Infection Control¶
Category: Operations Sources: UCLA EMT Ultimate Study Guide (2026) Last updated: 2026-05-06
Overview¶
Infection control in EMS encompasses PPE selection and use, equipment decontamination, exposure management, and provider wellness. Effective infection control protects both providers and patients. The same mechanisms that prevent pathogen transmission also define how EMT-B providers respond to occupational exposure, manage stress, and sustain long-term function in a high-exposure environment.
Key Points¶
- Standard Precautions: treat every patient's blood and body fluids as potentially infectious — regardless of diagnosis, appearance, or stated history
- PPE selection is determined by transmission route — see the transmission-routes framework in communicable-diseases
- Post-exposure = report immediately — timing determines eligibility for prophylaxis; delays close treatment windows
- Decontamination after every call — equipment, stretcher, and ambulance surfaces are potential reservoirs
- CISM (Critical Incident Stress Management) is the EMS framework for psychological exposure — peer support and formal debriefing are structured responses, not optional add-ons
- Stress response is cumulative — EMS providers face chronic exposure to traumatic events; recognizing and responding to stress early prevents long-term harm
PPE Selection by Risk Level¶
| Scenario | Minimum PPE |
|---|---|
| All patient contact | Gloves |
| Splash/spray risk (blood, vomiting, suctioning, wound irrigation) | Gloves + eye protection (goggles or face shield) |
| Respiratory illness — known or suspected droplet-spread disease | Gloves + surgical mask + eye protection |
| Known or suspected TB / measles / varicella | Gloves + N95 respirator + eye protection |
| Aerosol-generating procedures (BVM, intubation, nebulizer) | Gloves + N95 + eye protection + gown |
| Suspected Ebola or viral hemorrhagic fever | Full barrier PPE: N95, gown, double gloves, face shield — contact Medical Control immediately |
KEY DIFFERENTIATOR — Surgical Mask vs. N95: A surgical mask blocks large droplets (>5 µm) and protects against droplet-spread diseases (influenza, meningitis, pertussis). An N95 respirator filters 95% of all particles including small airborne particles (<5 µm) — it creates a tight seal against the face. Only an N95 protects against TB, measles, and varicella. A surgical mask is not adequate for airborne diseases.
NREMT RULE — Mask on the Patient: For droplet-spread respiratory illness, place a surgical mask on the patient as well as wearing one yourself. This limits the patient's droplet output. Common NREMT testing point.
Donning and Doffing PPE¶
Donning (putting on) — sequence: 1. Gown (tie at neck and waist) 2. N95 respirator (fit-check: inhale — mask should collapse; exhale — no air escape at edges) 3. Eye protection (goggles or face shield) 4. Gloves (pull over gown cuffs)
Doffing (removing) — sequence matters because outer surfaces are contaminated: 1. Gloves (peel off turning inside out — outside contacts outside) 2. Eye protection (remove by grasping clean inner surface or strap) 3. Gown (unfasten ties; pull away from body turning inside out; roll and discard) 4. N95 (remove by grasping straps only — do not touch front of mask) 5. Hand hygiene after every step
KEY DIFFERENTIATOR — Doffing Order: The gloves come off FIRST because they are the most contaminated surface. N95 comes off LAST. Incorrect doffing order is a documented source of provider self-contamination — it is specifically tested on NREMT.
Equipment Decontamination¶
| Level | Process | When Used |
|---|---|---|
| Cleaning | Soap and water — removes gross contamination | Before disinfection; all equipment after every call |
| Disinfection | EPA-registered disinfectant — kills most pathogens | All equipment that contacts patient skin or body fluids |
| Sterilization | Destroys all organisms including spores | Invasive equipment; not typically EMT-B level |
Ambulance surfaces: Wipe down stretcher, railings, O2 equipment contact points, door handles, and any surface the patient or provider touched. Use agency-approved EPA-registered disinfectant.
Single-use items: dispose immediately after use — do not reuse suction catheters, NRBs, BVM masks, or lancets.
Sharps safety: never recap needles by hand (one-hand scoop technique if recap is necessary); dispose in rigid sharps container immediately after use.
Post-Exposure Protocol¶
Any exposure to blood, body fluids, or potentially infectious material — needlestick, splash to mucous membranes or non-intact skin, or known contact with airborne pathogen without PPE:
- Immediately wash skin with soap and water for 15 minutes; flush eyes/mucous membranes with water for 15 minutes
- Notify supervisor and infection control officer immediately — do not wait until end of shift
- Seek medical evaluation — Post-Exposure Prophylaxis (PEP) for HIV must start within 72 hours (sooner = better); HBV HBIG must be given within 24 hours if unvaccinated
- Complete exposure documentation — PCR (patient care report), exposure incident report
- Follow-up testing per agency protocol — baseline and repeat serology
KEY DIFFERENTIATOR — PEP Timing Windows: HIV PEP: must start within 72 hours, ideally within 2 hours. HBV HBIG: within 24 hours if unvaccinated and HBsAg-positive exposure. Once these windows close, prophylaxis becomes ineffective. This is why immediate reporting matters — delays cost the window.
Critical Incident Stress Management (CISM)¶
CISM is a structured system for managing the psychological impact of critical incidents on EMS providers.
What is a critical incident? Any event that overwhelms normal coping — pediatric death, mass casualty, provider injury or death, violent crime, prolonged unsuccessful resuscitation, or events involving people the provider knows.
CISM Components:
| Component | Timing | Purpose |
|---|---|---|
| Pre-incident education | Before incidents | Normalize stress; teach coping strategies |
| Defusing | Within 8 hours of incident | Brief informal group discussion; led by peer support team |
| CISD (Critical Incident Stress Debriefing) | 24–72 hours post-incident | Structured group process; review facts, thoughts, reactions, coping |
| Individual follow-up | As needed | One-on-one support for those with ongoing reactions |
| Family support | As needed | Education and support for provider families |
| Referral | As needed | Mental health referral for providers requiring professional treatment |
KEY DIFFERENTIATOR — Defusing vs. Debriefing: Defusing is informal and happens within 8 hours — it is a brief check-in to stabilize immediately after an event. CISD (debriefing) is more structured and occurs 24–72 hours later — it is a guided group process with a trained facilitator. Both are part of CISM; they are not the same thing.
Kübler-Ross Stages of Grief (DABDA)¶
EMT-B providers will encounter death and dying regularly, and will assist patients and families in crisis. The Kübler-Ross model describes common responses to loss:
| Stage | Name | What it Looks Like |
|---|---|---|
| 1 | Denial | "This can't be happening" — shock, disbelief, emotional numbness |
| 2 | Anger | "Why me / why us?" — outward anger at providers, family, God, the situation |
| 3 | Bargaining | "If only we had..." — guilt, what-ifs, attempts to negotiate or delay |
| 4 | Depression | Profound sadness, withdrawal, despair |
| 5 | Acceptance | Coming to terms with the reality — not happiness, but acknowledgment |
EMT-B application: - Family members may be in any stage — do not interpret anger at you personally - Acknowledge feelings: "I'm sorry for your loss" — do not say "I understand how you feel" - Allow family to stay and see the patient if compatible with scene safety and protocol - Do not rush family through stages or tell them what they should feel
Provider Stress Response Types¶
| Type | Description | Signs |
|---|---|---|
| Acute stress reaction | Immediate response to a single event | Trembling, disorientation, emotional flooding immediately after incident |
| Cumulative stress | Gradual buildup from repeated exposure over time | Emotional blunting, cynicism, detachment, decreased performance |
| PTSD (post-traumatic stress disorder) | Persistent symptoms after traumatic exposure | Flashbacks, nightmares, hypervigilance, avoidance; requires clinical treatment |
| Compassion fatigue | Depletion from sustained empathic engagement | Emotional exhaustion, reduced empathy, withdrawal from patients |
| Burnout | Chronic occupational stress without adequate recovery | Physical and emotional exhaustion, depersonalization, reduced efficacy |
Warning signs requiring intervention: Sleep disturbance, substance use, increasing irritability, persistent intrusive memories, loss of interest in work or relationships, self-isolation.
NREMT Relevance¶
- Surgical mask = droplet protection; N95 = airborne protection — this distinction is heavily tested
- Doffing order: gloves first, N95 last; hand hygiene between every step
- Post-exposure: wash immediately, report immediately, PEP within 72 hours for HIV
- CISM = structured psychological support system for critical incidents
- Defusing (within 8 hours) vs. CISD debriefing (24–72 hours) — know the difference
- DABDA: Denial → Anger → Bargaining → Depression → Acceptance
Related¶
- communicable-diseases — transmission routes and pathogen-specific PPE requirements
- safety-bsi — body substance isolation; standard precautions foundation
- legal-ethical — documentation requirements; exposure incident reports
Sources¶
- UCLA EMT Ultimate Study Guide (2026) — Ch 23: EMS Operations / Infection Control / CISM