According to the Centers for Disease Control and Prevention, hospital-acquired infections constitute the fourth-greatest cause of death in the United States — following only cancer, heart disease and stroke. More Americans die every year from hospital-acquired infections than from breast cancer, HIV and automobile accidents combined.

One out of every 20 patients in a hospital will become even more ill than when he or she arrived because, during the time spent at the hospital, these patients contract and suffer the horrors of a deadly infection, also known as nosocomial infections.

Hospitals in the United States have become cesspools of deadly bacteria, viruses and toxic mold. Approximately 2.5 million individuals become infected this way each year, and more than 100,000 of them die. To put this in perspective, the American Hospital Association says there were 33.4 million inpatient hospital admissions in 2006. These statistics are frightening, and are especially disheartening, because these infections are preventable.

And some of the most dangerous hospitals of all are the ones nobody keeps statistics on. They are the rolling hospitals EMS professionals work in every day: rescue units and ambulances. Essentially, these are small hospitals that make house calls. And EMS providers are encapsulated in these rolling emergency rooms everyday they go to work. Ambulances are not only constantly exposed to new diseases, but they are the perfect breeding grounds for infectious and deadly viruses and bacteria.

Ambulances are the front line of medical care in the United States. And the risk of exposure is present at every call. Each patient brings along his or her entire medical history into these rigs. A call dispatched for a patient with chest pain could easily end up exposing responders to HIV, Hepatitis C, methicillin-resistant Staphylococcus aureus (or MRSA) or tuberculosis. According to the Association for Professionals in Infection Control and Epidemiology, MRSA can stay virulent on hard surfaces for as long as 56 days. And a study done by the state of New Jersey shows that MRSA can stay virulent on hard surfaces for as many as 90 days.

This danger is amplified by the sad fact that most patients won't tell the responder everything associated with their medical histories. Often patients are too embarrassed or do not think their medical histories is relevant to the medical problem they are experiencing at that moment. Other patients only respond when asked specific questions regarding their medical histories. And even more patients won't mention anything, no matter how many times they are asked.

Some won't have the capacity to discuss medical history with responders. When unconscious patients bleed all over the back of a rig, EMS responders have no idea what they just brought into the back of the vehicle. The same is true for the patient who has no known medical history and has a persistent and productive cough. He may be running a fever and have fluid in his lungs. But providers will not know what he has and how to protect themselves. Is a mask going to be enough or has the patient already infected the back of the rig and the responders the process?

Some patients may not have what EMS responders consider a deadly disease. Yet, a mere cold or flu can be just as dangerous. For most healthy individuals, a cold or flu is handled effectively by the immune systems. The patients can be a very different story because many have weakened immune systems. For example, responders may finish treating a woman carrying cold or flu viruses and then be dispatched to treat an elderly patient. The elderly patient is exposed to every virus and bacterium that the previous patient brought into the back of the ambulance. Certainly, the flu can be devastating to elderly patients.

When EMS responders transfer patients to the hospital, there is the chance that they will bring even more infectious viruses and bacteria back from the emergency room to the rig. So the back of the rolling hospitals may be contaminated with hospital-acquired infections. EMS providers need to start properly protecting patients from exposures to rolling hospital-acquired infections. The patients shouldn't suffer from infectious contagions living in ambulances.

Although all hospitals have cleaning and janitorial crews (though they are largely ineffective), ambulances and rescue rigs have only the responders. When they have time, they attempt to clean ambulances by using hand-sprayed disinfectants and even toxic chlorine bleach solutions. This practice is largely ineffective and can be more harmful to responders than being exposed to the ambulance-acquired infectious contagions they are trying to kill. Is it better to die of surface contaminated Hepatitis C or the toxic effects of excessive chlorine bleach inhalation? That's a choice responders shouldn't be forced to make.

The industry must explore better disinfecting and sterilizing alternatives for its rolling hospitals. One example is micro-particle, dry-mist disinfectant applications, which can be performed safely while the rigs are not in use or idling at the emergency room during a patient transfer.

Effective cleaning and disinfecting procedures must be performed on a regular basis. Proper personal protective equipment must be worn on every call and body-substance isolation procedures must be the norm and not the exception. Responders must remember to wash their hands. They must make sure all of their equipment, supplies and vehicles are properly maintained, cleaned and disinfected on a daily basis.

Responders must be better patient advocates and protect them from further complications resulting from ambulance-acquired infections. Maintaining a sanitary ambulance is the right thing to do. And the by-product of this extra effort is better health and safety for not only for the patients and the first responders, but also for the families of both.

Jason Schneider is a seven-year member of the fire service who is a firefighter, paramedic and hazmat technician in Central Florida. He also is vice president of the public safety division of Zimek.