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Policy/Procedure

Definition/Description: Bed bugs (Cimex lectularius) are small, brownish, flattened insects that feed on the blood of humans and warm-blooded animals.

Adults are small, brownish insects, just under a 1/4” long and are relatively flat. They are nearly as wide as they are long, and oval in shape. Immature bed bugs (nymphs) resemble the adults, but are much smaller and lighter in color. Newly hatched nymphs are translucent and are no bigger than a pinhead (1 mm). After feeding on a blood meal the immature bed bugs may appear bright red in color. Bed bugs lack wings and therefore they do not fly, but they are capable of moving swiftly on both horizontal and vertical surfaces. The eggs are very small (approximately 1mm), whitish, and very difficult to see on most surfaces without magnification (individual eggs are about the size of a dust speck).

Bites on the skin are a poor indicator of a bed bug infestation. Bed bug bites can look like bites from other insects (such as mosquitoes or chiggers), rashes (such as eczema or fungal infections), or even hives. Some people do not react to bed bug bites at all.

Bed bugs can survive and remain active at temperatures as low as 7°C (46°F), but they die when their body temperatures reaches 45°C (113°F).

Bed bugs can live in almost any crevice or protected location. The most common place to find them is the bed or where people sleep. This is especially true during the early stages of a problem. As infestations grow larger, the bugs tend to move beyond beds into other locations making control more difficult. When not feeding, bed bugs hide in a variety of places. Around the bed, they can be found near the piping, seams and tags of the mattress and box spring, and in cracks on the bed frame and headboard.

If the room is heavily infested, you may find bed bugs:

• In the seams of chairs and couches, between cushions, in the folds of curtains.
• In drawer joints.
• In electrical receptacles and appliances.
• Under loose wall paper and wall hangings.
• At the junction where the wall and the ceiling meet.
• Even in the head of a screw.

Since bed bugs are only about the width of a credit card, they can squeeze into really small hiding spots. If a crack will hold a credit card, it could hide a bed bug.

Looking for Signs of Bed Bugs

A more accurate way to identify a possible infestation is to look for physical signs of bed bugs. When cleaning or changing bedding look for:

• Rusty or reddish stains on bed sheets or mattresses caused by bed bugs being crushed.
• Dark spots (about this size: •), which are bed bug excrement and may bleed on the fabric like a marker would.
• Eggs and eggshells, which are tiny (about 1mm) and pale yellow skins that nymphs shed as they grow larger.
• Live bed bugs.

Be Prepared for Encountering Bed Bugs (protect your clothing and equipment).

As an emergency first responder, bed bugs are part of your future. It is important that the presence of bed bugs does not distract you from your work and yet, you need to avoid picking them up and transporting them with you.

Bed bug precautions Overview:

• Have a crew member on bed bug alert
• Have plastic bags on hand (e.g. infectious waste bags).
• Have Extra linen or Disposable blankets in the medic unit.
• Do not transport the patient’s bed linens

When entering a home have a crew member be on bed bug alert, looking for the signs of infestation. Signs to look for are: live and dead bed bugs; fecal spots; skin and egg casings; raised, red welts/bite marks on patient; etc.

Have plastic bags (hazardous materials bags will work) available that you can lie on the floor before you kneel down to work on a patient. Set your equipment down on the plastic bags.

Always avoid placing canvas bags containing medical supplies or oxygen on upholstered furniture, bedding, or on carpeted floors. Whenever possible, place bags that were taken inside patient’s homes on hard surfaces such as a kitchen countertop, hardwood/linoleum floor, or outside the entry door. Keep in mind that, unless the infestation is severe, bedbugs prefer softer, warmer surfaces close to places where people sleep and rest. If you have any reason to suspect that your equipment has become infested, you can bag it on the way out for later cleaning.

Sometimes the patient needs to be moved from their bed onto the portable cot or backboard. It is never recommended that the patient’s own sheet be used as a sling to move them onto the cot (due to a number of pathogens that may be in the patient’s bed). However, if the use of the patient’s linens is unavoidable, care should be taken to make sure that the linens are not infested. If they are, you can partially contain the patient and their sheets in Hospital sheets, hospital blankets or a disposable blankets or some other plastic sheeting to prevent them from infesting your cot and transport vehicle.

If infested linens are transported, they should be transferred into a marked (bed bugs), sealed plastic bag upon arrival at the emergency room. Dispose of the bagged linens or plastic sheeting you used for wrapping the infested patient in a sealed container, and warn the ER charge nurse or the receiving nurse about the bed bugs.

Inspect your bunks daily to identify bedbugs early. Early detection is essential when it comes to eliminating them quickly.

Inspect your clothing, shoes, jacket, and all bags after every EMS run and before entering the station, and have a spare uniform at the station.

If you suspect bed bugs are in apparatus:

1. Emergency Vehicle Inspection

1. Carefully remove linen from cot and place in sealed bag prior to laundering/disposal.
2. Inspect cot mattress and all equipment that entered the residence.
3. Inspect interior of vehicle, including cracks, crevices and horizontal surfaces.
4. If no bed bugs are found, the vehicle should still receive a thorough cleaning (i.e. vacuuming, washing/sanitizing, etc.)
5. If bed bugs are found, Notify Company Officer who will notify their Battalion Chief.
6. The apparatus will be placed out of service until it is determined to be free of bed bugs

If you suspect bed bugs are in engine house:

1. Notify Company Officer who will notify their Battalion Chief

2. Battalion Chief will investigate and attempt to confirm presence.

3. When possible, capture bug, dead or alive.

4. Battalion Chief will contact Fire Dispatch Supervisor at 419-720-0271 and report issue.

5. Fire Dispatch Lieutenant will contact TFRD Buildings Supervisor or Deputy and Operations Deputy for further instructions.

If crews suspect they have been exposed to or have evidence of bed bugs, their clothes and bedding should at minimum be sent thru the dryer at the hottest setting for a minimum of 30 minutes. If the clothes or bedding is not washed and/ or dried at the station immediately, the articles should be placed in a sealed plastic bag to prevent contamination of other areas.

The best way to limit the exposure to bedbugs is to become well educated and continue to follow the trends and techniques of control and eradication.

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