Key Takeaways
- Standard precautions (BSI) assume that ALL blood and body fluids are potentially infectious and include gloves, eye protection, masks, and gowns as appropriate
- Hand hygiene must be performed before and after every patient contact, after removing gloves, and after contact with potentially contaminated surfaces
- Hepatitis B (HBV), Hepatitis C (HCV), and HIV are the primary bloodborne pathogens of concern; the Hepatitis B vaccine is required for EMS providers
- N95 respirators are required for airborne precautions when caring for patients with suspected tuberculosis (TB) or other airborne diseases; the patient should wear a surgical mask
- Post-exposure protocols require immediate washing of the affected area, reporting the exposure to the supervisor, and seeking medical evaluation within 1-2 hours
- Critical Incident Stress Management (CISM) includes defusing (within hours), debriefing (24-72 hours post-incident), and ongoing peer support programs
- Signs of burnout include emotional exhaustion, depersonalization, and reduced sense of personal accomplishment; PTSD symptoms include flashbacks, nightmares, hypervigilance, and avoidance behaviors
- Responder wellness requires attention to sleep hygiene, nutrition, physical fitness, and mental health resources including employee assistance programs (EAPs)
Last updated: February 2026
Standard Precautions (BSI)
Standard precautions (formerly called Body Substance Isolation or BSI) assume that all blood and body fluids are potentially infectious, regardless of the patient's diagnosis or appearance.
PPE Selection Guide
| PPE | When to Use |
|---|---|
| Gloves | ALL patient contact; change between patients; change if torn |
| Eye protection (goggles/face shield) | Risk of splashing blood or fluids (suctioning, childbirth, arterial bleeding) |
| Surgical mask | Potential for droplet exposure (coughing patient, suctioning) |
| N95 respirator | Airborne precautions: suspected TB, COVID-19, measles, chickenpox |
| Gown | Significant blood/fluid exposure expected (childbirth, major trauma) |
| Shoe covers | Large amounts of fluid on the ground |
NREMT Key Point: Gloves are the minimum PPE for every patient contact. Additional PPE is selected based on the situation.
Hand Hygiene
Perform hand hygiene:
- Before patient contact
- After patient contact
- After removing gloves (gloves are not a substitute for hand washing)
- After touching potentially contaminated equipment or surfaces
- Between patients
Methods:
- Soap and water -- preferred when hands are visibly soiled; wash for at least 20 seconds
- Alcohol-based hand sanitizer (60%+ alcohol) -- acceptable when hands are not visibly soiled
Bloodborne Pathogens
| Pathogen | Transmission | Vaccine Available | Key Facts |
|---|---|---|---|
| Hepatitis B (HBV) | Blood, body fluids, needlestick | Yes -- required for EMS providers | Can survive on surfaces for up to 7 days; most infectious of the three |
| Hepatitis C (HCV) | Blood (primarily needlestick) | No | Leading cause of liver transplant; chronic infection common |
| HIV | Blood, body fluids, needlestick | No | Lowest transmission risk of the three per exposure; post-exposure prophylaxis (PEP) available |
Risk Reduction
- Use sharps containers immediately after use -- never recap needles by hand
- Use safety-engineered needles when available
- Clean up blood spills with an EPA-registered disinfectant or 1:100 bleach solution (for routine cleaning) or 1:10 for large blood spills
- Follow engineering controls and work practice controls per OSHA Bloodborne Pathogens Standard
Airborne Precautions
Some pathogens spread through tiny particles that remain suspended in the air:
| Disease | Precautions |
|---|---|
| Tuberculosis (TB) | N95 respirator for EMT; surgical mask on the patient; keep ambulance ventilation on high |
| COVID-19 | N95 or higher; eye protection; gown; maximize ventilation |
| Measles | N95; highly contagious; airborne for up to 2 hours after patient leaves |
| Chickenpox (Varicella) | N95; airborne and contact precautions |
The patient wears a surgical mask. The EMT wears an N95 respirator. This is a common NREMT test point.
Post-Exposure Protocols
If exposed to blood or body fluids through a needlestick, splash to mucous membranes, or contact with broken skin:
- Immediately wash the affected area with soap and water (for mucous membranes, flush with water or saline)
- Report the exposure to your supervisor as soon as possible
- Seek medical evaluation within 1-2 hours -- do not delay
- Document the incident: source patient information, type of exposure, body fluid involved, PPE worn
- Follow up with occupational health for baseline blood draws and possible post-exposure prophylaxis (PEP)
- The source patient may be tested with their consent (or per state law)
Critical Incident Stress Management (CISM)
CISM is a comprehensive system for managing stress responses after traumatic events in EMS:
| Component | Timing | Purpose |
|---|---|---|
| Pre-incident education | Before incidents | Teaches coping strategies and normalizes stress responses |
| Defusing | Within hours of the incident | Brief, informal small-group session to stabilize responders |
| Critical Incident Stress Debriefing (CISD) | 24-72 hours post-incident | Structured group discussion led by trained peer counselors and mental health professionals |
| One-on-one support | Ongoing | Individual sessions with a counselor or peer |
| Follow-up | Weeks to months | Ensures ongoing recovery; referral to professional help if needed |
Common Triggering Events
- Pediatric death or serious injury
- Line-of-duty death of a colleague
- Mass casualty incidents
- Prolonged or particularly difficult calls
- Incidents involving personal connection to the patient
Responder Wellness
Recognizing Burnout
| Sign | Description |
|---|---|
| Emotional exhaustion | Feeling drained, unable to cope, compassion fatigue |
| Depersonalization | Treating patients as objects rather than people; cynicism |
| Reduced accomplishment | Feeling ineffective, questioning career choice |
Recognizing PTSD
Post-Traumatic Stress Disorder symptoms may appear weeks to months after a traumatic event:
- Intrusive thoughts -- flashbacks, nightmares, unwanted memories
- Avoidance -- avoiding places, people, or situations that trigger memories
- Hyperarousal -- difficulty sleeping, irritability, exaggerated startle response, hypervigilance
- Negative mood changes -- guilt, shame, detachment from others
Wellness Strategies
- Sleep -- Aim for 7-9 hours; maintain consistent schedule even on shift rotations
- Nutrition -- Balanced meals; limit caffeine and energy drinks; stay hydrated
- Exercise -- Regular physical activity reduces stress and improves resilience
- Mental health -- Use Employee Assistance Programs (EAPs); seek counseling without stigma
- Social connections -- Maintain relationships outside of work
- Substance avoidance -- Alcohol and drugs are maladaptive coping mechanisms, not solutions
Test Your Knowledge
When caring for a patient with suspected tuberculosis, the EMT should wear which type of respiratory protection?
A
B
C
D
Test Your Knowledge
Which bloodborne pathogen can survive on environmental surfaces for up to 7 days and has a vaccine available?
A
B
C
D
Test Your Knowledge
After a needlestick exposure to a patient's blood, the EMT should FIRST:
A
B
C
D
Test Your Knowledge
A Critical Incident Stress Debriefing (CISD) is typically conducted:
A
B
C
D
Test Your Knowledge
Which of the following is a sign of burnout in an EMS provider?
A
B
C
D
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