SPECTRE Blog Series Part 2: EMS Biosafety Transport for Special Pathogens: A Guide to Implementing the Hierarchy of Controls Framework

High-consequence infectious diseases, also known as special pathogens, pose significant public health risks as they are highly infectious, contagious, and can be fatal. Patients infected with special pathogens, such as Ebola Virus Disease, should be given priority for treatment and isolation in specialized biocontainment care units (BCUs). Emergency Medical Service (EMS) professionals are vital in safely and cautiously transporting patients afflicted by the most highly infectious pathogens to BCUs for proper care. This process involves the implementation of safety measures, such as the Hierarchy of Controls Framework, that can provide guidelines to prevent the spread of infectious diseases when handling and moving such patients to and from healthcare facilities. The hierarchy of controls is a method of infection prevention that can be used to safely manage the transport of patients with special pathogens by making changes in the environment, administrative policies, work practices, and the use of PPE. Precautionary measures and recommendations include:

Modification of the ambulance

  • Separate the driver compartment from the patient compartment  
  • Adjust air handling to introduce fresh air in both compartments  
  • Turn the exhaust fan on high in the patient compartment 
  • Consider draping the interior of the ambulance to limit contamination by potentially infectious bodily fluids (e.g., vomit, diarrhea, respiratory secretions, blood, urine) that will make it more difficult to clean and disinfect 

Patient prep

  • Ask the patient to put on a surgical mask, or put a surgical mask on the patient 
  • Explain to them the procedures and maintain humanism 
  • Place the patient on an impervious sheet or in an impervious suit, coverall, or inside a mobile isolation containment unit to contain infectious bodily fluids and contamination from their clothes
  • Consider placing the patient in additional undergarments to help collect uncontrolled, potentially infectious diarrhea  
  • Have a leakproof container on hand for vomiting    
  • Consider providing the patient with anti-nausea medicine before loading and transporting to reduce the risk of vomiting 

Protection of EMS Personnel

  • Using a trained monitor, supervise PPE donning and doffing 
  • Stay at least 6 feet away from the patient if not providing direct care 
  • Limit the number of personnel that are providing direct care of the patient and in the “hot” environment
  • Implement a procedure where the driver of the ambulance does not make contact with the patient to avoid contamination of the driver compartment of the ambulance  

Clinical care

  • Limit the use of sharps and aerosol-generating procedures if possible  

Ambulance decontamination/disinfection and waste management 

Post-mission medical surveillance 

  • EMS crews should be monitored for signs and symptoms of illness for one incubation cycle, or until the disease of concern is ruled out  
  • Coordinate with public health for additional requirements

Klarissa Garza is a 2nd year Master of Public Health – Bioethics graduate student at the University of Texas Medical Branch School of Public and Population Health. She is also a Research Associate in the Neurology Lab on campus studying Alzheimer’s Disease and plans to go to medical school after completing her MPH. In her free time, she enjoys being outdoors, singing and playing the guitar and violin.


Ebola Patient Transport Drill | Johns Hopkins Medicine and Lifeline 

EMS Biosafety Transport - Viral Hemorrhagic Fevers: Ebola Virus Disease 





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