Lone Star

Let me ask you this Dwayne..... You're working a MVA with a patient who has one of the infectious diseases that we've been talking about (not the contagious ones that got thrown in). After the call, while you're peeling off your gloves, you notice that the glove has been compromised (ripped, punctured, etc) and you're bleeding from an open wound..... Are you going to dismiss it as an acceptable risk, go wash your hands and just 'forget about it'? After all, the risk is negligible, and since the occurance of infection is astronomically small,....

First off, lets not confuse 'contagious' with 'infectious'. To even draw a correlation between the two, shows that the line between them has been blurred. In none of my posts have I mentioned anything about influenza, mrsa/vrsa, the common cold, etc. My initial topic was the infectious diseases such as HIV, Hepatitis A-C, TB.... I'm currently working through the CDC in Atlanta on this issue. I've got some 'reccomended reading' to do, but from what I've seen so far, it does not apply to EMS personnel, but rather to clinicians such as surgeons and dentists/oral surgeons. As I obtain the information that is relevant to this topic and I've had a chance to read it; I'll post my findings. Furthermore, the CDC reccomended that I also contact OSHA, and see what they have to say about the whole mess as well.

Where do you draw the line between 'acceptable risk' and 'unacceptable risk' when it comes to the possibility of passing an infectious disease on to your patient?

First off, those 'universal precautions' aren't a guarantee that 'we' are protected from 'them'! If that were the case, I wouldn't have had to go through the testing, the worry, the fear and all the other emotions I had to deal with. Remember how it happened....I got cut on a piece of metal or plastic while attending to, and helping extricate patients involved in a MVA. Since my hand got cut, guess its pretty safe to say that the glove on that hand was also compromised....thereby negating ANY 'precautionary' effect that glove had when I first put it on! Now...with that fresh in your mind.....if the infected EMT were to go through the same type of situation..... It's not that much of a 'leap' to figure out that the infected EMT is now at risk of transmitting his disease to the patient, a situation that could have and SHOULD have been avoided in the first place!

"Summer In The City" - Loving Spoonfull

"Summer Lovin'" - John Travolta/Olivia Newton John

"Petticoat White (Summer Sky Blue)" - Bobby Vinton

"Courtesy of the Red, White and Blue" - Toby Keith

As it stands, the infected health care provider is NOT obligated by law to divulge the nature of their disease, so in the event of the transmission of an infectious disease, the recipient of such a 'gift' is pretty well screwed! There will be nothing that they can do, no recourse for the victim! Since the infected person has no obligation to divulge this information, the employer is also kept 'in the dark' on this, and IF it comes to light, there's nothing the employer can do to protect themselves, because the infected employee is protected by the AwDA. An infectious disease is considered a 'disability' and therefore, to fire the employee is considered 'discrimination', and the employer will not only pay for the discrimination lawsuit, if it come to light that the employee was the source of the transmission of an infectious disease, they'll be paying for that as well. One reason I only have '2 posts in this fray' is because I have other responsibilities that prevent Me from responding to every post in this discussion, not to mention that up until last night(while I was sleeping), not many had really posted to this thread, so I'm allowed some time to read and respond! This IS a REAL issue to me, and further, I am VERY concerned about it! Sometimes I need a little time to sit down, cool off and gather my thoughts so that I might post something that appears to be reasonably intelligent, based on logic and fact, as opposed to some 'knee-jerk response'. If this weren't such a 'real issue' with 'real concerns', I surely wouldn't have taken the time to do what research I have done, nor would I even be 'bothered' with posting it in the first place! In MY opinion, even a 'negligible risk' is too high in this field! Having had to go through the whole process of testing, and the worry, fear and depression that goes along with an 'exposure incident', and I wouldn't want to put ANY patient of mine through that! Not to mention the absolute HATRED that goes along with the above feelings. These aren't the only emotions you'll feel, but they're the easiest ones to put into words. Even as a member of this 'misguided camp', I am firm in MY beliefs that while the infected health care provider may not be required by statute to divulge this information, they should at least have the MORALS and ETHICS to be RESPONSIBLE enough about their disease to take EVERY precaution available to PREVENT the transmission of this disease to some innocent patient! Being RESPONSIBLE should include 'self exclusion' from activities that clearly could promote the chances of even an 'accidental transmission'! Since we are part of the medical community, shouldn't the Hippocratic Oath apply to us as well (even if loosely applied)? There is a line in the Hippocratic oath that I think applies here: I will prevent disease whenever I can, for prevention is preferable to cure. How can we honor this line, when we're putting the patients at risk (however 'small' that risk might be) by potentially exposing them to something that they can't ever be cured of? The person that inspired this whole thread (no names given), stated that they're using 'tear proof gloves'..... I've heard of gloves that are "RESISTANT" to puncture, ripping and other breeches of the universal precautions, but even those are not 'BREECH PROOF', they're just a bit thicker to be more resistant to the effects of puncture, ripping, cuts, etc. I stated above that I had an 'exposure incident' on scene. The REALLY frightening thing was that it occured while working an MVA, with multiple patitents, and it wasnt discovered until AFTER the call had been dealt with! There was no way to guarantee that the blood inside and OUTSIDE My glove hadnt been mixed, nor was it any 'consolation' that there was a 'low risk' of infection! Another 'frightening aspect' of this is the knowledge that while the 'normal incubation period' (as explained by the doctor that was doing the testing) is 6 months to 5 years....that is no guarantee that the disease isn't just lying dormant, only to present later in life, when I have quite possibly 'forgotten' all about the exposure incident!

The whole point of this thread was; where do we draw the line where a risk, no matter how 'negligible', is acceptable? We're supposed to be HELPING our patients, not putting them at risk of infecting them with something that could potentially kill them in 10 years. I'm not saying that everybody gets cuts and scrapes working a MVA, but it's been known to happen. It's also been known to happen that when you get that cut or scrape, the barrier of the exam glove can be (and usually is) compromised, presenting the situation where your infected blood can make contact with the patient's open wound. By the very nature of our job, I don't see where that 'negligible risk' is acceptable! In EMS, we know already that the general public's 'knee-jerk reaction' to HIV, AIDS and the various strains of hepatitis, would be similar to"OMG! He/she sweated on me, and now I'm gonna get it!"; "He/She touched me with no gloves, now I'm infected!" Further, in EMS, we know what routes are necessary for the transmission of infectious diseases, and we should act responsibly. I think that since it's a criminal offense to put someone at risk by having unprotected sex while HIV positive; it should also be a criminal offense for putting a patient at risk in this situation. I know that there are those that were infected with these diseases through no fault of their own (not engaging in high risk activities attributed to the initial infection/transmission of the disease), but I further don't think that these people belong in a high risk environment to potentially transmit the disease to others. Nurses and doctors who work in a safer environment than EMS, may be able to practice their skills with little to no risk...but in the field....theres too much of a chance of accidental transmission, and this should be addressed. The fact that the infected EMT is not obligated in any way to inform the patient of possible infection isn't going to help the patient figure out HOW they got the disease, and secondly, it isn't fair to the patient to be left with all the questions that are sure to follow, while the infected EMT goes on to keep practicing and putting other patients at risk! What happens to the dentist that infects his patients with HIV or other disease? Do they not lose their licenses? Isn't the risk of transmitting the disease even more 'negligible' than it would be in EMS? Why is it acceptable for a dentist to lose his license and not be able to practice his 'trade' (no pun intended), while the infected EMS worker keeps right on doing what they do?

Ok, Rich....you served...I'll volley! "Blue Velvet" - Bobby Vinton You're not the only one that knows the Polish Prince! En Garde! BTW... "L'amour Est Bleu" - Paul Mauriat was also made into a hit by Andy Williams....good selection!

The singer in question here was Ferlin Husky "Blue Bayou" - Linda Ronstadt I don't mean to be 'nit-picking' (again), just trying to get the correct information out there. In your defense though, I can see the confusion though, because at the time Ferlin Husky was performing this song, there WAS a singer by the name of Farron Young.

I don't know if this one's been used already,. I scanned the thread, and didnt see it,.... "Wind Beneath My Wings" - Bette Midler

I did some research and found out some very distressing news. I found out that people that are infected with HIV, HAV, HBV, and HCV, TB and other potentially deadly infectious diseases are NOT prevented from entering the EMS field. Personally, I disagree with this entire thought process, but it seems that those individuals rights are protected under the ADA (Americans with Disabilities Act), and I also found out that there is no statute that requires the infected EMT to inform his patients that they may have been put at risk. I was further told that to prevent these individuals from entering the EMS field, would amount to a successful discrimination suit. Looking at this situation in a logical manner, one would think that with the risk of coming in contact with sharp edges at an MVA call is quite high, and one way these viruses are transmitted is through contact with the infected persons blood. We are 'protected' in a fashion, by having the hospital test the patient to see if we have been potentially exposed, but the reverse isn't true. Further, I believe that any person who knows that they are infected with any infectious disease should NOT enter a field where they can potentially infect the patient, and if they are infected from exposure in the field, they should be responsible enough to remove themselves from the health care field, to prevent accidental spreading of the disease.

While AK has advocated FOR the medic in this situation, I have to agree with him to a point. It is NOT the employers responsibility to make sure that the employee is happy in what ever form of a 'private life' they have, nor are they responsible for making the dreams of the employee come true. While AK advocates reassignment, I disagree. It is NOT the employers responsibility to make sure that the employee is given a job that is the employee's dream job. If the employee cannot do the job (whether for physical or mental limitations, along with religious considerations, etc), then the employer is completely justified in terminating the working relationship with said employee. As long as the termination isn't for race, gender, religion (fired because they're Catholic or Baptist), there is NO guarantee that you're going to be employed with XYZ, Inc. for any predetermined length of time, (unless you have signed a contract that has that stipulation in it.). Life does NOT guarantee that everybody gets their 'dream job', nor guarantees that if you DO get your 'dream job' that you'll keep it...... In the event that the employee tells the employer, that 'if you fire me, I'll kill myself.' should be terminated for attempted extortion, or blackmail! Again, it is NOT the employer's responsibility to make life a bowl of cherries for the employees! I have to agree with AK's assessment in his final comments of his post. Life is NOT all 'hugs and kisses', and it's high time that those that want to spread that way of thinking wake up and smell the coffee! No matter how much you want this 'kinder, gentler America', it has it's limits, and it has NO place in the business world. From the administrative aspect, EMS (private carriers), IS a business! Life is going to be chock full of 'bad things' that will serve to make us stronger, and more deterimined to work harder to succeed....but it's not going to be handed to us, and we WILL have to acually do some work in order to make it happen. Even then, there's no guarantees in it, no matter how passionate you are about your dreams, cause, or wants.

There's at least 3 factors that I dont think are being considered here.... 1. As a medic, she should already be aware of what happens when you're non-compliant with meds, especially in bipolar situations. 2. Armed with this knowledge, she chose to become non-compliant. It's not like anyone coerced her into non-compliance,.....it was something that she did by choice, even after knowing what the end results would be. 3. Since she made this decision after knowing the facts, shows a complete disregard for not only her own safety, but those around her. Since the employer cannot force her to take her meds, then she is an unacceptable risk factor. What's to say that the next time she decides to attempt suicide, she's not driving to recieving facility with a pt on board? Since she opted to 'go off her meds', no one can guarantee that it wont happen again! As an employer, that's not a risk Im willing to take. 4. Since a diagnosis of being bipolar is a mood disorder, not an 'intellectual disorder', she should have known that her actions would have serious repercussions! Rather than 'molly coddle' her for being bi-polar, she needs to just deal with the situation that she created. It is NOT the employers responsibility to risk such liability in order to cater to someone who created their own mess! No, she didn't ask to be bi-polar, but she DID decide to stop taking her meds, even knowing what would happen. As cold and hard as it sounds, she should have her license revoked by the state, and be fired as well. I don't think that the company should make 'special provisions' for her, to keep from 'depressing' her. In my book, all that does is reward stupidity!

Three years ago, in Genesee County (Flint, Michigan), Genesee County Sheriff's Department Echo unit (non transporting ALS) pulled over a local ambulance for running 'hot' for a possible tib fx. Needless to say, he was ticketed, removed from service, and fired the following morning. Again, I can only quote that which I know; Michigan Motor Vehicle Code states that if you activate warning lights, (aside from the manufacturer's 'hazard lights'), you MUST also activate an audible warning device (Siren, or exhaust whistle) that can be heard at 500 feet, 360 degrees under normal atmospheric conditions. While I can see using the lights and not keying up the siren in a quiet residential neighborhood at 0300, out on the 'main streets', if you've got a need for the lights, you've got a need for the siren as well.

And they say that men dont know how to shop for that 'toughtful gift'!

I hope that medic was charged criminally for assisting a suicide, and the family owned him in civil court for wrongful death!

In Michigan, when running 'code' 'hot' or what ever term you use to describe running with lights and sirens, the motor vehicle code CLEARLY states that the emergency vehicle will bear to the LEFT at all times. This is right under the part about driving no more than 10 mph over the 'prima facie speed limit (posted speed limit). First off Robert, if you were with any credible company, you would be fired on the spot. In one of your later posts, you said the rated speed for the tires was 106 mph. 100 mph is NOT 'well below the speed ratings'! Second of all, even if the vehicle in it's best mechanically operating condition WAS able to sustain such abuse, it doesn't mean you HAVE to abuse the vehicle in that manner! There is NO situation that can be used to justify such a reckless disregard for public safety, abuse of the vehicle, or the lack of common sense you have admitted to when you stated that you've attained speeds of 100 + mph! At that speed, any little thing can cause you to completely destroy the truck, kill you/your partner/ and anyone that just happens to be around you. If you feel the need to drive at those speeds, I suggest you buy your own race car and enter it at the local track, where those speeds are 'justified'. Until then, stop watching NASCAR, because you're obviously too young and impressionable. Not only are your actions reckless, but they're criminal as well. And if you don't think that ambulances can be pulled over for reckless driving (which includes excessive speeds), you need to think again! As far as your statements of 'there were no speed limits', that 'justification' holds no water either. Same goes for the 'clear, dry, strait surfaces. If you're driving '10 or 15 miles in the middle of nowhere'...then you should be driving with even more caution, due to animals that might enter your path. The lights and sirens do nothing more than daze and confuse them! My personal suggestion for you is to turn the keys over to a more RESPONSIBLE driver, and do NOT touch them again until you have gotten over this 'need for speed' phase you seem to be stuck in!

Good call, Rich! I couldn't remember Norma Jean's last name, so I went with what I could remember. Either way, the song is basically the same, so I guess I could have gotten away with just the title, without the reference.

"Candle In The Wind" (Tribute to Princess Diana) - Elton John

"On The Dark Side" - Eddie And The Cruisers

Pocket Taser Stun Gun, a great gift for the wife. A guy who purchased his lovely wife a pocket Taser for their anniversary submitted this: Last weekend I saw something at Larry's Pistol & Pawn Shop that sparked my interest. The occasion was our 15th anniversary and I was looking for a little something extra for my wife Julie. What I came across was a 100,000-volt, pocket/purse-sized taser. The effects of the taser were supposed to be short lived, with no long-term adverse affect on your assailant, allowing her adequate time to retreat to safety....?? WAY TOO COOL! Long story short, I bought the device and brought it home. I loaded two AAA batteries in the darn thing and pushed the button. Nothing! I was disappointed. I learned, however, that if I pushed the button AND pressed it against a metal surface at the same time; I'd get the blue arc of electricity darting back and forth between the prongs. AWESOME!!! Unfortunately, I have yet to explain to Julie what that burn spot is on the face of her microwave. Okay, so I was home alone with this new toy, thinking to myself that it couldn't be all that bad with only two triple-A batteries, right? There I sat in my recliner, my cat Gracie looking on intently (trusting little soul) while I was reading the directions and thinking that I really needed to try this thing out on a flesh & blood moving target. I must admit I thought about zapping Gracie (for a fraction of a second) and thought better of it. She is such a sweet cat. But, if I was going to give this thing to my wife to protect herself against a mugger, I did want some assurance that it would work as advertised. Am I wrong? So, there I sat in a pair of shorts and a tank top with my reading glasses perched delicately on the bridge of my nose, directions in one hand, and taser in another. The directions said that a one-second burst would shock and disorient your assailant; a two-second burst was supposed to cause muscle spasms and a major loss of bodily control; a three-second burst would purportedly make your assailant flop on the ground like a fish out of water. Any burst longer than three seconds would be wasting the batteries. All the while I'm looking at this little device measuring about 5' long, less than 3/4 inch in circumference; pretty cute really and (loaded with two itsy, bitsy triple-A batteries) thinking to myself, 'no possible way!' What happened next is almost beyond description, but I'll do my best... I'm sitting there alone, Gracie looking on with her head cocked to one side as to say, 'don't do it dipshit,' reasoning that a one second burst from such a tiny little ole thing couldn't hurt all that bad. I decided to give myself a one second burst just for the heck of it. I touched the prongs to my naked thigh, pushed the button, and . . . HOLY MOTHER OF GOD . . . WEAPONS OF MASS DESTRUCTION . . . WHAT THE HELL???!!! I'm pretty sure Jessie Ventura ran in through the side door, picked me up in the recliner, then body slammed us both on the carpet, over and over and over again. I vaguely recall waking up on my side in the fetal position, with tears in my eyes, body soaking wet, both nipples on fire, testicles nowhere to be found, with my left arm tucked under my body in the oddest position, and tingling in my legs. The cat was making meowing sounds I had never heard before, clinging to a picture frame hanging above the fireplace, obviously in an attempt to avoid getting slammed by my body flopping all over the living room. Note: If you ever feel compelled to 'mug' yourself with a taser, one note of caution: there is no such thing as a one second burst when you zap yourself! You will not let go of that thing until it is dislodged from your hand by a violent thrashing about on the floor. A three second burst would be considered conservative? SON-OF-A-BITCH, THAT HURT LIKE HELL!!! A minute or so later (I can't be sure, as time was a relative thing at that point), I collected my wits (what little I had left), sat up and surveyed the landscape. My bent reading glasses were on the mantel of the fireplace. The recliner was upside down and about 8 feet or so from where it originally was. My triceps, right thigh and both nipples were still twitching. My face felt like it had been shot up with Novocain, and my bottom lip weighed 88 lbs. I had no control over the drooling. Apparently, I shit myself, but was too numb to know for sure, and my sense of smell was gone. I saw a faint smoke cloud above my head which I believe was coming from my hair. I'm still looking for my nuts and I'm offering a significant reward for their safe return!! P. S. My wife loved the gift, and now regularly threatens me with it! 'If you think Education is difficult, try being stupid.'

I didn't see this one listed already, so I submit: "Blame It On The Moon" - Katie Melua