The organization of ambulance decontamination during the COVID-19 pandemic: a process analysis based on the Lean Thinking philosophy

The COVID-19 pandemic led to massively increased emergency medical services (EMS) activity. The need to decontaminate emergency vehicles after conveying a suspected or confirmed patient to the hospital represented a critical step, slowing the activities and impacting the number of available ambulances. This brief paper analyzes the flow of EMS processes according to the Lean Thinking management approach, which focuses on reducing waste in a production cycle. The different steps of the whole process (arrival to the Emergency Department, handover phase, decontamination, return to service, and the required transfers) and a series of strategies are discussed. The organization (centralized or delocalized), number, and location of the decontamination centers impact transfers and waiting times and, consequently, the availability of ambulances. Optimizing these processes may lead to a global performance improvement, reducing transfers and time, with greater availability of emergency vehicles.