2.5 Infection Control, PPE, Scene Safety & Disaster/Evacuation Planning

Infection Control, PPE, Scene Safety & Disaster Planning

Transport cabins are small, shared, and hard to ventilate. Crews move from patient to patient within hours, often in unfamiliar hospitals and at uncontrolled scenes. The NCC outline lists scene safety, evacuation protocols, survival training, disaster planning, and PPE/infection control as core safety topics.

Standard and Transmission-Based Precautions

Standard precautions apply to every patient: hand hygiene, gloves for contact with blood or body fluids, eye protection and a mask when splashes are possible, safe sharps handling, and respiratory hygiene.

Aerosol-generating procedures (intubation, bag-mask ventilation, suctioning, high-flow oxygen, nebulizers) raise exposure risk. Use a viral/bacterial filter between the bag or ventilator and the patient and wear respiratory protection matched to the suspected pathogen.

Neonatal-specific points

• Neonates are highly susceptible to infection; follow strict hand hygiene before touching the isolette.
• Infants of mothers with active varicella around delivery, and infants with suspected HSV vesicles, need contact (and for varicella, airborne) precautions.
• Keep isolette portholes closed when not in use; this protects thermal stability and limits contamination.

CAMTS Exposure-Control Requirements

The CAMTS 12th Edition standards require:

• Written policies on communicable diseases that follow OSHA and CDC (or equivalent national) guidance
• An exposure control plan with work restrictions for exposed or infected staff, a list of regional disease risks, and a bloodborne pathogen program consistent with the OSHA standard
• Annual review of exposure-control policies and initial and annual education on potentially infectious patients
• Patient-cabin floors, walls, and ceilings that can be cleaned and disinfected, with no carpeted floors

After a bloodborne exposure

1. Wash needlesticks and cuts with soap and water; flush mucous membranes with water or saline.
2. Report immediately so source testing and post-exposure prophylaxis (PEP) decisions can be made. HIV PEP works best when started as soon as possible, ideally within hours.
3. Document the event per the exposure control plan.

Crew immunizations (hepatitis B, influenza, measles-mumps-rubella, varicella, and Tdap) are part of occupational protection.

Scene Safety

Most neonatal/pediatric transports are interfacility, but teams also meet other crews at scenes, landing zones, and roadsides. Before patient contact, ask:

• Traffic and terrain: Is the vehicle positioned to shield the team? Are high-visibility vests worn? (CAMTS requires reflective vests for medical crews and vehicle operators responding to night scenes.)
• Hazardous materials: Is there smoke, a chemical odor, or a spill? Contaminated patients must be decontaminated before loading. CAMTS requires a plan for patient decontamination before transport, and off-gassing in a closed cabin can incapacitate the crew.
• Violence or unrest: Is law enforcement needed? Is the family agitated?
• Aircraft hazards: Rotor systems, landing-zone debris, and fuel (Section 2.2).

If the scene is unsafe, do not enter. Stage nearby and let the appropriate agency make it safe.

Evacuation Protocols and Survival Training

• Vehicle and aircraft evacuation: Every crew member should know exits, harness releases, oxygen shutoffs, fire extinguisher locations, and how to remove the patient or isolette. CAMTS requires an evacuation plan for the helipad where the helicopter is based, with annual education and hands-on drills for personnel who load and unload patients.
• Survival training: CAMTS requires survival and egress training suited to the program's geography, including water egress training when routes regularly cross large bodies of water. Hands-on practice with survival-kit items must occur at least once every two years (Section 2.3 covers post-crash survival priorities).

Disaster Planning and the Incident Command System

Transport services support hospitals and regions during mass-casualty incidents and evacuations. CAMTS requires services that respond to scenes or disasters to have staff complete FEMA Incident Command courses:

• IS-100 (Introduction to ICS) and IS-200 (ICS for Single Resource and Initial Action Incidents) for rotor-wing pilots and medical crews, fixed-wing medical crews, ground crews, maintenance, and communications specialists
• IS-700 (National Incident Management System) and IS-800 (National Response Framework) for key managers, with at least one manager holding IS-800 when the service joins national disaster response

Pediatric mass-casualty triage: JumpSTART

JumpSTART adapts START triage for children (roughly 1–8 years; infants are triaged with modifications):

1. Can walk? → Minor (green).
2. Not breathing? → Open the airway. If still apneic, check a peripheral pulse. If a pulse is present, give 5 rescue breaths. If breathing starts, the child is immediate (red). If not, the child is expectant.
3. Respiratory rate <15 or >45 → Immediate.
4. No palpable peripheral pulse → Immediate.
5. AVPU: inappropriate response to pain ("P") or unresponsive ("U") → Immediate. Otherwise → Delayed (yellow).

The rescue-breath step exists because children often arrest from respiratory causes and may resume breathing with brief ventilation.

NICU and PICU evacuation

When a unit must evacuate (fire, flood, power failure, hurricane):

• Horizontal evacuation (to an adjacent smoke compartment) comes before vertical evacuation.
• Plans pre-assign triage categories by the resources each infant needs (for example, ventilated infants needing a person to hand-bag versus stable infants in open cribs). Units use evacuation sleds, aprons that carry several stable infants, and battery-powered equipment.
• Keep identification bands and records with each patient, and track destinations centrally for family reunification.
• Regional coordination ensures receiving NICUs and PICUs are not overwhelmed. Transport teams may be assigned by the regional incident command rather than by the usual referral system.

Clinical Scenario

A transport team is called to a rural hospital for a 10-month-old with a fever, a spreading petechial rash, and hypotension. Before entering the room, the team puts on surgical masks and eye protection (droplet precautions for suspected meningococcemia) in addition to gloves. The nurse intubates with a filter on the bag, and the team starts ceftriaxone after blood cultures. Two days later, the receiving hospital confirms N. meningitidis. The respiratory therapist had suctioned the airway without a mask before the team arrived, so she is evaluated for chemoprophylaxis under the exposure control plan. The masked team members need no prophylaxis. The vehicle is disinfected with an EPA-registered product before the next mission.