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Catrina
01-14-2004, 10:23 AM
I just had my first EMT-B class, and I was positively shocked to hear that as an EMT you may not tell anyone, even your driver or the ED staff, that your patient has HIV, should you happen to find that out. This may not even be listed on the PCR. YOu may list the meds the pt. is taking for HIV on the PCR, though. You also may not give any 'hints' letting on that your patient has HIV. The information you received is considered confidential, and your patients right-to-privacy overrules any safety concerns. May I also note that you may tell those who need to know of any other infectious disease you may learn about, just not HIV.

THis is so utterly ridiculous and stupid. Sure, right to privacy is important, but not when it threatens other people's safety! What do you think of this insane rule?

PFire23
01-14-2004, 10:48 AM
Catrina, you may think the rule "stupid" however, all rules are in place for a reason. HIV comes with a huge stigma still, even after many years of being a threat to many, and after much public education. Confidentiality is a huge part of the job we do, we learn very personal information about some of our pt's. It's the patient's right to disclose that sort of information, it is not your place to do so. If you take all the necessary precautions, and the people you work with take the necessary precautions then you really have very little to worry about. HIV is not easily transmittable, it is a very unstable virus and doesn't live long outside the body, and MUST be transmitted via bodily fluids as I'm sure you know. Our patient's well being is our utmost concern, and along with the physical aspect that includes the emotional and mental side as well. Think about your patient and not yourself in this instance.

Might I also add, regarding the reporting of other infectious diseases and the "right to report" of those...... several diseases that are infectious that may affect the Emergency Health Care worker are carried through air born particulates, and therefore are a bigger risk to us than HIV infection. I personally feel that if you are that concerned about "catching" something, you are in the wrong profession. The risk of disease infection is something that we in the emergency medical field accept at face value, and the onus is on you, as an individual to see to it that you take the precautions necessary to keep yourself as safe as possible.

Catrina
01-14-2004, 11:10 AM
Originally posted by PFire23

If you take all the necessary precautions, and the people you work with take the necessary precautions then you really have very little to worry about.
Think about your patient and not yourself in this instance.

Might I also add, regarding the reporting of other infectious diseases and the "right to report" of those...... several diseases that are infectious that may affect the Emergency Health Care worker are carried through air born particulates, and therefore are a bigger risk to us than HIV infection. I personally feel that if you are that concerned about "catching" something, you are in the wrong profession.

We all know that there are times when you will take more precautions if you know there is a reason to. If you know that someone has an infectious disease, you will naturally take more precautions. Now, you might say, one should take those precautions all the time, but come on, that's not practical or realistic.

I think my safety and the safety of my crew and the safety of the ED staff is more important than emotional concerns of my patient, okay? Too bad if HIV carries a stigma. I am concerned with protecting myself and those around me. (I am not planning on breaking the law, FYI. But I will be sure to point out the meds my pt. is taking to the ED staff. There are only 19 drugs for HIV, so they'll know w/out my actually saying it that the pt. has HIV.)

Okay, so what if there are more readily transmitted diseases? The bottom line is that you CAN be infected with HIV from your pt. That makes it a big enough risk for me.

I am absolutely not paranoid. But I am going to do what needs to be done to protect myself and keep my crew safe, no matter how seemingly small the risk may seem. I'm not fearful, but I'm also not stupid.

CollegeBuff
01-14-2004, 04:28 PM
I haven't been doing this for very long but I do remember one thing quite clearly, from DAY ONE of Basic school:

Scene Safety/BSI

Scene Safety Priorities:

1. Self

2. Partner

3. Patient

4. Bystanders



EMT Responsibilities on a Call:

1. Personal Safety

2. Crew, Patient, Bystander Safety

3. Patient Assessment

4. Patient Care

5. Lifting and Moving

6. Transport

7. Transfer of Care

8. Patient Advocacy

kghemtp
01-14-2004, 05:18 PM
When it comes to the law, we have to play it very carefully with patient rights. Now I agree that we must protect ourselves & each other in every possible way. If you know something your partner doesn't & he/she hasn't donned gloves near a situation that warrants protection, advise the partner of universal precautions & don't be shy about it. As for reporting things to caregivers at the hospital, I would quietly but very distinctly urge the use of precautions without any other description.

People have a misconception about Body Substance Isolation, BSI, and the need for gloves. We have to realize that precautions are meant to be used when there IS a body substance we actually need to isolate ourselves from. We touch an arm or leg without gloves, no biggie. We check a pulse, again no biggie. Blood, urine, or any other substance that isn't ours start coming out for various reasons, we have gloves. We use gloves as long as there is a substance to isolate. Check for veins, set up the IV stuff, glove up, stick him, tape & clean it all up nice, and the gloves get thrown away because that's the last of the exposure. Should bleeding start, new gloves are used.

I know some of this goes against the teachings of classes. We have to think about what's going on. Yes, gloves prevent us from touching blood, but we also have to know that when we use gloves to touch something, anything that gets touched with that gloved hand is contaminated. So just like being cautious in using gloves, we also have to be cautious of when NOT to wear gloves.

Excellent topic of conversation!

lutan1
01-14-2004, 05:22 PM
Think about your patient and not yourself in this instance.

PIGS BUM!!!!!!! :eek:

I firmly beleive that anyone who comes into contact with this patient has the right to know. Whilst we should be taking every possible precaution at all times, I find I tended to (as did others) treat an infected casualty a little more carfelly given the risks....

Also, good answer CollegeBuff;)

Ltmdepas3280
01-14-2004, 06:24 PM
In NYS if the patient tells you he has HIV or any other infectious diseases you can document this info on your PCR. You can not do this if it comes by way of a third person. You may ask if this person has any infectious diseases that we need to know about, so that you can give the proper care to that person. There are many ways to get and pass on the information you need to keep your crew and the ER staff safe.

P.S. Most people when they call for help will give you anything that they think will help them with their treatment including HIV and AIDS info ...be smart about it!

Weruj1
01-14-2004, 06:56 PM
Catrina I am not sure what state you are in but in Ohio that is not true, HIPAA or not. You can MOST CERTAINLY tell anyone involved with that patients care they have HIV.............so I dont know whom may have told you or where they got that information.

PFire23
01-14-2004, 07:27 PM
I'll clarify a little bit here. When I said to think of your patient and not yourself I was in no way meaning to disregard the safety of yourself for your patient. All I meant was if the law where you are at states that you do NOT reveal the pt's HIV status then you don't. For myself, I document onto the form whatever my pt tells me. For both my job and my volunteer position. While I cannot disclose to anyone not directly involved with the incident what was on that form, unless subpoenaed to do so in a court of law, I am still able to write on the form. With my job there have been several times that we have been told to be "extra" careful by dispatch as the pt is HIV or has some other communicable disease. My main point is that patient confidentiality is important, and you have to follow the laws and protocols that govern you in your area. We don't always have to like what we "have" to do, but regulations are in place and as such have to be adhered to.


Originally posted by kghemtp If you know something your partner doesn't & he/she hasn't donned gloves near a situation that warrants protection, advise the partner of universal precautions & don't be shy about it. As for reporting things to caregivers at the hospital, I would quietly but very distinctly urge the use of precautions without any other description.

This is GREAT advice!! There's nothing that says you cannot STRESS the importance of universal precautions to those who will be taking care of the patient. I have no problems with saying "you'd better glove up, you might want a face shield ....... etc"

And I agree that this is a good topic.

lutan1
01-14-2004, 08:56 PM
While I cannot disclose to anyone not directly involved with the incident what was on that form, unless subpoenaed to do so in a court of law, I am still able to write on the form.

Are you saying that if you know the casualty has HIV, you won't tell the hospital staff when you arrive, or are they "involved in the incident"?

PFire23
01-14-2004, 09:21 PM
Well LUTAN, since I do not take my pt's to the hospital, I pass them over the the ambulance service, then NO I won't be the one telling them. As for what's on my form, it is whatever information I get from my pt, anything the pt tells me goes on my form which is given to the ambulance crew upon their arrival. So if my patient doesn't have the ability to tell me anything, or is not wearing a medic alert for any condition then the form is pretty sketchy for information. You really shouldn't attempt to read more into someone's words than is there. I will see if I can find the privacy standards which we operate under and post them here for you, perhaps that will make understanding easier.

Oh and to answer your question, I will not breach the policy regarding privacy both within my FD and at my job. I agreed to the oath of confidentiality when I joined the dept and when I got hired on at my job.

CaptainGonzo
01-14-2004, 10:12 PM
Patient confidentiality laws are sacrosanct. The easiest way to protect ourselves is to use universal precautions for every patient whether they call for "flu like symptoms" or bleeding like Enron's bank accounts. Gloves are cheap... medical expenses aren't.

The EMT's, Medics and ER staff will know what type of disease the patient has just by looking at the list of meds. We have EMS field guides, and they have a med list that has the type of med and what they are for. If your patient is a frequent flier, you should have their med hx down pat!

DrParasite
01-14-2004, 11:00 PM
Originally posted by Catrina
I just had my first EMT-B class, and I was positively shocked to hear that as an EMT you may not tell anyone, even your driver or the ED staff, that your patient has HIV, should you happen to find that out. This may not even be listed on the PCR. YOu may list the meds the pt. is taking for HIV on the PCR, though. You also may not give any 'hints' letting on that your patient has HIV. The information you received is considered confidential, and your patients right-to-privacy overrules any safety concerns. May I also note that you may tell those who need to know of any other infectious disease you may learn about, just not HIV.

ummm, I think you misundestood what was said in class. you can tell the crew that the person is HIV positive. you can write that the person is HIV positive. it's part of their history, similar to cancer or the flu. it can affect treatments that are given in the ER. As such, you can document it on the PCR, and a copy of the PCR does get left when you drop a patient off at ER, you leave the pink copy wit them.

What you were probably told was not to tell everyone that the person as HIV positive just for the sake of telling them. It's a private thing, and as was mentioned, it's not your place to say anything. however, you are permitted to tell other healthcare professionals if it will have an impact on the way the patient is medically treated.

you should always utilize proper BSI. this usually means gloves at the minimum, however you need to decide what level is appropriate. if a guy has anb artirial bleed, you might want to wear glasses, gloves and a gown. but you should always treat all fluids as if they are bad for you, whether they are or not.

Remember the old EMS saying, "If it's wet, if it's sticky, if it's not your, don't touch it!!!"

ABMedic
01-15-2004, 02:21 AM
I have to agree that some miscommunication has taken place, any disease process including all known infectious diseases are documented on the PCR and subsequently reported to the appropriate ER staff.

Although I agree that there is a stigma to certain infectious diseases (HIV-AIDS, HepB, HepC and other STDs) one should treat that component of the medical history in the same fashion as one would treat any other component. In other words, like the rest of the history and findings they are considered confidential, but are documented and reported in the medical record.

I think you should clarify the comments made by your instructors because they probably don't reflect either the letter of the law nor the spirit of the law as it was intended. The law was intended to deal with privacy issues surround an individual's right to have the expectation that their medical record could not be revealed to third party individuals. Those third party individuals include anyone not directly involved in the provision of their care. This includes other ER staff, EMS, lab techs, neighbors, family members etc etc etc.

I routinely ask high risk groups (especially known IVDA) if they have any history of infectious diseases including HepB, HepC and HIV. That is not an invasion of their personal rights nor more than asking about heart disease, diabetes, etc.

Thoughts

ABMedic

DaSharkie
01-15-2004, 09:28 AM
The last time I dealt with an HIV positive patient he was obviously a little ashamed of his condition but he told me his PMH and when we got into the ambulance and got closer to the the ED I jus topenly asked the guy if it was OK that I gave his HIV status to the ED staff and he said yes. No problems, no concerns.

This does not mean that when I walk into the ED pulling the stretcher I am screaming HIV, HIV, HIV. WE got him into the room, I closed the door, and told the nurse his status, opened the door and that was that.

Unless you have a real dink of a person for a patient they are just as scared of anyone else contracting the disease and have no problem telling others, discretely about their status.

As for the glove thing, I do not touch patients. It is a general rule applied to every patient I come into contact with. I have gloves on from the start of the call until patient care is turned over at the ED. I have the belief that murphy is around every corner and wants to get me. KGHEMTP is right about just touching people, usually not a concern, but over the years I have come to just protecting myself and my patients. If I get blood on a glove, I usually change it, problem occurs when I get into another service's ambulance and they have very few non-latex gloves (I'm latex sensitive) and I can't change because of my own stupidity of not grabbing gloves from my rig.

BSI / Universal Precautions (I wonder what the new name for it will be in a few years) works both ways, it protects you from what the patient has, and the patient from what you have.

lutan1
01-15-2004, 02:06 PM
PFire I'm not trying to read into your words- I'm trying to understand the reasoning behind them...

I firmly beleive that these sort of rules are crazy!

Dave1983
01-15-2004, 04:08 PM
Catrina, I hope youve just been give the wrong information. It cant be HIPPA, since it allows patient information to be passed between the people providing patient care, and to be documented on patient care reports. It only appplies to the release of that information to anyone not directly involved with patient care. If someone told you it does, they need to read the law again.

In Florida, we not only ask if a patient has HIV/AIDS, its documented on the PCR. We cannot, however, transmit that information over the radio.

Dave

spyonline
01-15-2004, 04:27 PM
Hello,

I've just taken my 2nd Emt-B class and I think my teacher called it Herper Regs or somthing to that where u couldnt talk about your patient to anyone.

We went over the various contagious and communicable diseases that are out there and it freaked me out a bit but I'm sure that is why there are "universal precautions" and "body substance isolation" rules to follow to protect the caregiver.

There is still a stigma and lack of knowledge on HIV, which is probably y laws are in place.

As my teacher put it, If I were to put a dab of HIV in front you on your desk, how long would it live for?.... Milli-seconds, it needs a host to survive. But If he did the same with a dab of hepatitis, it would last for 5-7 days. WoW, what a eye opener.

Universal precautions were put in place, and i think as long as u
follow them with out slacking you should be alright.

DaSharkie
01-15-2004, 06:58 PM
You bring up a good point about Hepatitis. Hepatitis is much more rampant throughout the population and MUCH easier to catch than HIV is yet everyone is scared to death of HIV.

I have become even more paranoid about people, hygiene, and those nasty little bugs out there since taking a microbiology course this past Fall. Scares the begeezers out of if you let it get ot you.

IAMedic
01-15-2004, 07:04 PM
ANYONE involved in that patient's care has the right-to-know any pertinent medical conditions for that incident. Having Hepatitis, HIV/AIDS, etc. can affect the treatment of that patient. So your partner, the ED Staff, and anyone else who may have contact with that patient in regards to their condition has the right to know so that the treatment and isolation precautions can be accurately performed.

This is another instance where ignorance of the HIPAA rules by an educator is causing confusion and misinformation. :(

firenresq77
01-15-2004, 07:33 PM
I second what the majority of people have said. Everyone involved with the care of that pt. has a right to know if they have HIV/Hepatitis, etc...

Weruj1
01-15-2004, 08:06 PM
'77 and IA are on the mark ......people are runnng their mouths and out spews __________!

movinsouth
01-16-2004, 11:52 PM
ok this is a topic that bugs me, i am truly proud that everyone wants to be safe, especially with a possible infectious pt. but people need to grow up a bit. i had a run a few months ago with a pt with hiv. and after the run my partner was like "did you spray down and clean the back of the squad?" first off this was a bls pt with no exposure risk, she was scared cause of the hiv so i took it in. did i wear gloves? nope, didnt need too pt was not bleeding pooping peeing or vomitting on me, no reason to. so when i told her no, she cleaned it out when we got back, good one less thing i gotta do in the morning, but seriously hiv does not come out of a pt's pores and soak into anything i comes in contact with. do you wear gloves on a bls flu pt? probly not, and you are more likely to catch that, gloves or not. and honestly, how many of us wear gloves each iv we start? do you wear gloves with kids? probly not unless there is a risk of exposure, but kids can have hiv too. i dont think some people are gonna be happy till we are all wearing hazmat suits and scba's with every pt. just in case. if you are scared of pt's and their diseases then quit, i dont want you in my squad/engine/or er. if my pt is bleeding then i wear gloves...regardless of their hiv status. and as far as telling the accepting hospital? you can tell anyone involved with direct pt care anything about that pt. if you bring in a gi bleed pt that just pooped are you gonna tell ER? of course, but thats embarrasing, there is a stigma with pooping your pants....oh well, its important, thats why its Pertinent Medical Hx.

firenresq77
01-17-2004, 01:34 AM
Yes I wear gloves with ALL patients. And yes, if the pt. pooped, and it was pertinant (sp) to their condition, I would advise the ER staff.......

ramseycl
01-17-2004, 02:57 AM
Our state protocal states you wear gloves on every run. If you are not wearing them because you THINK you don't need to and you catch something, you are responsible and they may not cover your medical expences. You can do anything with gloves on that you can do with out them, so why not protect yourself?

DaSharkie
01-17-2004, 09:14 AM
how many of us wear gloves each iv we start?

I do. I revert back to my previous post. I do not touch patients, you never know when they will vomit or anything else and you do not get warning of what the patient may or may not do during a call. I challenge this argument everytime. A patient may vomit or begin bleeding anytime within a call for a myriad of reasons and you are no good to your patient, partner, or family if you must stop and take a minute to apply gloves while in the back of the truck during a transport to apply appropriate PPE.

As ramsey said, my state protocols for the application of appropriate PPE for a call. Gloves are the minimum standard of appropriate PPE for any call.


do you wear gloves with kids?

Yup. Most children think that they are cool and enoy them, they are great ice breakers and ways of relaxing a child by giving them a topic of discussion to reduce their anxiety. Not to mention you cna them show them how to make a baloon and relax them even more.

I see no need for wearing a "Haz-Mat suit" only wish for people to properly protect themselves and anticipate what may happen in the back of the truck.

LadyCapn
01-17-2004, 11:32 AM
do you wear gloves on a bls flu pt?

Are you kidding? Having just gone through the whole SARS gammit you're damn right we wear gloves on every flu patient. There is in fact a medic from Toronto who will never work EMS again because he was exposed and came down with it.

Now as far as the topic of the thread goes. Simple body fluid procedures for every patient that is oozing some type of body fluid, and and potential contagious type call (which includes the flu). Keeps you safe and no one can accuse you of treating anyone differently because of any specific disease they may have.

SPFDRum
01-17-2004, 11:51 AM
We use the same notification line that IAMedic does. All those directly involved in Pt care from the first responder to the ED staff is informed of any blood/body fluid precautions or any other concerns.
Everybody knows BSI, but substitute Hep or HIV with active TB- do you think it maybe a good idea for people involved with pt care to know?

spyonline
01-17-2004, 03:26 PM
How often you guys and gals where eye protection or even a face shield?

firenresq77
01-17-2004, 03:55 PM
We are issued a pair of glasses by the fire department and they are supposed to be worn on all EMS runs.

kicks82
01-17-2004, 04:23 PM
I don't know if it's New York State protocols or what but I was told the same thing during my EMT class. It is fine to tell the ER that a patient has Hepatitis, but not ok to tell the ER if the person has HIV or AIDS. As far as my understanding goes, it is the responsibility of the ER to tell the ambulance crew if there are any other communicable diseases that may not have been mentioned to the ambulance crew WITH THE EXCEPTION OF HIV or AIDS.

Weruj1
01-17-2004, 06:55 PM
HUH ^^^^^^^^^^^^^^^^^ ? That makes no sense !

Catrina
01-17-2004, 08:30 PM
Originally posted by kicks82
I don't know if it's New York State protocols or what but I was told the same thing during my EMT class. It is fine to tell the ER that a patient has Hepatitis, but not ok to tell the ER if the person has HIV or AIDS. As far as my understanding goes, it is the responsibility of the ER to tell the ambulance crew if there are any other communicable diseases that may not have been mentioned to the ambulance crew WITH THE EXCEPTION OF HIV or AIDS.

This poster is absolutely correct. That was exactly what I was told, and I did not misunderstand. I'm reading the NYS protocols right now, and I'm trying to figure this out. But basically, NYS is tne most strict state concerning HIV and confidentiality. We are not allowed to tell anyone if we learn our pt. has HIV, only advise the pt. to tell the ER staff. We may list the meds the pt. is taking on the PCR. We may not say anything like, "You had better wear gloves for this one," or anything like that. If anyone is familiar with the NYS protocols and can confirm this, I would appreciate this.
And under the Ryan White CARE Act, the ER staff cannot tell us if the pt. is discovered to have HIV, as they are required to do with other infectious diseases. It appears that in order to protect the pt.'s confidentiality, crew safety is being compromised. This is a crying shame.

Ltmdepas3280
01-17-2004, 08:34 PM
Originally posted by kicks82
I don't know if it's New York State protocols or what but I was told the same thing during my EMT class. It is fine to tell the ER that a patient has Hepatitis, but not ok to tell the ER if the person has HIV or AIDS. As far as my understanding goes, it is the responsibility of the ER to tell the ambulance crew if there are any other communicable diseases that may not have been mentioned to the ambulance crew WITH THE EXCEPTION OF HIV or AIDS.

I have been a NYS EMT ,EMT-I and EMT-P for over 20 years and who ever told that information during your basic class was dead wrong. You are allowed to pass information to the ER staff if you gain that info while doing a Med HX and anyone that has direct contact with that Pt has the right to know. Your Instructor need to read the Ryan White act and mesh that with the protocals in NYS basic course. We had some yahoo instuctors around here doing the same thing and had to be set straight NYS health department.

Catrina
01-17-2004, 08:53 PM
^^^See, and I'm finding info in the NYS protocols that also seems to contradict what my intructor said. Of course, that is just my understanding of the protocols. *Sighs* Why does this have to be so complicated. Oh, and by the way, this is NOT a HIPAA thing (can't blame everything on HIPAA), but a separate HIV confidentiality thing, FYI.

Weruj1
01-17-2004, 08:58 PM
Well at least is aint a HIPAA thing !!!!!!!!! that poor horse gets beat enough .......

Catrina
01-17-2004, 09:18 PM
Originally posted by Ltmdepas3280


Your Instructor need to read the Ryan White act and mesh that with the protocals in NYS basic course.

The Ryan White CARE Act does not apply to HIV, to my understanding. My textbook said so, and everyone knows textbooks are the highest authority (yeah...right!).

Ltmdepas3280
01-17-2004, 09:33 PM
The Ryan White act is limited to those illness that are communicable and HIV/AIDs is also included....Ryan had AIDS

ARFF26
01-17-2004, 10:50 PM
Catrina, you need to put the HIV contraction risk that you will face into proper perspective. Be far more concerned about Hep. You will come into contact with every known body fluid and substance (and a few others) during the course of your career and you will face a far greater risk of contracting Hep than HIV. Always use universal precautions and go to the CDC website, read up on HIV and HBV to see what your real risk is and don't blow things out of proportion.

Weruj1
01-17-2004, 11:23 PM
All members are issued a fanny pack with shears, glasses, mask, and minor first aid stuff.

MikeWard
01-18-2004, 07:34 AM
Catrina asked a great question. There are three issues as this thread evolved:

1) What can you say to who
2) EMS caregiver personal protection
3) Compliance with federal laws

I have been an ALS provider for 22 years and an emt-instructor for 25 years. Most of the EMT textbooks do not reflect the current HIPAA and reporting rules, which went into effect last April. The rules change faster than the textbooks are updated.

Through the courtesy of The George Washington University, here is a link to a presentation that describes, in gory detail, what HIPAA means. http://66.40.168.196/HIPAA.htm

It is a large, 95 slide, PowerPoint presentation that covers the wide range of privacy issues that a university research medical center handles. You will need Adobe Acrobat Reader to see the presentation.

While slogging through the presentation, it eventually explains the responsibilities of EMTs/Paramedics and law enforcement when handling the sick or injured. We make the EMT and paramedic students who attend GWU complete this module (well, we had no choice . . . university policy.)

If you decide to look at it, please note that you are NOT eligible for CEUs (gotta work for the university) so do NOT fill out the end of presentation questionairre or submit personal information. If you still have questions, contact the PRIVACY OFFICER at your local hospital, since they are your privacy gatekeepers.

Personal protection means that you ALWAYS wear gloves and you SHOULD wear eye/filter masks when your patient is coughing, sneezing or when you are preparing to intubate. Just as important, you must immediately notify the DESIGNATED OFFICER when you *think* you have an exposure. The DO has the training and authority to make sure you are safe while complying with the federal regulations. Your emergency organization is required to provide initial and update infection control training on a regular schedule.

By the way, you DO wash your hands after every patient contact, right?

Consider this scenario ...
You are off-duty and encounter a 10 pm Saturday crash where a family is trapped in an overturned SUV that is leaking fuel. Without BSI, you crawl into the car and remove the occupants. In the process, you are covered in blood, gasoline, puke and other stuff. One of the patients is dead at the scene. If you wait until Monday to report your exposure, the DO has lost most of the ability to provide you with immediate information about the infection status of the dead and injured. Now you will need a court order.

If you notified the DO when you first could, at 10:44 pm Saturday, she could have immediately started the exposure reporting process as part of the crash incident.

Federal laws are passed to address a variety of social, economic and political issues. As ems providers, we are on the fringe of most of these regulations; like COBRA, FDA, NDD, FLSA and HIPAA, but we need to comply and fully use the infrastructure that develops to allow us to safely operate in this environment.

HIV is the least of your infection worries, it is hepatitis that disables and kills more ems personnel and SARS that disabled Canadian caregivers.

Mike

Michael J. Ward, MS, MIFireE
Adjunct Assistant Professor of Emergency Medicine
Emergency Health Services - EMS Management program
The George Washington University
Washington, DC

P.S. When I was an engine officer we had end-stage AIDS patient who we saw more-and-more frequently as he was fading away. I had a recruit on the engine when we responded to this guy's house to assist the private ambulance. I have no idea what the recruit was told in EMT, but he got off the rig with full PPE, including being on SCBA air. It is that panic over-the-top response that drove the Ryan White legislation.

ffexpCP
01-20-2004, 02:00 AM
I can understand the confusion with the laws, I am going through my MFR classes and I have trouble myself. I can also understand the fear of contracting a disease. I personally know someone who contracted hep from a medical run. Sadly, in this line of work Iím sure Iím not the only one.

Hereís some statistics from tonightís lecture:

*The hepatitis B vaccine is 97% effective.
*Hepatitis is 7 times easier to contract than HIV.
*More than half of the population will have had Hepatitis A sometime in their life.
* A healthy person should fight off Hepatitis A within a few weeks.
*Hepatitis C can be completely killed by the immune system 50% of the time.
*Hepatitis B can be completely killed by the immune system 33% of the time. Chances are better if you receive an immediate booster after a potential exposure.
* Another 33% of Hepatitis B carriers will not show symptoms.

Correct me if Iím wrong, my notes arenít exactly the neatest.

shintu
01-20-2004, 02:19 PM
We all know that there are times when you will take more precautions if you know there is a reason to. If you know that someone has an infectious disease, you will naturally take more precautions. Now, you might say, one should take those precautions all the time, but come on, that's not practical or realistic.

Yes, it is both practical and realistic. From day one in the EMT-B class they stress BSI. You get out of the ambulance, you're got your gloves on, you're got your turn out gear on (I think in most jurisdictions it qualifies as a protective gown), you've probably got your helmut on (and in most cases it does have a face shield), and you've got safety glasses either on, or possibly hanging around your neck. There's your BSI. On every single call you already have your BSI on, or at the very least, at an arms reach. With the two squads that I've run with, the squad REQUIRED that for EVERY call you wore you're turn out gear. Period. No debate. If you didn't wear it, you were verbally warned. The second time, you were written up, the third time, you were written up again and the fourth time, you were kicked out of the squad.

As for not telling anyone about an HIV infection I'd be willing to bet that when you get to the hospital you're gonna start reading off the list of medications the patient is on. Anyone who's spent any time in the emergency field of medicine is going to recognize that X, Y, and Z drugs are prescribed to HIV patients. You may nat have to come right out and say, 'Jim has HIV.' They're probably going to figure it out as soon as they hear the list of meds.

It's also possible that the patient may actually inform you that they have HIV. I have run HIV positive patients to the hospital before and in every case, the patient has stated to my squad right up front that they have AIDS. Well, ok, that's nice, but you're already wearing your BSI. What more can ya do?

NCMEDIC749
01-26-2004, 06:58 PM
north carolina has "right to know" legislation. we are allowed to tell in our report to the nurse or md the full medical history including hiv