Engine Company EMS: Protecting Patients from the Dirty Work of Firefighting

By Michael Morse

Firefighting is a dirty job: we get dirty, our gear gets dirty, and our equipment gets dirty. Keeping our firefighting equipment clean and operational is second nature. Most good engine companies periodically dump the hose beds and scrub the feeders and attack lines, do a systematic check of the nozzles, disassemble the self-contained breathing apparatus, and maintain the cab (especially the officer’s side). Washing the truck is a daily ritual; waxing monthly; painting tools, and cleaning rust from poles and ax heads are standard operating procedures.

But what about your EMS gear? In all probability, the greatest chance of infecting a patient will come from your EMS interventions. Most engine companies have their EMS equipment stored in a dedicated area, hopefully its own compartment, away from the firefighting tools. It is easy to forget “that compartment” when doing regular maintenance on the engine. If the equipment isn’t used, “leave well enough alone,” is a common philosophy among fire-EMS crews.

Your EMS bags, medications, boxes of gloves, and IV and ET kits need to be placed on an even higher priority than your firefighting tools. Forcing a door with a dirty ax isn’t going to hurt anybody.  Pulling ceilings with rusty poles never killed anybody, and sooty feeder lines will shorten service life, but neither of these have likely infected patients.

Your EMS Compartment is Your Temple

Prioritize your EMS gear. After turning in your pack and giving the apparatus a quick once over, try to make the EMS equipment your first priority in daily inspections and maintenance. I have found that I start my checks fairly clean.  By the time I’ve cleaned the tools, checked the fluids, swept the cab and washed the vehicle, I’m no longer the epitome of sanitation. By checking the EMS meds and equipment first, there is less chance of contaminating the things that need to stay the most sanitary.

Replacing protective glove boxes when they are empty–rather than stuffing a handful snagged from the bus on the last EMS run into a month-old container keeps–those very important pieces of personal protective equipment fresh and sanitary. Consider rotating the glove box from the storage closet, to the EMS compartment and finally the cab.  Rotation helps assure that the gloves in the cab are as clean as possible before initiating patient contact.

The IV kit is best placed in its own sealed container inside the EMS compartment, not the cab. I used to take a Ziploc® storage container and fill it with enough alcohol swabs, 2x2s and 4x4s, tape, occlusive dressings, 16, 18, 20 and 22 gauge catheters and tourniquets to start two IV’s in the field. The rest are left in the trauma, medical, and maternity bags, along with the IV fluids. I could grab the pre-made IV kit on the go, periodically replacing my supplies from the bags, which were restocked, cleaned, and date checked monthly.

Collars kept in the cab are subject to contamination. Keeping them in the meticulously maintained EMS compartment keeps them as clean as can be expected on an ALS engine. Dedicated EMS blankets and towels belong in there as well.

Many of our patients are not very healthy; every effort we make to keep things up to the high standards of the fire service helps prevent spreading disease to them.  By keeping our EMS supplies and equipment in top shape, we accomplish two goals:

1 Provide the best patient care possible

2- Set high standards for ourselves and our colleagues

The morale of the fire-EMS Company is reflected by the appearance of their apparatus, the tools and personnel on board, and the medical equipment stored neatly. Keep your critical lifesaving EMS tools cleanly and easily accessible in a dedicated compartment.

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Michael MorseMichael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.

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