Should People With Infectious Diseases Be Allowed in EMS?

[katgrl2003]

Kat, I can't even figure out what you are talking about. If you really don't see a difference, then you must have zero experience in emergency healthcare. What we reluctantly accept when our backs are against the wall, and desperate for lifesaving options, is indeed very different from what we prefer and demand on a day-to-day basis. Pragmatically weighing your options is simply part of human nature.

Ok, please forgive me. It was a result of just waking up and checking the city while trying to get ready for work. Note to self: don't post when you're still half asleep.

-Kat

[DwayneEMTP]

I've also noticed that the question hasn't been answered by anyone since I posted it.....

Which question?

[VentMedic]

How about this question: How many healthy EMTs and Paramedics expose their partners, many, many HCWs, bystanders and other patients to TB, Hepititis, Pertussis, Varicella and Meningitits (along with many other bacterial/viral diseases) with the exhaust from the BVM, portible ventilator or CPAP on a daily basis?

Since we can determine which patient someone is infected from, should we prosecute those who have no regard for others when bagging a pt? It is rare that some EMS workers are mindful of what or who they are spraying when they enter the ED. This can include bloody droplets sprayed on HCWs and any equipment in the area. THIS IS A COMMON OCCURENCE and not one of those "what if" scenarios that have been tossed around on this thread.

Getting sprayed by BVM or Ventilator spray is probably one of the leading causes for occupational exposure in the ED and is responsible for many HCWs testing positive for TB. Hopefully their body's immune system keeps it as latent. If EMS was more diligent about testing for TB and Heptitis, they would find many people working that are positive for something and not symptomatic. Many systems only test the employees involved if a hospital notifies them of an exposure.

In EDs, the employees know that strict universal precautions are required for resuscitation of any type. The hospital can also choose not to cover the employee for workmen's comp claims if they violate precautions.

As far as the original question, I think I made my answer pretty clear.

TB should not have been even included in the question and just shows how little education about very important issues is in the EMS field for some.

[Lone Star]

Which question?

This one:

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,....

[chbare]

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.

[gvandellen]

Sorry, but it comes back to my belief that the patient should have the right to decide whether or not your disease is significant to him.

The public aka the patients opinion is based on FOX news driven hysteria however, fine you don't want an doctor for an elective procedure but in prehospital EMS it's hard enough to find good people. Some one just brought up a good point abut false positive result and that made me think the following for all that oppose the infected.

I have been working 7 years now medicine. I spent my first few years as a hospital transporter, I've work 5 years in the ER and as an EMT, and now I'm an active 911 paramedic. I have been exposed 5 times in 7 years. I've been stuck, I've had a mouth full of blood spit in my face where you could see the blood running from my eyes from a patient that had a seizure in a hallway that was a known Hep C pt (the only time I took the drugs BTW). I've had IV tubing filled with blood from a patient I never even saw squirt into my face and eyes, I've been bit, and last year I had an IV fling blood in my eyes while placing an IV in an overdose and someone didn't quite have the arm held down. All unfortunate, but my point being, should I not work for 6 months each time I'm exposed for that slight risk that I may in fact infect someone else. If you have never had an exposure or aren't familiar with the process then here it is. Exposure, blood draw for baseline, (medication if wanted), 1 month blood draw, 3 month blood draw, 6 month blood draw. The last blood draw clears you. So at any point in this series I could infect someone because I myself don't know. Should I not be allow to work now? Should I be allowed to take disability for 6 months each time I get an exposure from helping a patient. Should my education be wasted when I am in great shape and perfectly capable of working? I know a LOT of people in the 6 month system right now and that would wipe out a lot of staff for maybes. If you get an exposure (and this is for people opposed) would you stop working? You may be a carrier now and not even realize it. Who's gonna pay the bill each time I have a really bad day? Should I not have sex with my wife because I could infect her? Exposures suck and I have been unlucky to get them but fortunately never to have gotten anything. If you have gotten exposed yet then good for you but it can happen. Again not directed at Ruff, If you are exposed should we write you off?

BTW I really didn't mean a death sentence as in dying. HIV, HepB/C, TB all require big lifestyle changes from lots of meds to not being able to drink in certain stages. Lifestyle changes that people do not want to make when they are young and healthy.

[tniuqs]

Quoting Dust:

That's not even a remotely valid question, with respect to the current discussion. The valid question would be, if someone you loved more than life itself was laying there dying, and you had a choice of a healthy, disease free paramedic and an HIV positive paramedic treating them, which would you choose? .

Interesting point in a perfect world, just for counterpoint and discussion:

A Disease Free Paramedic .... agreed this in a perfect world ALL would be, yet this is hardly a perfect world. My point prior and I will expand just a bit, that it is quite impossible to assure this lofty goal based on many disease process, due to pathology. So introduction of other diseases that infectious/contagious could/may be carried by a HCP... for good measure, bear with me svp.

Strep can be harboured in the renal system, who out there has been treated for strep throat and worked the 2 days before they booked off ?

They were infected.

Organisms of resulting in meningitis (many organisms) can be carried in the nasal mucosa.

Have you been checked lately?

After all, we're talking about whether or not those people should be in the field in the first place

YES we are.

Just my 2 cents but if I worked with an extremely well educated / experianced Paramedic, that was knowingly infected, took all precautions possible, (most likely more intelligent than the rest of we morons to boot) I personally have no issues with this at all, none, zip, zero, WHY because I know the risk assessment.

Lets talk STIGMA: I just can not imagine the daily nightmare that a male nurse (that may even BE of difference sexual preferance) and due to that, BELIEVED to be a possible carrier of HIV due to the uninformed, red necked, lay patient, those proud gradute (s) of fine preschool education, could we be perpetuating sterotypes in fact ?

In conclusion as this will be my last post on this topic as I believe my position is more than Crystal Clear, education is the key to understanding all of the issues with the known and unknown infected HCP.

Pragmatic vs Idealistic, Does this not become a MUTE thread now ? Those that actually have read all the points/ counterpoints of ALL posts, we walk away from this being better educated, hopefully a bit more tolerant is my wish.

CAN YOU BELIEVE that Princess Diane .... actually touched and gasp "without a gloved hand" children that were KNOWN to be infected with FULL BLOWN AIDS, she was not afraid as she was educated and through her actions this affected the World.

ringo I try so hard to be the good shepard.

[mrmeaner]

The public aka the patients opinion is based on FOX news driven hysteria however, fine you don't want an doctor for an elective procedure but in prehospital EMS it's hard enough to find good people.

It does not change the fact that you are making the decision that it is acceptable to put the pt. at risk for developing a disease without them knowing it. Are you saying that if you removed all EMS providers that have Hep B, Hep C, HIV and AIDS from you service that you would be significantly short staffed?

I have been working 7 years now medicine. I spent my first few years as a hospital transporter, I've work 5 years in the ER and as an EMT, and now I'm an active 911 paramedic. I have been exposed 5 times in 7 years. I've been stuck, I've had a mouth full of blood spit in my face where you could see the blood running from my eyes from a patient that had a seizure in a hallway that was a known Hep C pt (the only time I took the drugs BTW). I've had IV tubing filled with blood from a patient I never even saw squirt into my face and eyes, I've been bit, and last year I had an IV fling blood in my eyes while placing an IV in an overdose and someone didn't quite have the arm held down. All unfortunate, but my point being, should I not work for 6 months each time I'm exposed for that slight risk that I may in fact infect someone else. If you have never had an exposure or aren't familiar with the process then here it is. Exposure, blood draw for baseline, (medication if wanted), 1 month blood draw, 3 month blood draw, 6 month blood draw. The last blood draw clears you. So at any point in this series I could infect someone because I myself don't know. Should I not be allow to work now? Should I be allowed to take disability for 6 months each time I get an exposure from helping a patient. Should my education be wasted when I am in great shape and perfectly capable of working? I know a LOT of people in the 6 month system right now and that would wipe out a lot of staff for maybes. If you get an exposure (and this is for people opposed) would you stop working? You may be a carrier now and not even realize it. Who's gonna pay the bill each time I have a really bad day? Should I not have sex with my wife because I could infect her? Exposures suck and I have been unlucky to get them but fortunately never to have gotten anything. If you have gotten exposed yet then good for you but it can happen. Again not directed at Ruff, If you are exposed should we write you off?

Until you are cleared you should be off work and covered by Workers' Compensation as it happened at work. Well, unless they found out that you weren't taking BSI precautions. Then they probably wouldn't cover you.

[Lone Star]

You can't see how it relates to the topic at hand? Let me see if I can break this down into words you might be able to follow...

You were concerned when you cut your hand while in a blood covered environment.....but for a person with HIV/AIDS/Hepatitis A/B/C....because they're an EMT....the risk is suddenly acceptable with the job title......I would LOVE to see the 'logic' on this one!

How is it that the risk becomes 'acceptable' because the infected person is an EMT and 'unacceptable' when the infected person is just a member of the public, and a patient?

[Dustdevil]

The public aka the patients opinion is based on FOX news driven hysteria however...

Ya know, anytime you preface a point with some nonsense about "Fox news driven hysteria," you lose about three-quarters of your audience before you even get to your point. You lost me. But hey, at least that's three minutes of my life I didn't waste reading your post, so thanks for the warning.