Should People With Infectious Diseases Be Allowed in EMS?

[ccmedoc]

See, the thing is...we are supposed to be health care professionals and, as such, we are supposed to have additional knowledge through education on these topics. We are supposed to know, for example; how the diseases are transmitted, the latency of certain viruses (approximate), and the proper way to protect ourselves and the patient from infection, to name a few. Like it or not, the public expects this.

Given this knowledge it is expected that the professional, acting as a professional, should know to take every precaution to limit the chance of infecting themselves or the patient. Often times, this is not entirely possible. To say that a health care worker should not work every time they have a sniffle is asinine. But these same people pose a very real threat to immunocompromised individuals whether they be cancer patients, HIV patients, or simply elderly. We need to know how diseases are transmitted, with reasonable certainty, and how to minimize the risk of transmission.

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?

The risk is acceptable when the HCW has taken the appropriate precautions, based on evidence based research, that minimize the chance of transmission to the lowest possible degree. As I mentioned earlier, to a growing demographic..the elderly.. a seemingly simple cold or 'sniffle' and pose a potential deadly threat.

Should you be held accountable for transmitting this illness and the ensuing long hospitalization and death??...

We are supposed to know the dangers, and the limits to which we can function effectively while minimizing said dangers.

A risk is considered unacceptable when all rationale and knowledge of the disease process and probability of transmission are ignored. I would say that crawling around an MVC with blood and body fluids present, without the proper protection (i.e. Leather gloves, turnouts or other protective clothing, helmet with mask, etc.) would pose an unacceptable risk to the HCW and patient alike, healthy or unhealthy.

I would suppose a better question to ask is how do you determine when a HCW is too high of an infection risk?

The HIV , TB, and Hep B that has been cited in numerous posts can certainly kill, and may be dormant in the body for years before presenting with symptoms. Far from a death sentence.

The same HCW with a sniffle or chest congestion can pass a seemingly harmless bacteria or virus to an elderly or otherwise compromised patient, and death can follow in a matter of weeks....Who is the 'acceptable risk'? Is is realistic to say that these HCWs should stay home until the sniffle is gone?

One last thing..it was brought up about universal precautions not being a guarantee from infection. I would say that these precautions do, in fact, minimize the chance of infection to the lowest possible factor. The precautions are, in fact, guidelines to follow and not the equipment proper. To ignore common sense and put the HCW and patient at unnecessary risk, as extrication without the proper equipment, is negligence...IMHO.

[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,....

[mrmeaner]

So I'm grateful that you all have taken the time to share your opinions.

Likewise. Considering that the rules have been written and the laws have been made, this wil remain what it is: expression of opinions. I still believe the discussion is worthwhile, though. Sometimes the idea of changing someone's mind isn't as intriguing as the idea of someone changing mine.

I guess my biggest point is that even though you may see the risk as minimal, the patient may not. That isn't to say that the pt. always has reasonable expectations.

I'll be interested to see what you find, Lone.

[chbare]

Ok then. Allow me to throw out a question? What makes you so sure prohibiting people with these diseases from working EMS will make your job so much safer? I fail to see how this will significantly improve patient safety. In fact, I suspect placing restrictions will only galvanize people into hiding their medical history or not seeking proper treatment because they do not want to loose their job. Somehow, I fail to see how this makes my work situation safer.

From what I gather, somebody had some kind of incident at work and now they are entertaining the idea that somehow restrictions would have created a safer environment? Regardless of our feelings and opinions, we need to carefully consider the sequelae of our actions. look at the big picture if you will.

In addition, we need to face the fact that these diseases are not going away and I cannot see a simple solution. Please correct my thinking; however, I do no think the solution is as cut and dry as some people seem to think.

To answer the question asked earlier. Yes, cutting my hand in an environment filled with blood and gore would be cause for concern. I am unsure how this relates to the topic at hand however.

Take care,

chbare.

[firedoc5]

I guess my biggest point is that even though you may see the risk as minimal, the patient may not. That isn't to say that the pt. always has reasonable expectations.

I'll be interested to see what you find, Lone.

That is something to think about. What if the patient finds out later that the medic that had treated him had/has some specific disease? When the patient finds out is freaks, "That medic had WHAT???". Will he want to sue? Be tested time and time again? Who knows what kind of legal action he may want to pursue.

[VentMedic]

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.

The IAFF already has done the research and posted their references which I referred to in a previous post.

Your employer, if you are employed in a company with more than 15 employees, also will have a copy of the CDC and OSHA quidelines that they follow.

You're not doing any new research that hasn't already be thoroughly studied, tried and trialed.

Read your company's P&P manual as they should also site their references especially when it comes to certain regulated state statutes and Federal law.

Of course if you choose to do selective reading you can find agruments of all types to support your own opinion although the source may not always be the most reliable. You can also select one sentence from an article published by the CDC to use at your own choosing and form your own interpretation. I think this has been done with the Bible for other purposes and specific agendas.

At far as a patient being informed of an employee's HIV or Hep C status? NO! How many people would want to even consider healthcare if they privacy was not respected and yet must respect the patient's privacy. My life is an open book for no one unless I myself make that information available to them. Most of the time even the HCWs don't always know what a patient has until we work them up for something. And even then, not every employee in the medical environment is entitled to all the information. A patient is NOT bound by any privacy agreement if given that information and could annouce it at the next town hall meeting if they so desired.

Now for those in EMS that are getting hurt and bleeding everywhere at scene. If this is acutally happening on a regular basis maybe some additional training on scene safety and extrication is needed for your EMTs and Paramedics. The FFs don't get themselves all cut up and dripping blood when they extricate a wrecked mess prior to me and my helicopter arriving. If there are FFs around, let them do the stuff they are better trained for so you don't get hurt.

How do you treat your patients? Most of them as I mentioned, as well as others, before will not tell you if they have an infectious or contagious disease and many may not know they have something.

I think education is the key here. Florida had (past tense) required HIV education with every license and recert for all professions.

With the EMT being only 110 hours and the Paramedic at 1000 hours, there is very little time to cover much of anything thoroughly. It is possible that some EMTs and Paramedics do not have enough information and education to form a scientific conclusion on some things in the medical profession. College A&P x 2 semesters, Microbiology and Pathophysiology should be required before either level is attempted.

[mrmeaner]

In fact, I suspect placing restrictions will only galvanize people into hiding their medical history or not seeking proper treatment because they do not want to loose their job.

By not disclosing the information to the employer or the patient (not making any accusations here), aren't they already hiding it in a sense? I do understand your point and it does not take any stretch of the imagination to see it happening. The idea is certainly not to make people guilty about or afraid to get treatment for a disease.

Ok then. Allow me to throw out a question? What makes you so sure prohibiting people with these diseases from working EMS will make your job so much safer? I fail to see how this will significantly improve patient safety.....Somehow, I fail to see how this makes my work situation safer.

Much safer, no, probably not. Nobody is claiming this to be a pandemic or even a very significant cause of morbidity or mortality. But safer, yes, I believe so. Two months ago, we had an EMT who cut herself putting the rig back together. She didn't realize it was her blood until someone else saw that she was bleeding. Not significant, but it would have been enough.

That is something to think about. What if the patient finds out later that the medic that had treated him had/has some specific disease? When the patient finds out is freaks, "That medic had WHAT???". Will he want to sue? Be tested time and time again? Who knows what kind of legal action he may want to pursue.

I say there's a pretty good chance there would be a lawsuit. Not that anyone but the lawyers would win unless there was an actual transmission of the disease.

[katgrl2003]

By not disclosing the information to the employer or the patient (not making any accusations here), aren't they already hiding it in a sense? I do understand your point and it does not take any stretch of the imagination to see it happening. The idea is certainly not to make people guilty about or afraid to get treatment for a disease.

Why would we disclose it to the patient? Yes, your employer should know, but why should the patient? My hepatitis status has nothing to do with my treatment of a patient. What possible effect would sharing this information have, other than scaring them?

-Kat

[chbare]

The idea may be filled with the best intentions; however, I am not talking about idea. I simply want people to look at the results or potential results. Making a law that prevents people with these diseases from working EMS is fine and dandy until we really consider the consequences.

Would it be hiding information or lying to their employer? Would it be considered wrong? I really do not care. I still maintain that proceeding down this road could open a can of unintended consequences that will only complicate the problem and cause additional problems.

I am not looking at this with my heart on my sleeve or with any significant emotional attachment. I am simply considering the pit falls of such a move. I do not see any great benefit to the patient or the provider when considering the potential consequences.

Take care,

chbare.

[Just Plain Ruff]

I can see that Mr. 9 posts to his name has not come back and made any more comments. To me that speaks volumes to his credibility and I will treat that credibility for what's it worth, NOTHING> .