Keeping Patients and Staff Safe From Disease

New Jersey’s Neptune Township EMS has become one of the first EMS departments in the nation to install a new in-vehicle disinfectant spraying system to protect its members and the residents of its community in response to the COVID-19 pandemic.

Designed by Frontline Innovations LLC, the unit features an onboard system to disinfect ambulances between emergencies and significantly reduces the time it takes crews to prepare for the next call, says Bil Rosen, EMS manager at Neptune Township EMS.

“We are committed, I am committed as the manager here, to keeping my staff safe,” says Rosen. “We’ve done a lot here to keep the staff safe. Decontamination of ambulances and equipment—it’s not just COVID. We know there are bad bugs out there. Now we have a three-minute spray built into our trucks.”

Neptune Township EMS is having the system installed into each of its six ambulances at a cost of about $7,500 each. The unit is described as the only fully integrated electrostatic disinfection system of its kind. Installers mount a supply pump and disinfectant container to an outside compartment of the unit that feeds into a spray head mounted inside the patient compartment. The system designers say the patented MaxCharge nozzle delivers the “fastest and widest-ranging coverage available.”

The system was created by Michael McCabe, paramedic and vice president of McCabe Ambulance Service, and Brian Borow, an EMT for three decades and retired Bayonne police detective.

“As first responders who have been in the industry for quite some time, there is an awareness that exists of areas that could be improved upon,” says McCabe. “That experience, as well as life during COVID, made it clear to us that the disinfection processes we employ on a daily basis need to be reassessed. A safe workspace for patient and provider should be available after every call, not just certain ones. Our hope is that the MEDS unit will revolutionize the way we operate moving forward.”

Since the pandemic emerged last year, EMS agencies around the country have scrambled to find ways to disinfect their vehicles between patients and specifically between those patients with COVID-19. To date, Neptune Township EMS has relied on UV lights and hand-held sprayers to handle those COVID calls, along with extensive disinfecting by hand. After a COVID call, a vehicle could be out of service for upward of 30 minutes, Rosen says, resulting in the potential for missed calls.

After each call members close the doors to the patient compartment and operate the sprayer system from the cab, Rosen says.

“The change in our operations with this is really big in terms of out-of-service time,” Rosen says. “Now we’re back in service in three minutes instead of 30.”

Installation on the vehicles takes about a week, Rosen says, and is handled by VCI Emergency Vehicle Specialists.

“Our EMS squad, led by Bil Rosen, has established itself as an innovator,” says Neptune Township committee member Carol Rizzo, who oversees EMS in the township. “The squads have protocols established with the hospitals so they can get patient information directly from the hospital to the EMS rigs, saving time and lives. Bil has also focused on assuring all our ambulances will have a disinfectant spray system that will protect the public and members of the squads. Our EMS squads are second to none.”

Neptune Township EMS is a combination volunteer and career service providing emergency medical and rescue operations to nearly 28,000 residents and several nearby communities. The organization is also a host agency of the New Jersey EMS Task Force and home to one of the NJEMSTF medical ambulance  buses.

Neptune Township EMS is the first EMS organization in the country outside of McCabe’s own ambulances to be fitted with the decontamination system.

“We are committed to the latest technology to maintain our fleet in above-standard condition,” says Rosen. “It’s all about health and well-being of our staff and our patients. We have been using electrostatic sprayers for about five years on our hazmat team, so we know it is a proven method.”  

Richard Huff, NREMT-B, is a former three-time chief of the Atlantic Highlands (N.J.) First Aid & Safety Squad.

Sidebar: Decontamination Best Practices

In October 2020 ambulance manufacturers Demers, Braun, and Crestline released a 16-page white paper titled Ambulance Decontamination: Information, Resources, & Considerations for High-Risk Infection Control in an Ambulance. The white paper presented best practices and recommended solutions to integrate into agencies’ strategic plans as they continue to combat infectious diseases.

Recommendations centered on five key areas:

Separation needs and recommendations—The CDC has recommended physical barriers to help protect against COVID-19 transmission. A fixed thermoplastic divider or curtain may be used to separate the driver and passenger in the forward cabin, provided consideration be given to safety in a collision, ergonomics, and air flow. In ambulance designs with open access between the cabin and patient compartment, sealing off the module from the cab via an electronically controlled window creates an air barrier and eliminates the need for a finger hole or handle to open and close it. An on-board intercom system can facilitate communication between the cab and compartment.

Air flow and filtration—Supplemental HEPA filters are “strongly recommended” and shown by studies to capture airborne viruses. HEPA filters can be retrofitted to an existing HVAC system (this can be a costly investment) or implemented through a portable air purifier on board the ambulance. Due to the multiple runs inherent in EMS work, air pressure systems designed to seal the cab from the module via air pressure do not appear to be a feasible method. Rear exhaust vents from the module to the 
outside can safely vent air outside the unit and away from EMS personnel.

Decontamination and disinfection systems—Self-contained decontamination and disinfection systems can be built into new ambulances, retrofitted to existing ones, or used across multiple units as a portable device. The three most common systems are UV light disinfection, chemical-based fogging systems, and ozone generators. A 2020 Columbia University study showed continuous exposure to far-UVC light an effective method of killing airborne viruses such as COVID-19. The EPA has curated a list of registered surface disinfectants proven effective against the virus that causes COVID-19, accessible via www.epa.gov. 

Surface treatments—Self-disinfecting surfaces such as anodized aluminum, copper, or silver  nanoparticles produce an antibacterial effect. Many biocide disinfectants are nonspecific and kill a wide range of microorganisms; use them with caution.

Interior materials—Vinyl is the preferred upholstery choice, with minimal stitching and Velcro to inhibit bacteria and virus growth. Aluminum cabinetry, rounded corners, and hardware without holes are easier to disinfect and create fewer crevices in which pathogens can collect. Strongly consider vinyl flooring because of its nonporous nature and extendability up the walls of the interior. A removable roll-up floor is another option to facilitate full decontamination.

Download the free white paper at https://dbcambulances.com.