EMS Disease Exposure, Transmission, and Prevention: a Review Article

  • Colton Bitely
  • Brian Miller
  • Jonathan GlauserEmail author
Infectious Disease (J Glauser, Section Editor)
Part of the following topical collections:
  1. Infectious Disease


Purpose of Review

This article aims to review recent literature regarding the risks of disease exposure to pre-hospital providers and the patients they serve, as well as the challenges they face in minimizing transmission and exposure.

Recent Findings

Many studies continue to show poor compliance with consistent universal precautions, as well as proper hand hygiene. Vaccination rates are suboptimal despite attempts to encourage compliance. With the spread of multi-drug resistant organisms, new techniques of decontamination need to be investigated.


There remains a general lack of information and studies regarding the risks of disease exposure and transmission to EMS providers despite the significance hazards their profession can pose. However, there remains a continued theme throughout the majority of EMS and pre-hospital studies, demonstrating that hand washing and consistent use of personal protective equipment remains a persistent, preventable means of disease exposure and transmission.


Emergency medical services Exposure Transmission PPE Contamination Decontamination Infectious disease 



The authors would like to thank Dr. Thomas Collins for reviewing their article.

Compliance with Ethical Standards

Conflict of Interest

Colton Bitely, Brian Miller, and Jonathan Glauser declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    McGuire-Wolfe C. A previously unidentified risk of needlestick injury in the emergency medical services setting. Am J Infect Control. 2014;42(3):325.CrossRefGoogle Scholar
  2. 2.
    Harris S, Nicolai L. Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions. Am J Infect Control. 2010;38(2):86–94.CrossRefGoogle Scholar
  3. 3.
    Lu P, Euler G. Influenza, hepatitis B, and tetanus vaccination coverage among health care personnel in the United States. Am J Infect Control. 2011;39(6):488–94.CrossRefGoogle Scholar
  4. 4.
    Corace K, Prematunge C, McCarthy A, Nair R, Roth V, Hayes T, et al. Predicting influenza vaccination uptake among health care workers: what are the key motivators? Am J Infect Control. 2013;41(8):679–84.CrossRefGoogle Scholar
  5. 5.
    Hakim H, Gaur A, McCullers J. Motivating factors for high rates of influenza vaccination among healthcare workers. Vaccine. 2011;29(35):5963–9.CrossRefGoogle Scholar
  6. 6.
    • Moser A, Mabire C, Hugli O, Dorribo V, Zanetti G, Lazor-Blanchet C, et al. Vaccination against seasonal or pandemic influenza in emergency medical services. Prehosp Disaster Med. 2016;31(2):155–62 This study reveals hesitations to vaccinations with some insights to limitations in trying to enforce compliance. CrossRefGoogle Scholar
  7. 7.
    Wepler M, Stahl W, von Baum H, Wildermuth S, Dirks B, Georgieff M, et al. Prevalence of nosocomial pathogens in German ambulances: the SEKURE study. Emerg Med J. 2015;32(5):409–11.CrossRefGoogle Scholar
  8. 8.
    Orellana R, Hoet A, Lu B, Anderson S, Stevenson K. Methicillin-resistant Staphylococcus aureus in Ohio EMS providers: a statewide cross-sectional study. Prehosp Emerg Care. 2016;20:184–90.CrossRefGoogle Scholar
  9. 9.
    Varona-Barquin A, Ballesteros-Peña S, Lorrio-Palomino S, Ezpeleta G, Zamanillo V, Eraso E, et al. Detection and characterization of surface microbial contamination in emergency ambulances. Am J Infect Control. 2017;45(1):69–71.CrossRefGoogle Scholar
  10. 10.
    Liang S, Vantassell P, Crowe R, Froelke B, Marschall J, Bentley M. Knowledge, attitudes, and practices regarding infection prevention among emergency medical services providers. Am J Emerg Med. 2015;33(5):725–7.CrossRefGoogle Scholar
  11. 11.
    •• Valdez M, Sexton J, Lutz E, Reynolds K. Spread of infectious microbes during emergency medical response. Am J Infect Control. 2015;43(6):606–11 This study is demonstrated EMS providers as significant vectors while also reiterating lack of consistent hygiene practices. CrossRefGoogle Scholar
  12. 12.
    Teter J, Millin M, Bissell R. Hand hygiene in emergency medical services. Prehosp Emerg Care. 2014;19(2):313–9.CrossRefGoogle Scholar
  13. 13.
    Barr N, Holmes M, Roiko A, Dunn P, Lord B. Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care. Am J Infect Control. 2017;45(7):771–8.CrossRefGoogle Scholar
  14. 14.
    Noh H, Shin S, Kim N, Ro Y, Oh H, Joo S, et al. Risk stratification-based surveillance of bacterial contamination in metropolitan ambulances. J Korean Med Sci. 2011;26(1):124–30.CrossRefGoogle Scholar
  15. 15.
    Alrazeeni D, Alsuif MS. Nosocomial infections in ambulances and effectiveness of ambulance fumigation techniques in Saudi Arabia. Phase I study. Saudi Med J. 2014;35(11):1354–60.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Oh H, Uhm D. Occupational exposure to infection risk and use of personal protective equipment by emergency medical personnel in the Republic of Korea. Am J Infect Control. 2016;44(6):647–51.CrossRefGoogle Scholar
  17. 17.
    • Barr N, Holmes M, Roiko A, Dunn P, Lord B. Challenges for environmental hygiene practices in Australian paramedic-led health care: a brief report. Am J Infect Control. 2018;46(6):723–5 Showed that despite very frequently working in contaminated conditions, many EMS workers are still under-educated and unprepared on the procedures and methods for decontamination. CrossRefGoogle Scholar
  18. 18.
    Isakov A, Miles W, Gibbs S, Lowe J, Jamison A, Swansiger R. Transport and management of patients with confirmed or suspected Ebola virus disease. Ann Emerg Med. 2015;66(3):297–305.CrossRefGoogle Scholar
  19. 19.
    Le A, Buehler S, Maniscalco P, Lane P, Rupp L, Ernest E, et al. Determining training and education needs pertaining to highly infectious disease preparedness and response: a gap analysis survey of US emergency medical services practitioners. Am J Infect Control. 2018;46(3):246–52.CrossRefGoogle Scholar
  20. 20.
    Kang J, Kim E, Choi J, Hong H, Han S, Choi I, et al. Difficulties in using personal protective equipment: training experiences with the 2015 outbreak of Middle East respiratory syndrome in Korea. Am J Infect Control. 2018;46(2):235–7.CrossRefGoogle Scholar
  21. 21.
    Al-Tawfiq J, Perl T. Middle East respiratory syndrome coronavirus in healthcare settings. Curr Opin Infect Dis. 2015;28(4):392–6.CrossRefGoogle Scholar
  22. 22.
    Knowledge and adherence to guidelines on the infection control of tuberculosis: survey among health care personnel in South Korean general hospitals. Am J Infect Control. 2008;36(5):E142–3.Google Scholar
  23. 23.
    Sampathkumar P. Middle East respiratory syndrome: what clinicians need to know. Mayo Clin Proc. 2014;89(8):1153–8.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineMetroHealth Medical SystemClevelandUSA

Personalised recommendations