Should People With Infectious Diseases Be Allowed in EMS?

[sledogg1]

Easy...........NO

[JPINFV]

1. Source [including section/sub section] for it being a person's "right" to seek what ever career they choose.

2. Source for having a contagious disease be a protected class [similar to age, sex, color, creed].

3. The problem I have with people infected with an airborn/contact/droplet contagious (really, I don't care if someone has a pinworm infection. Oral-fecal route shouldn't be a problem if the provider is practicing decent hygiene. Scabies on the other hand) diseases is that they are exposing their patients to the disease. I think there can be an argument for excluding immunocompromised people from patient care because they are more at risk of contracting a disease and not showing signs/symptoms of a disease [example: PPD tests might not be accurate in immunocompromised patients because they simply aren't able to react to the protein], but that should be on a person by person decision.

[Jinketsu]

THIS is the real question, and I'm afraid I forget who raised it (Sorry!) My theory is, anyone who is contagious with an airborne disease should be restricted from patient care until they are no longer contagious (this includes those who are TB+, the flu, the common cold, or anything else), but anything that requires extraordinary measures (i.e. blood contact) should not be restricted at all. The point that an infectious (NOT contagious) person with any kind of chronic ailment should be restricted should be the point at which they are no longer able to perform patient care (due to disease process, medication side effects, whatever).

interesting.... its nice to know that someone has given this some serious thought and has given their own opinion on it.

as ems providers we are subjected to so many diffrent hazords a day and in the city that i work in we barley get any protection from anything because we are not firefighters/ems.,thats seperate here but in my time as an emt(5 years) i have gooten so many uri's and numerous cuts and scars from the job but at the same time are we not screened before we go into the ems system where we are about to help people.and are we not required not only by our protocols but also by our general traning as a whole to question every paitent and treat every one like they may have an infectios disese on them at all times?

if a person has tb are we not supposed to cover them up with a mask as well as do the same for ourselves.yes i know there are people who do not want to tell us some things about their medical history because we are not doctors but if you are really that worried about infection then do one of two things.......either work in a haz-may suit at every call until you get back to your station or quit being EMS because we knew what we were getting into and if you think about it you are more likely to get sick in the streets walking around than you are from a paitent.....especially if you live in a city where you take crowed mass transit like new york city has

basicly what im trying to say if you didnt understand it was that if they can pass the medical clearance then anyone should be allowed to work EMS and dont complain about it if you get sick because thats what we deal with....sick people

[Lone Star]

I have read alot of the posts in this topic, and I have to say, I am surprised at some of the responses. Discrimination is not limited to race or sex or religious beliefs, it is also discriminative to exclude a person from their constitutional right to seek whatever career makes them happy just because they had or have a disease. Right now, if a person has committed and was convicted of a felony, in most cased they are automatically disqualified from applying for a job with Fire or EMS, that was their choice to commit that crime, Now, people don't always contract a disease like the afore mentioned from illicit drug activity or unprotected intercourse, there are plenty of babies born with those types of diseases every day, and some are purely and simply accidental, so should those people have lesser rights than the rest of us? Absolutely not. Compassion for others and the ability to put yourself in the shoes of others, who are by no choice of their own less fortunate than you, should be a part of all of "us" who joined the Fire and EMS service to help others, now do I want to be worked on by a person with HIV or AIDS or any other contractible life altering disease? Not really, but who's to say I haven't been already? and who's to say it should be illegal? My opinion is that we as a society, should not let our fear allow us to discriminate against other less fortunate people, all in all we are ALL God's creation, brothers and sisters who are called to "love one another"

Show me, in the United States Constitution, where anyone is guaranteed by that document, or the Bill of Rights, or the amendments to the Bill of Rights, that we are guaranteed by our creator the unalienable right to gainful employment that just makes us all warm and fuzzy happy every day! (no, the 'persuit of happiness does NOT guarantee the career choice!)

basicly what im trying to say if you didnt understand it was that if they can pass the medical clearance then anyone should be allowed to work EMS and dont complain about it if you get sick because thats what we deal with....sick people

So if you're working on a HIV/AIDS positive patient, or one with hepatitis A/B/C, or TB positive patient, and you contract that disease...its no big deal because after all, "thats what we deal with"?

[Miz Black Crow]

2. Source for having a contagious disease be a protected class [similar to age, sex, color, creed].

JPINFV, please see the first post in this topic.

...it seems that those individuals rights are protected under the ADA (Americans with Disabilities Act),

...I think there can be an argument for excluding immunocompromised people from patient care because they are more at risk of contracting a disease and not showing signs/symptoms of a disease [example: PPD tests might not be accurate in immunocompromised patients because they simply aren't able to react to the protein], but that should be on a person by person decision.

Didn't you just counter your own argument? Immunocompromised patients, ESPECIALLY those with a background in healthcare, are (or are made to be) VERY aware of the ramifications that illness has on their body, their reactions to disease and infection, and the possibilities regarding their ability to continue working. What you just said boils down to, 'it's the provider's choice, knowing the impairment that their body has and its lessened ability to fight infection of any kind, whether or not to continue working with the sick and injured.' I could choose to juggle fire for a living, knowing fire can burn. If I get burned doing it, it was my choice to make, not anyone else's. If my skin is extra-flammable for some reason (say, for example, bathing in alcohol and diesel fuel is some new treatment for acne), and I choose to do it anyway.... IT'S STILL MY CHOICE. In the end I'm not going to have anyone to blame except myself if I catch on fire and burn to cinders in the street.

However, it's not the risk to the provider that we've been discussing; it's the risk to the patient. Which, until someone finds hard scientific data on providers exposing patients to the provider's blood or BBPs, I'm going to write off as "negligible" and move along.

~Miz Black Crow

[Jinketsu]

Show me, in the United States Constitution, where anyone is guaranteed by that document, or the Bill of Rights, or the amendments to the Bill of Rights, that we are guaranteed by our creator the unalienable right to gainful employment that just makes us all warm and fuzzy happy every day! (no, the 'persuit of happiness does NOT guarantee the career choice!)

So if you're working on a HIV/AIDS positive patient, or one with hepatitis A/B/C, or TB positive patient, and you contract that disease...its no big deal because after all, "thats what we deal with"?

first of all isnt there something called the discrimination act,i could of swore that was a part of civil rights that is in the constitution....

and if i got aids from a person,yuea i would be fucking pissed but im not going to blame it on the system.i knew the risks when i took the job and if i didnt take the neccisary prectaions then its my fault.and in all seriousness here,when was the last time we heard about anyone in ems getting THAT sick from a pt.if you use BSI and take take your time then your chances are lessened greatly.

and like i said,if your THAT scared then your in the wrong business.

[JPINFV]

first of all isnt there something called the discrimination act,i could of swore that was a part of civil rights that is in the constitution....

Closest thing I could find was amendment 14.. To be able to use that as justification, though, you would also have to prove that disease status is a protected class AND that gainful employment in a field of a citizens choice is a right. Some diseases might be protected (AIDS?), but the vast majority are not. Furthermore, there is no guarantee that people get to go into the field that they want to.

and if i got aids from a person,yuea i would be fucking pissed but im not going to blame it on the system.i knew the risks when i took the job and if i didnt take the neccisary prectaions then its my fault.and in all seriousness here,when was the last time we heard about anyone in ems getting THAT sick from a pt.if you use BSI and take take your time then your chances are lessened greatly.

and like i said,if your THAT scared then your in the wrong business.

I think you're confusing the issue. The issue is not whether people with infectious diseases are treated by EMS. The issue is if people with infectious diseases can be EMS providers. These are two separate issues completely.

[Dustdevil]

I think you're confusing the issue. The issue is not whether people with infectious diseases are treated by EMS. The issue is if people with infectious diseases can be EMS providers. These are two separate issues completely.

After reading his previous post, his confusion cannot possibly be surprising to you, can it? In only his first five posts, he firmly established a pattern of confusion, to put it mildly. Too much time spent on role playing fantasy games tends to distort one's ability to maintain a focus on reality.

But, back to the topic, and as JPINFV alluded to, those with infectious diseases can legally be excluded from performing patient care. This is well established. Rubella, Rubeola, Varicella, Typhus, Hep A, and Pneumonic Plague are all infectious diseases that would absolutely prohibit you from direct patient care, and established law would support that restriction. If you found out that the restaurant you fed your family at last night was knowingly employing food handlers with any of those diseases, you would understandably raise hell. So there is legal precedent for excluding infected persons from patient care jobs. That is not even a valid question. The only remaining question is, which diseases do and do not fall into that category. Unfortunately, there is disagreement between medical and legal authorities on the matter. But, as for me personally, I'd rather allow the risk of Varicella transmission than HIV transmission. That just seems to be a no-brainer to me. And only somebody who has never taken microbiology could possibly be so silly as to debate this.

[Jinketsu]

to descrimintae against someone who has a disease AND is healthy enough to work meaning they are not calling out sick every other day or something of that nature is kinda messed up because the public is afraid of the EMS proviver who shows up giving them something...its called BSI

i could care less if my co worker had aids,im not sleeping with them and if im working with them and caring for a pt im going to take neccisary bsi to keep from both being contamintated and giving the pt whatever i may have at the same time

[Eydawn]

Having had a medical microbiology primary literature based course, I find plenty to debate here. Infectious diseases are influenced by so many variables in terms of their contagion level and deleterious effect on the host; so much so, that as with many other isses, putting out a blanket decree in terms of who is and is not allowed to continue working as a HCW is a rather stupid idea.

While there may be legal precedents for excluding contagious individuals from certain activities, or even restricting their physical and legal freedoms (to wit, the arsehole with antibiotic resistant TB that's locked up in a hospital in Denver somewhere... who flew around the world *knowing* he was contagious), it does not mean that any indication of disease status is an automatic signal for the appropriateness of said restriction.

I disagree with Dust. I would not rather see Varicella OR HIV transmitted, as both have dangers to specific populations that can be equally lethal, and I would like to see precautions taken that cover both. Those precautions may involve a period of isolation, or extra PPE measures, but do not necessarily have to include banning the person from being a HCW ever again.

I believe it comes down to the issue, again, of infection vs level of contagion. You may just have been infected with HIV and just found out about it, but your immune system may not weaken for years to come. If you take the precautions that we all take in terms of not exposing one another to bodily fluids, why shouldn't you continue working?

I'd much rather see employees who come down with illnesses that are spread in an airborne or other highly contagious fashion be given a forced leave until they are no longer contagious (kind of like how I couldn't go to work until I had been on antibiotics for 48 hours when I had strep throat a couple weeks ago).

I think this is much more pertinent to protecting our patients than forcing an HIV+ nurse to quit just because she carries HIV in her body. Same with Hepatitis... if you've had it, but are no longer contagious, your history shouldn't preclude you from the employment of your choice as long as you meet all the requirements.

As a side note.... those who don't want to see a zing in Dust's direction, jump off the thread here.

Dust, would you knock off the holier than thou for I am educated bit? It's starting to get rather irritating. Just because we would like to debate this highly pertinent issue and tease out the nuances doesn't make us ignorant. I think blindly accepting everything you're taught and never questioning it is much dumber... and that the best way to learn is to challenge something, examine it from another perspective, and then return to the issue to see where you really stand.

Perhaps it is much easier for someone with your lengthy experience to automatically know where they stand on the issue... but it doesn't necessarily automatically ensure that you are correct, nor that others' opinions are invalid or "silly." Also, I feel that there are many who have contributed to this discussion that *have* taken microbiology.. yet there are still things to discuss. Just my honest opinion. If this gets too hairy, let's take it to PM

Wendy

CO EMT-B