This is the August, 2000, "Street Smarts" column from EMS Magazine, often co-authored with paramedic Denis Meade. The column ran regularly from Nov.1997-Dec. 2000.

Using street smarts goes beyond dealing with nasty people, messy situations or chaotic scenes. Indeed, one subtle goal of any comprehensive safety program is to wage "germ warfare" on the many microscopic threats that arise in our hazardous line of work. Viruses and bacteria are enemies just as real (If not as glamorous) as a weapon-wielding wacko. Just ask anyone in the Canadian town of Walkerton, Ontario, where at least seven people died in May (and at least 56 others were sickened) by a nasty little bug called e. Coli.

Ways to Protect Yourself

Each day on the streets, your body is asked to fight billions of germs. Influenza, the common cold, hepatitis, tuberculosis and other infecåous agents are all ready and willing to get you. Luckily, most EMS providers are hearty souls who have enough physical ability to resist the advances of most bugs. It is when your resistance is low that these agents find the chinks in your armor, gain entry and multiply until you are felled by an illness you'd rather not have.

One of the best ways to prevent being sidelined from both nuisance illnesses and big-time diseases is a simple, everyday procedure that most people learn before they head off for grade school: hand washing. If you take the time to wash your hands after every run (even when you wear gloves), before you eat and after you use the restroom, your good hygiene will help you stay healthy. If you're like me, EMS is one place where you actually wash your hands before and after you use the bathroom.

Ideally, hand washing is done at a sink, with warm water and soap. In our less-than-ideal environment, it's okay to use a waterless product. This may not do much to remove grime from your hands, but its antibacterial properties will minimize germs. However, when water is available, the microbe-killing hand-washing technique is pretty straightforward (see Table 1).

There are related hygiene issues that also deserve mention. First, for the sake of any patient you ever haul who is like my mother, keep your fingernails clean. Not only are dirty fingernails a hotbed of lurking infection, but it's hard for some people to trust your abilities as a health professional when you can't even take care of basics like cleaning your fingernails (at least, that's how my mom sees things).

Second, don't pick your nose. It's obvious, but worth mentioning. Think of the germs in there.

Finally, get adequate rest and exercise. Fit EMS providers will avoid most or all of the nasty illnesses tossed at them every day. Listen to your body and treat it well—most of it is irreplaceable, and none of it needs to get sick.

Overcoming the Macho Mentality

It seems that one of the trickiest parts about hand washing for health professionals is simply doing it. On one memorable occasion, I was the visiting presenter at a state conference and had the opportunity to ride along with the local EMTs. Upon arriving back at their emergency department station after workinga call, I spotted a sink and began washing my hands, when the charge nurse—a bustling, stereo-battle-axe type—whisked by. "You can always tell who the new people are," she said in passing, "because they're the ones who still wash their hands."

Table 1: Effective Hand-Washing Technique

1. Lather hands with plenty of soap, using warm water.

2. Using lots of friction, scrub for at least 15 seconds. A good rule of thumb is to hold your breath when you start, and keep scrubbing for as long as you can hold it. Be careful to scour between the fingers and underneath the fingernails.

3. Rinse well. If you use a towel to turn off the faucet, you'll avoid the germs that are commonly found there.

4. Dry with a clean towel.

With a 'hmph!" she was out the door, leaving my evvo hosts flabbergasted and embarrassed in her wake. I had at least 10 years' experience over each of them.

Taking my cue, we all laughed (behind her back!) and I finished my routine. To this day, hand washing is an enduring habit of mine, and I almost never get sick.

If you remain unconvinced about the importance of hand washing, why not run a little experiment? Watch your EMS colleagues and note which ones wash their hands appropriately and which ones do not. Over the course of a year, notice who gets sick and how often. Chances are, those who practice decent hygiene will be out there running calls, while the rest will be laid up, reaching for the Kleenex. Which group appeals more to you?