strickland cited increased seat belt use and tougher drunk driving enforcement as key contributors to the decline in traffic deaths. There was no mention of EMS. This is a grim reminder that we need better methods of documenting the outcomes of care we provide on the streets and highways of our great nation. No doubt seat belts, airbags, safer vehicle design and improved traffic enforcement all reduce deaths and injuries on our roadways. But, according to the CDC, so does expeditous transport to a Level I Trauma center when initiated by savvy EMS providers who recognize a need for specialty care. I’ll bet permissive hypotension, capnography, better pain management, and improved tactics also reduce mortality. It’s time to let NHTSA, DOT, the CDC and our communities know about the EMS contribution to reduced injuries and deaths. If we don’t, no one will ever know.

Mike McEvoy
EMS Editor
Fire Engineering

EMS LODD and a Lesson

Champion EMS EMT-trainee Casey Steenland, aged 33 died on Friday, August 13th in Texas, an apparent victim of Carbon Monoxide poisoning. Three other Champion EMS members were treated, two required HBO (hyperbaric oxygen) according to local news sources. All four were apparently exposed to CO from an ambulance generator left running in crew quarters where they were sleeping. There were no CO detectors in the building.

We deeply regret the loss of our sister, Casey Steenland. I have long believed that every brother and sister who dies in the line of duty has a message they most certainly would like us to hear. It is our duty to honor these heroes by actively listening to their cry. As OSHA investigates the circumstances of this multiple victim CO incident in Texas, let’s take the immediate lesson that Champion EMS heard right away. Do your crew quarters have CO detectors? Every Champion EMS station had them by Friday afternoon. Your crew quarters need to have them by tonite.

Mike McEvoy
EMS Editor
Fire Engineering

Ambulance Delayed: NFPA 1917

National Fire Protection Association (NFPA) Technical Committee on Ambulances balloting this week failed by one vote to move a draft “NFPA 1917, Standard for Automotive Ambulances” forward into the review and public comment process that would have rolled an ambulance design standard out the door during mid-2012.

At issue was inclusion of several AMD (Automobile Manufacturers Division of the National Truck Equipment Association) testing standards incorporated into the draft document without copyright release. While most likely an oversight by the non-legal eagles on the 1917 technical committee, redacting the AMD material from the draft standard (on the advice of NFPA counsel) left some rather large holes.

Had the draft been approved and forwarded this week to the NFPA Standards Council, it would have been released for public comment, closing November 23, 2010. Responses to comments would have been published June 24, 2011 opening an additional comment on the comments period ending August 30, 2011. A final draft would have been published February 24, 2012 and, depending on receipt of any official objections, have taken effect in either July or August 2012.

No word on how long the process will now be delayed, but returning the 1917 draft to committee will likely result in resolution of some significant gaps between the current General Services Administration (GSA) “triple K” or KKK ambulance purchasing specification and other ambulance design or purchasing standards, including AMD. Prior to the smack down resulting from this week’s failed balloting, it appeared the committee intended to use public commentary to steer several controversial decisions. Stay tuned for word on when the draft 1917 document might be resuscitated. The feds have made it abundantly clear that, if and when, an NFPA Ambulance Design Standard hits the pavement, they’ll cease issuing and updating triple K.

Mike McEvoy,
EMS Editor – Fire Engineering magazine
NFPA 1917 Technical Committee Member

EMT Fraud: Bad People or Flawed System?

Recent news from Massachusetts reporting suspension of 207 EMTs and revocation of 4 Instructors for bogus refresher training smacks of poor oversight. But it may also highlight continued frustration with recertification requirements placed on EMS providers across the United States that fail miserably at providing any real education. That’s right, perhaps the system is broken. For whatever reason, EMS providers are subjected to reruns of the very same material they were taught in their original training. Year in and year out, over and over again. No other profession feels compelled to revisit basic education with such vigor, nor does any other profession reteach basic material under the guise of “continuing education.” Refresher training per se, for nurses or physicians, is reserved for those who have been out of practice, or who have been removed from practice for obvious performance problems. Why have EMS educators failed to evolve recertification requirements to the needs of providers?

Don’t get me wrong: I’m not endorsing falsification of training records. But I am endorsing a root cause analysis of what led a whole group of really good EMS providers to fail to take their recertification process seriously. The problem may lie with the system and I’m willing to bet that it is not confined soley to Massachusetts…

Mike McEvoy
FireEMS Technical Editor

Dumb Stuff We Gotta Do

Well, one cat’s outta the bag. In the continued debate over the efficacy of prehospital spinal immobilization, it would appear from a study published the January 2010 issue of the Journal of Trauma that prehospital spinal immobilization doubles the risk of death for certain patients. Researchers at Johns Hopkins looked at 45,284 penetrating trauma patients in the National Trauma Data Bank. Of these, patients who received prehospital spinal immobilization consistently had double the mortality of those who did not receive this time consuming and potentially compromising treatment in the field. Curiously, 30 of the 45,284 patients who were shot or stabbed actually had spinal injuries (0.01%). Yet, further analysis demonstrated it took immobilizing only 66 patients to result in one death; saving one life with spinal immobilization took 1,032 backboard jobs. Hmmm, that translates to causing more than 15 deaths in order to save one life. Jeepers! Not very hard to see why the authors concluded that prehospital spinal immobilization results in higher mortality in patients with penetrating trauma and should not be routinely used. Another example of dumb stuff we gotta do. Hopefully, changes are coming.

Mike McEvoy
EMS Editor – Fire Engineering

Taking a Shot at Public Health

As a firefighter/paramedic, I’m embarrassed over the scene being created by health care workers (including nurses, medics, and firefighters) refusing flu vaccination. The consequences are serious: they cast public doubt over the best tactic we have to prevent spread of influenza in our communities. Vaccines have slashed death rates from twenty five diseases. Get a flu shot in the fall and you are half as likely to die during winter as people who don’t. When physicians, nurses, medics, and firefighters get flu vaccines, their patients are also less likely to die.

Flu is serious – it kills more than 36,000 Americans every year, the majority of victims over 65 years old. The H1N1 virus causes relatively mild illness in healthy adults but threatens the lives of the very young and weak. It is a robust virus that spread worldwide like wildfire and never went away. It is now a pandemic, and H1N1 shows every indication that it is here for the winter, if not longer. We have no better public health tool than vaccination to protect our children and each other.

So is there danger in the vaccine? Not at all. The danger is in unvaccinated people, and especially unvaccinated health care workers. While firefighters and paramedics are less likely than their patients to get sick with the flu, they readily carry the virus to others, infecting vulnerable patients as well as their own friends and families.

Firefighters are not just inhabitants of their communities; they are public role models. We have a moral and ethical duty to make responsible choices and act with the understanding that others are watching. Lives are on the line in your home and in the communities you serve.

Mike McEvoy
EMS Editor
Fire Engineering

Air Medical Safety and the Fire Service

Our recent news announcing proposed FAA rule revisions on Helicopter Emergency Medical Services (HEMS) and a public hearing by the NTSB in February 2009 cry out for fire service involvement (see: www.fireengineering.com/display_article/346289/25/none/none/HLTHS/FAA-and-NTSB-react-to-air-medical-crashes). 2008 promises to end as the most catastrophic year in the history of HEMS. Sound familiar? Any firefighter would feel the deja vu. With a history of grabbing the safety bull by the horns, confronting tough issues, naming problems, and taking opportunities for improvement, I’d say the fire service has a whole lot to contribute to any industry in the throws of safety troubles. But wait, there’s more. The FAA suggested last year that ground providers contribute to unsafe HEMS operations. We do this by “helicopter shopping” or calling around until we find a HEMS willing to respond in whatever adverse conditions exist at or around our scene. Is the fire service part of the HEMS problem? Maybe. Can we be part of the solution? Absolutely.

Mike McEvoy
EMS Technical Editor
Fire Engineering