Next time you stop at a red light next to an idling ambulance (such a common occurrence), notice what the folks in the cab are doing. Chances are they’re rubbing their hands together a la Simon Legree (“Mwoo hoo ah ha ha!”) They are probably not doing this because it is payday, but rather for a more practical reason.

Hand cleaner.

You see, we all gots cooties.

“DTs, you lie like a rug,” you insist. “Our strapping EMTs are the flower of healthcare, and bathe regularly. They brush and floss, and their strength is as the strength of ten, because their hearts are pure, too.”

Be that as it may, but the ambulance gig is inherently one in which we become cozy with Microbes Galore.

It is a hard truth, and difficult to reconcile with what we all know is public perception: The gleaming ambulance as it roars down the street. Bright chrome throwing foam-like sparkles as the unit flashes under the street lamps. Past homes, the sirens doppler up, then down, and mothers smile at their children. The unit stops at its destination. Red lights flash as beacons of aid. Doors open, and out step Our Heroes, to the rescue.

Such is public perception. Right.

So, how can these paragons of virtue, wise, and so noble of feature, have… cooties?

“Cooties” is actually the penumbral term for the host of organisms to which EMS is exposed. When we arrive at a home because a patient isn’t feeling well, we know we may be walking in to an infestation of Biblical proportions, with bacterium swarming like locusts through the air. Lord knows there have been times where it seems one needs to swat the germs aside to get to the patient, and can feel the buzzing, scrabbling things crunch underfoot.

Remember, though, that this same patient felt “just fine” a few hours ago and was sniffling right behind you in line at the grocery store.

It is not from such exposure that EMS gets cooties. BSI, or Body Substance Isolation (meaning at a minimum the donning of latex or latex-free gloves) is pounded into your EMT-B from Day 1 of class, and second in importance only to Scene Safety. Arguably, BSI may be considered part of a safe scene. BSI also includes masks, gowns, eye protection, and other steps to minimize cootie transmission. Isolation gear ala The Andromeda Strain is a bit over the top, most of the time.

“Patient flavored” cooties are easily dealt with by proper BSI, and of little worry to EMS. They are of little concern to patients, too, for the units themselves are disinfected after each patient transport. One need not fear that the previous occupant of The Box had some Creeping Crud – we cleaned it up, don’t worry.

Perhaps it won’t be surprising to learn that the two flavors of cooties with which EMS is mostly concerned, (and I use the term “concerned” very loosely, as we shall see) are born and bred in the hospital.

MRSA, pronounced “mur-sah”, is an acronym for methicillin resistant Staphylococcus aureus. This bug likes wounds, especially pressure sores, which occur when a bedridden patient isn’t moved once in a while. The part of the body contacting the bed is compressed, the cells die, and a gaping ulcer results. Most end up going all the way to the bone. Pressure sores can also form when a patient is sitting in a recliner, or on a chair, or any other position which doesn’t change a whole lot. Obviously, we don’t stick our fingers in the wounds, but if one is moving a patient from the cot to the bed, contact can occur. MRSA can also live in a patient’s sputum, so we tend to cover those coughs.

VRE, or vancomycin resistant enteroccus, is another big cootie. In the US, the only place to get this one is at a hospital – it lives on bed rails, doorknobs, equipment – hell, it can probably jump on you from the toilet seat. If you’ve been to the hospital, as EMS folk are wont to do, you have contacted (but not necessarily contracted) VRE.

So what’s a medic to do? Actually, not a lot. We wear gloves, and strip ’em off when we’re done “touching stuff”. Wash our hands with soap and water. No biggy. Both MRSA and VRE are wussy germs. They are the “before” picture in the Charles Atlas ads. Our immune systems kick sand in their faces. Medic Man, him good, him strong.

Ah, but for the elderly, the ill, newborns – well, cooties isn’t such a good thing for them. And so, even though we think we’re clean, a brisk handrubbing with waterless hand cleaner every now and then never hurts – and kills 99.99% of the suckers. Take that, cooties! Mwoo hoo ah ha ha!


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