News outlets nationwide are telling frightening stories about the comeback of the bedbug, a tiny critter that emerges at night from its hiding place in mattresses and bedframes to feed on the blood of the unsuspecting. After receiving several calls from EMS responders who had encountered bedbugs during calls and were worried about infesting their ambulances or bringing the … ahem, suckers … home to their families, Bob Delagi, chief of prehospital medical operations and acting director of Suffolk County (N.Y.) Department of Health Services EMS Division, decided he needed a plan for dealing with such encounters.
After consulting with entomologists and public health experts, Delagi got some good news: Abiding by standard ambulance cleaning and decontamination procedures and wearing protective gear during calls in infested homes will reduce the risk of infestation substantially. What’s more, the typical ambulance is not the type of place bedbugs particularly like, because there are few surfaces in which they can hide. The most vulnerable area of the ambulance is the stretcher.
“The likelihood of an infestation happening is minimal if personnel clean their ambulance as they are supposed to,” Delagi says. “Standard bleach, hot water and a scrub brush will eradicate any bedbugs or eggs.”
Now for a little background. After being all but vanquished in the 20th century, bedbugs are again showing up in homes, hotels and dorm rooms in multiple states, probably because pesticides used to the control them are no longer used, experts say. Though often associated with unsanitary conditions, bedbugs are not drawn to dirt, nor are they more likely to be found in lower-income households. Rather, they tend to turn up in places where large numbers of people pass through, raising the chances someone will introduce them in, say, a suitcase. Bedbugs also like to have places to hide such as in bedding, boxes and mattresses. Adult bugs can survive for up to six months on a single blood meal, and although the bites may make you scratch, they are not known to carry disease, although some people can have allergic reactions, Delagi says.
Adult bedbugs are visible to the naked eye, are straw-colored to reddish-brown in color and oval shaped. Before feeding, the adult is relatively flat, but after feeding, its body length increases and takes on a bloated, dark-red appearance. Bedbug eggs appear as small, white, cylindrical or elongated objects, about 1/32 inch in length, usually in clusters of 10 to 50 eggs.
Bedbugs do not have wings, which limits their ability to cross from person to person during an EMS encounter. Nor do they latch onto clothing, so there is little to fear from them being transferred during routine emergency medical care, Delagi says.
Since both bedbugs and their eggs can be seen, having staff inspect themselves, their equipment and their vehicles if they’ve entered a home with an infestation can go a long way in making sure the critters don’t come along for the ride; they also should wear a cap, booties and other disposable protective gear. In addition, the patient can be wrapped in a disposable plastic blanket. Hospital staff should be notified that bedbugs were sighted and linens and blankets placed in a sealed trash bag. Then, make sure crews do their standard cleaning and decontamination procedures, Delagi says.
To view the detailed memo that Delagi sent to fire departments in his region, visit nysvara.org/news/2010/nov/101129.pdf.
AMR Acquires Orange County, Calif., Ambulance Service
Emergency Medical Services Corporation, the parent company of American Medical Response, has acquired Doctor’s Ambulance Service in Orange County, Calif. Doctor’s Ambulance Service currently holds 11 contracts and transports 32,000 patients annually. The company will continue to operate under the Doctor’s brand, according to a company news release.
FDNY to Begin Charging Hospital-Based Services
New York City will begin charging private, hospital-based ambulance services that answer emergency calls a fee of up to $1 million a year. The fee, set to go into effect July 1, will help offset some of the costs of providing dispatch and telemetry services for these ambulance services, says New York City Fire Department (FDNY) spokesman Steve Ritea.
“This is a cost-sharing program,” Ritea says. “There is a cost associated with us running this vast 911 system and a cost to operating our telemetry service. New York City is currently in the midst of a very severe budget crisis.” (The telemetry service includes emergency physicians who answer calls from paramedics and EMTs.)
FDNY has agreements with 25 private hospitals throughout the city’s five boroughs to provide 911 ambulance services. Typically, FDNY ambulances account for about 64 percent of ambulance tours (a tour is defined as each ambulance in service for an eight-hour shift), while hospitals account for roughly 37 percent. The city has 967 eight-hour ambulance tours scheduled every 24 hours. Of those, the fire department handles 614; the private hospitals’ ambulances handle 353.
Hospital participation in answering 911 calls is voluntary, says Allison Burke, vice president for regulatory and professional affairs for the Greater New York Hospital Association. Hospitals already cover the costs of the ambulance, equipment and staff. The fees may prompt some hospitals to cease answering 911 calls, she adds. “We completely oppose the imposition to charge our hospitals these fees,” Burke says. “They are providing a valuable service at no charge to the city, and hospitals are extremely financially strained right now and bracing for more Medicaid rate cuts.
“The fire department already needs to have dispatch and medical control,” she adds. “We think the benefit of the free ambulance service to the city outweighs charging hospitals for that.”
The fee would be $25,000 a year for each eight-hour tour. The annual fee is expected to range from about $73,000 to $1 million per hospital, Ritea says. Mayor Michael Bloomberg has approved the new fee, which the FDNY can impose without city council approval, Ritea adds.
Neither side would comment on what percentage of revenues or profits reaped by hospital-based ambulance services the fees would represent, or to what degree hospitals benefit by being able to direct emergency patients to their facilities. But Lewis Marshall, chairman of emergency medicine at Brookdale University Hospital and Medical Center in Brooklyn, told the Wall Street Journal this new fee may cause hospitals to stop providing ambulance service. He estimates his hospital’s fee would be about $300,000 annually.
“Hospitals such as ours in underserved areas would most likely think of not participating because of the added cost,” Marshall told the newspaper. “If a lot of hospitals drop out, then patients are going to suffer because of longer wait times.”
In November, the mayor unveiled $585 million in new budget cuts in the current fiscal year and $1 billion for the following fiscal year, according to news reports. The fire department may close 20 fire companies and reduce the number of firefighters on each engine from five to four on about 60 engine companies, Ritea says. Charging hospital ambulance services these fees will generate about $8.7 million annually, according to Ritea.
“We are glad to have these private hospitals working within the 911 system,” he says. “We rely on them to do the great job EMS does in New York City. We are just asking them to share in those costs.”
