Fleet Decontamination During a Pandemic

by Joseph Cahill

Influenza – “the flu,” in common parlance – is a respiratory disease caused by a virus that mutates from one year to the next into a slightly new strain that requires a new annual vaccine. A flu pandemic occurs when influenza becomes easily transmissible from person to person and the global population has little or no immunity to the new strain – a lethal combination that results in millions of people – sometimes tens of millions – throughout the world dying or becoming seriously ill. The only saving grace is that, despite the horrendous loss of life, most of those infected eventually will recover from the illness.

The goal of most communities within the United States, and overseas as well, preparing to cope with an influenza pandemic is to at least lower the percentage of the population that is sick at any given time, a successful strategy that may perhaps mean the difference between 20 percent and 30 percent of the local population being ill simultaneously. Whatever the percentage, even a relatively small difference – when applied to critical staff such as emergency services technicians, transportation personnel, and many others playing key roles in the overall healthcare community – is significant enough to save hundreds or perhaps thousands of lives.

It is important to remember that the emergency-response community does not use the terms “disinfection” and “decontamination” interchangeably. Disinfection refers to removing or killing the microorganisms that cause the flu; decontamination refers to removing or neutralizing a substance or microorganisms from a person or object and moving that person or object to a contamination-free environment.

Not only healthcare officials but also planners and decision makers at all levels of government already have spent a great deal of time working out the processes and procedures needed to provide for the decontamination of patients not only at the scene of an incident involving hazardous materials and/or terrorism but also at the doors of the hospitals and other healthcare facilities within their communities.

This vital work is essential, of course, to combat the specific threats mentioned; however, the same plans cannot always be used to cope with a pandemic flu – for two reasons. The first reason relates to the nature of the hazard, which in this case is a microorganism. A person infected with influenza does not exhibit a surface contamination; instead, the contamination is embedded deep in his or her lungs. The second reason is that, if and when a pandemic flu strikes any given community, there would seldom if ever be a “clean zone” available through which a decontaminated ambulance could pass.

Processes, Procedures, and the Prevention Strategy

The standard operating procedures used to disinfect an ambulance during an influenza pandemic would be the same as the disinfection procedures used after an outbreak of any other respiratory-based illness. In fact, they should be exactly the same as those used in taking a patient with flu-like symptoms to the hospital during flu season or at any other time.  

The difference is not in the disinfection process or in the illness; it is in the context of the pandemic itself. During a pandemic, disinfectants and other supplies may quickly become very scarce, not only because of the suddenly increased demand but also because there probably would be a decrease in the supply of disinfectants available – the latter problem would be caused by the debilitating effects of the pandemic both on the production staff (of the companies that produce the disinfectants) and on the transportation workers who deliver the disinfectants not only to warehouses and other storage sites but also to hospitals, clinics, and other healthcare facilities.

One strategy that can be used to combat these expected shortages is to stockpile materials in advance. However, many agencies and/or communities do not have the financial resources or the storage space needed to implement this strategy. A better strategy for most organizations and agencies facing this problem is a multi-faceted prevention plan. Requiring any coughing or sneezing patient, for example, to wear a mask to contain the virus-carrying droplets being emitted will minimize both the amount and the spread of the virus adhering to surfaces within an ambulance and/or hospital room. Obviously, EMS, transportation, and healthcare staff should be wearing masks for the same reason.

A full-scale prevention strategy also would entail keeping ill employees from their normal working places, and vaccinating those who have not yet become ill (but it should be remembered that a vaccine is likely to be available too late to help most of those likely to be infected). The most important step in the prevention strategy, however, is frequent and consistent hand washing as well as the use of liquid hand disinfectants when soap and water are not available.    

A final footnote: Because most ambulances usually are busy transporting people who are already weakened by other diseases, or by injuries, the ambulances themselves should be disinfected as frequently as possible, particularly when a patient suffering from a respiratory illness is being or has been transported – this extremely important prevention step should be standard practice in any case, regardless of whether there is a global pandemic or not.

Joseph Cahill, a medicolegal investigator for the Massachusetts Office of the Chief Medical Examiner, previously served as exercise and training coordinator for the Massachusetts Department of Public Health, and prior to that was an emergency planner in the Westchester County (N.Y.) Office of Emergency Management.