Updated: Dec 17, 2020
A recent article in Cureus has brought to light a problem that, until now, has received little attention: the growing frequency with which emergency medical service (EMS) providers are having to deal with bed bugs.
From the 1950s to almost the start of the 21st century, bed bug infestation was actually uncommon, at least in so-called First World countries. But this was not to last. In the past few years there has been a virtual explosion in bed bug populations.
In fact, a paper published in Clinical Microbiology Reviews reports that “not only was the reappearance of this pest unexpected, but the degree of the resurgence has almost been met with awe by many in the pest management industry.”
Of course, hygiene and pest-control issues have always been a problem in health care settings. For example, the National Pest Management Association remarked that:
“It is hard to imagine a more sensitive [issue for] hospitals . . . [especially since]
there are 5,810 registered hospitals in the US that see about 32 million
inpatients, 83 million outpatients, and 108 million emergency room patients per
The Bed Bug Invasion
Regarding the bed bug ‘problem’ in particular, Health Facilities Management reports that some of the ‘hot spots’ for bugs in healthcare facilities include:
“Employee locker and break rooms, janitorial closets, laundry rooms, food service
areas, restaurants, coffee and snack bars, vending machine areas, food carts,
bedside furniture in patient rooms, floor drains and sink areas, intensive care wards,
surgical suites, kidney dialysis rooms, autopsy rooms, trash dumpsters, loading
docks and related spots.”
Until now, however, little attention has been paid to ambulances and other EMS-related vehicles. While the authors of the study make no claims about how widespread the problem really is (the publishing protocols governing peer-reviewed scientific journal articles prevent this), it is hard not to extrapolate from these findings and wonder just how extensive the problem really is.
In the Cureus study, which anonymously surveyed 407 EMS providers from 180 EMS agencies in northeast Ohio between September 1, 2018, through March 31, 2019, its authors report that:
“Bed bugs are now one of the most likely ectoparasites encountered by US healthcare
providers. In a 2018 survey, 59% and 39% of pest management professionals reported
that they had decontaminated nursing homes and hospitals for bed bugs, respectively. Emergency department (ED) visits related to bed bugs are estimated to have increased
seven-fold between 2007 and 2010."
The authors also went on to say that “the study population involved EMS agencies in and around Cleveland, Ohio, which is one of the most bed bug-infested cities in the United States.”
Bad Bed Bug News
“[Those] who reported seeing bed bugs at least monthly, 30% took the affected EMS
stretcher out of service when they encounter a bed bug, 43% took the EMS rig out
of service, 83% cleaned the EMS stretcher with a disinfectant, and 88% notified the
ED that their patient has bed bugs.”
Unfortunately, the authors of the study also found that the EMS personnel they surveyed “scored poorly (mean: 69% correct responses) in a seven-question assessment of basic bed bug biology and public health.”
In fact, they termed the overall EMS awareness of the issue “suboptimal”, which is a nice, diplomatic way of saying ‘poor’. Or, as the Cambridge Dictionary so tersely puts it “below the highest level or standard, or not done in the best way possible.”
What is interesting about this study is the fact that most of the EMS professionals interviewed had some knowledge about the habits and behavior of bed bugs. They knew, for instance, that bed bugs can’t fly; that they do feed on human blood, but do not lay their eggs under human skin; and that bed bugs do not necessarily live only in unsanitary conditions. In fact, 70% of the survey subjects were able to provide correct answers to such questions. Still, that leaves a good 30% (roughly one out of three) who were unable to answer these questions correctly.
That said, the final conclusions offered by the authors of the paper are nevertheless of concern:
“EMS providers, especially those working in an urban environment, encounter bed
bugs frequently during patient care. Even though EMS providers are concerned
about getting bed bugs, they have inadequate knowledge about bed bugs and their
effects on human health. Most EMS providers reported low compliance with basic
interventions to limit the spread of bed bugs, including taking the EMS rig out of
service, cleaning the EMS stretcher with disinfectant, and notifying the ED about a
patient having bed bugs.”
Bed Bugs and the Emergency Department
EMS providers almost invariably transport their charges to the emergency department (ED) of a hospital, and this constitutes the next step in an inevitable process of bed bug infestation. And it’s a big problem.
Another recent survey, which appeared in Emergency Medicine International, looked at the ways in which bed bugs were introduced into the ED environment, especially via EMS vehicles. What they discovered was illuminating:
Patients with reported home bed bug infestations were significantly more likely than those without bed bug infestations to arrive to the ED by ambulance.
Only 21% of those reporting a home bed bug infestation were placed in bed bug isolation precautions at the time the survey was completed.
Those reporting no home infestation, but were in ED bed bug isolation precautions, indicated that ED staff found a bed bug on, or next to the person, suggesting the patient either did not know they had a home infestation, did not respond truthfully to the survey question, or the bed bug was already in the healthcare environment prior to the patients’ arrival.
Only 18% of persons with bed bugs notified EMS providers or ED staff about their home infestation.
According to the survey, people did not report home bed bug infestations to EMS or ED staff because they “did not think about it”, “did not think it was necessary”, “were not asked”, “did not feel like it was a problem”, or felt they were either in "too much distress", or were just "too embarrassed.”
How hospitals in general, and EDs in particular, deal with their bed bug problems is outside the purview of this piece. But, we have discussed the problem in such previous blogs as Applying Pesticides in Hospitals, Sanitization and Cleanliness in Hospitals and Health Care Facilities, and Why Is It So Hard to Get Rid of Bed Bugs? among many others.
How to De-Bug Your EMS transport
Clearly, one of the biggest problems for EMS providers is how to eliminate bed bugs in their vehicles.
However, it’s worth pointing out that bed bugs can make their way into any EMS vehicle, regardless of whether or not patients bring them on board. In one of our earlier blogs, we noted that:
“Bed bugs often make their way undetected into homes, offices, hospitals, etc.
And they can be brought in on clothing, in luggage, nested in used beds and
couches, and clinging to other everyday objects, like shoes, books, newspapers,
and shopping bags. You name it — they can use it as a mode of transport.”
In other words, they are practiced ‘hitchhikers’, and their small size often makes it difficult for humans to spot. Another problem with these unwanted guests is that they prefer to hide away in discreet, out-of-the-way spots, which makes the task of finding them even more difficult. In fact, bed bugs have been found in some very odd places, such as electrical outlets, computers, toys, headphones and even acoustic guitars!
Even though the coronavirus pandemic means that almost all EMS vehicles are now subject to stringent disinfecting procedures, they can sometimes escape such measures. Here are some of those out-of-the-way places that should always be checked in an EMS vehicle:
Behind the dashboard.
Inside glove compartments and other storage spaces (e.g. cup holders, etc).
Under floor mats and in cracks between seats.
Within medical equipment.
Inside the vehicle engine itself.
Inside electronic devices (e.g. walkie-talkies, cell phone, etc).
Regardless of the disinfectant/pesticide being used to sanitize an EMS vehicle, there are some other areas that should also be treated, such as:
Door handles and gear shift.
Seat adjustment controls (and seat memory buttons).
Rear-view and side mirror controls.