Transporting a patient with TB or measles: airborne precautions in a NEMT van

Treat a rider with infectious TB or measles as an airborne case, not a cleaning case. The rider wears a surgical mask and rides alone, the van pulls in outside air instead of recycling cabin air, and any driver who needs a respirator falls under OSHA’s respiratory protection standard. Wipe-downs and disinfectant are covered in the infection control guide. This page covers what changes when the germ travels through the air.

Why airflow matters more than wipes

TB and measles both spread through the air, which is why the usual cleaning routine does not stop them.

TB. CDC says TB bacteria travel through the air when a person with TB in the lungs or throat coughs, speaks, or sings, and that touching a surface does not spread them. Whether a rider infects anyone depends on how infectious the person is, how much fresh air the space gets, and how long and how close the contact lasts. Drug-resistant TB spreads the same way as any other TB. TB infection without active disease, the latent kind, is not contagious, and TB outside the lungs is usually not infectious either. “The rider has TB” therefore tells a dispatcher very little. What matters is whether the clinic has the rider on airborne precautions today.

Measles. CDC says measles virus can stay infectious in the air for up to 2 hours after an infected person leaves, and that up to 9 of 10 susceptible people in close contact with a patient will catch it. A patient is contagious from 4 days before the rash appears to 4 days after, so a rider can sit in your van before anyone knows what is wrong. CDC reports 3,887 confirmed measles cases in the United States so far in 2026 (as of October 1), after 2,289 in all of 2025.

What the van needs for a rider on airborne precautions

CDC’s 2005 TB guidelines for health-care settings are the closest federal text for a van, because they include a section on transport vehicles. Applied to a NEMT trip:

• A mask on the rider. The guidelines say a person with suspected or confirmed infectious TB who is transported should wear a surgical or procedure mask if possible. A rider who cannot tolerate one follows cough etiquette. For measles, CDC says anyone with symptoms should get a facemask and be kept apart from other people.
• Outside air, no recirculation. For a vehicle that is not an ambulance, the guidelines call for a ventilation system that brings in as much outdoor air as possible and runs in the nonrecirculating mode. If the cab can be physically separated from the rear, the rider sits in the rear seat.
• A solo trip. A shared ride puts every other rider in the same air for the whole drive. CDC’s measles guidance asks for a route with minimal contact with other people and for the receiving area to be told ahead of time. Book the trip so that no one else is on it.
• Notice at both ends. For a patient leaving a facility, CDC says the facility should tell the receiving site and the transport crew in advance that airborne precautions apply. A dispatcher can ask for that call when the trip is booked.
• Airing the van afterward. The vehicle section of the TB guidelines gives no clearance time. CDC’s measles guidance keeps a room empty for up to 2 hours after the patient leaves so the air can clear, and says staff who go in sooner need an N95-level respirator. Nothing in CDC’s text covers vans. Keeping the van out of service with its doors open for at least that long is the cautious reading, and the health department can set a different rule.

CDC’s pages do not all say the same thing about crews. Its general isolation page says personnel transporting a patient on airborne precautions need no mask or respirator when the patient is masked and any infectious skin lesions are covered. Its measles page says a transporter inside a facility wears an N95-level respirator, and the 2005 TB guidelines word it more loosely, saying drivers and other transport staff “might consider” an N95. The OSHA guidance below is stricter for a closed vehicle. Where the sources differ, follow the stricter one.

When a driver needs a fit-tested N95

OSHA’s TB guidance names a closed-vehicle transport of a person with infectious TB as a case for at least an N95, and a respirator you require brings the full fit-testing program with it. OSHA has no standard written for TB. It proposed one in 1997 and ended that rulemaking on December 31, 2003. For measles its website says “There is no specific OSHA standard covering measles.” Inspectors use the respiratory protection standard (29 CFR 1910.134), the PPE standard, and the general duty clause instead.

OSHA’s TB directive, CPL 02-02-078 (effective June 30, 2015), tells inspectors that CDC recommends at least an N95 when TB calls for respiratory protection. Its examples include emergency medical response personnel or other workers who transport, in a closed vehicle, a person with suspected or confirmed infectious TB. The directive’s model citation for an employer that handed out only a surgical mask says an N95 is the minimum. It covers settings where emergency medical services are provided and does not name NEMT companies, but a van is a closed vehicle and the transport language is plain. OSHA’s measles page recommends a NIOSH-approved N95 or higher, mainly for healthcare workers, based on a hazard analysis, and puts it inside a program with medical evaluations, fit testing, and training.

Once you require a respirator, the standard asks for:

1. A written program with procedures for your worksite (paragraph c).
2. A NIOSH-certified respirator (paragraph d).
3. A medical evaluation before the driver is fit tested or wears it on the job (paragraph e).
4. A fit test before first use, whenever the facepiece size, style, model, or make changes, and at least every year (paragraph f).
5. Training that is repeated every year (paragraph k).

A driver whose facial hair comes between the seal and the face cannot be fit tested for a tight-fitting respirator (paragraph g). If drivers choose to wear their own N95 when you have not required one, the voluntary-use paragraph asks you to give them the standard’s Appendix D information. The program takes an appointment and a clinic visit to set up, so it needs to exist before the first call, not after it. The longer treatment of respirator programs is in OSHA for NEMT companies.

Questions to ask when the trip is booked

A dispatcher can settle most of the risk in one call by asking:

• Is it disease or infection? Ask whether the rider is on airborne precautions now, not only what the diagnosis is. Latent TB infection is not contagious.
• Who cleared the rider? For TB, the treating clinician or the health department’s TB program can say that a person is no longer infectious. A dispatcher cannot.
• For measles, what day did the rash start? CDC keeps airborne precautions on for 4 days after rash onset, counting the rash day as day 0. People with weakened immune systems stay on them for the whole illness.
• Can the rider keep a mask on the whole way? If not, tell the driver before pickup.
• Can the trip wait? CDC limits transport of these patients to essential trips. The clinic makes that call, not the van.
• Who at the destination knows? The receiving site should be warned before the van arrives.

Rides for TB care often come as a series. CDC calls directly observed therapy the standard of care: a health care worker watches the patient take each dose, in person or by video, and treatment typically takes 4, 6, or 9 months. CDC accepts video as an equal substitute for in-person visits. A rider on in-person doses can mean many trips on a fixed schedule, which is what standing orders are for.

If a driver or another rider was exposed

For TB, a contact investigation decides who needs testing, and CDC’s guidelines count emergency medical services staff among the people included in screening and in contact follow-up. If a driver later tests positive after being exposed to someone with known active TB, OSHA’s recordkeeping rule (29 CFR 1904.11) says to record the case as a respiratory condition on the OSHA 300 log. The exceptions are a driver who lives with someone who has active TB, a driver the health department tied to a contact unrelated to work, and a case a medical investigation traces to exposure away from work.

For measles, CDC defines an exposure in a healthcare setting as sharing air with an infectious patient, or entering air the patient left within the previous 2 hours, without the recommended respiratory protection. CDC’s rules for exposed healthcare personnel, last updated April 5, 2024, are the closest written standard for a driver:

• Two documented doses of measles vaccine. No work restriction. Check for symptoms daily from day 5 after the first exposure through day 21 after the last.
• One dose before the exposure. No work restriction. Give the second dose as soon as possible, at least 28 days after the first, with the same daily check.
• No evidence of immunity. Offer postexposure prophylaxis and keep the person off work from day 5 after the first exposure through day 21 after the last.

That last case takes a driver off the schedule for 17 days. If immune globulin is given instead of a vaccine, CDC says to consider extending the exclusion through day 28, which makes it 24 days. The rash usually shows up about 14 days after exposure. For prophylaxis, CDC says MMR vaccine works within 72 hours of the first exposure and immune globulin within 6 days, and that the two are not given together. The health department decides who qualifies, so call it the day you hear about the exposure.

These rules depend on paperwork you can find today. CDC accepts written documentation of vaccination, lab evidence of immunity, lab confirmation of measles, or birth before 1957, and it says not to accept a verbal report of vaccination without a written record. A driver with no record on file is the one who comes off the board. The rules are written for healthcare personnel, a group CDC says includes emergency medical service personnel and contract staff but does not list NEMT drivers by name. Treat them as the closest standard and let your local health department decide what applies to your crew.

OSHA adds two points for measles. A case a worker caught at work is recordable, and if that worker is hospitalized the employer must tell OSHA within 24 hours. OSHA also says employers may encourage the MMR vaccine and that workers are more likely to get it when it costs them nothing, and tells a worker who contracts measles on the job to contact the local health department.

Records the health department asks for first

A health department’s contact investigation starts with who shared the air with the patient. For measles, that means every rider who shared the van with the patient and every rider who stepped into it within the next 2 hours, plus earlier trips by the same patient during the 4 contagious days before the rash. For TB, the program decides which period to look at, so ask which dates it needs. If you can pull a list of riders, drivers, vans, and pickup and drop-off times for those days within the hour, the call goes much faster, and the people who truly need a vaccine or a test get it inside the 72-hour and 6-day windows.

Keeping exposure records in HealthRide

HealthRide keeps a timestamped record of every trip with GPS-recorded miles, and the trip log exports as a CSV or PDF, so the list a health department asks for is a report rather than a search through paper. Team chat lets dispatch send every driver an announcement and require each one to confirm they read it, which helps when a driver needs to be told to call the health department the same day. See reports and team chat.