Should People With Infectious Diseases Be Allowed in EMS?

[ccmedoc]

Many of your patients are immunocompromised enough as it is and adding our infection to their mix can be a deadly thing.

Going with this though; if you are sick with strep or another virus, or the common cold, do you think these could lead to complications quickly leading to death....certainly. There is probably a greater risk of these, droplet and airborne viruses and bacteria, infecting your patient than hepatitis or HIV..

Would you be held in the same irresponsible light?

[Lone Star]

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?

[Don1977]

Someone with the diseases that Lone Star mentioned should not be in EMS period!

[JPINFV]

Does anyone have any actual data on the actual transmission risk (similar to the risk of HIV transmission in a needle stick. Note: HIV risk from a needle stick is 0.3% (percutaneous), 0.09% for mucus membranes, 6-24% for Hep. B, and 1-10% for hep C. (Hep is going from an infected patient to a non-immunized provider)*) for transmission from provider to patient? It would be interesting to know how much of this is based on science and how much is based on hand waving freakoutery/emotion.

There is a distinct difference between a 6-24% risk/needle stick incident for HepB and a <1% risk for HIV. If the numbers are similar, it would be interesting to compare transmission rate of needle sticks to ambulance collisions when transporting or responding with lights and sirens.

*transmission risk is from the E-medicine article "Needle-stick Guideline".

http://www.emedicine.com/EMERG/topic333.htm

[VentMedic]

Lonestar, Are you referring to the Kimberly Bergalis case and her dentist in Florida 20 years ago? That dentist was truly the exception and not the norm.

As far as dentists losing their license because they have HIV:

http://www.ada.org/prof/resources/topics/hiv/legal.asp

Is HIV/AIDS education not done anymore in EMT or Paramedic school? Are updates not done at any of the recert classes?

This is the IAFF position on FF and EMS personnel with infectious diseases including HIV.

http://www.iaff.org/et/JobAid/InfDis/What_...t_screening.htm

Manual on infectious diseases which should be required reading regardless of the source.

http://www.iafflocal21.org/docs/IAFF%20Inf...se%20Manual.pdf

You can also search the CDC for their position. As I mentioned before, it all depends on the job description. Making a blanket statement for all EMTs and Paramedics is not appropriate and only shows a "knee jerk" attitude of your own.

As far as the nurse and doctor safe environment thing:

When you consider the number of patients and open wound care that nurses and doctors see on a daily basis, it is not even a close comparision in most cases.

Yes, JPINFV, the CDC has the stats.

[gvandellen]

I have rarely gone to work sick. No matter how much money I was going to lose. If I'm sick I'm sick and I am rarely sick so I know that when I get sick I am really sick.

But see that is the problem. Rarely means that you have done it. Your first call of the day could be for a febrile 50 Y/O cancer patient. Your rarely could kill them. The problem is no employer will allow you to call out sick for every time you get a 24 hour cold. So it's sort of a catch-22. Do we risk not infecting our patient knowing we truly shouldn't be working? One cough could harm. I've had exposures to patients and unless it was a hollow needle stick I barely even thought of it the next day. The odds of an HIV positive EMT working a car accident even around all that glass and sharp metal wearing proper gear exposing the patient would be astronomical. I could think of a lot of other ways to harm my patient by my mistakes. HIV or HepB/C are not actively contagious diseases like TB due to it's route of infections so for an HCP to have one of those diseases would have effect on their ability to work.

We sure find a lot of reason for people not to do our job. We aren't that special.

Let's run down the list.

Can't be depressed or bipolar? Medication apparently doesn't help people. Guess I don't need a drug box on calls.

Can't have a missing limb? Prosthetics could never substitute for a real leg. It might snap off when I'm putting someone in the ambulance and drop them.

Can't wear glasses of contacts? Might fall off or out and then they can't see. I certainly don't want people in the military with glasses. How can we trust that they have the right prescription and are seeing 20/20. I don't want someone like that as a partner in my squad.

Certainly can't be overweight? They may not be able to get in a good position to put in an ET tube in a confined space.

Can't be older then 50? Your just not as sharp as you used to be and your critical thinking skills could be hindered.

Can't be female! Their compassion will get in the way and the are way to weak to lift a patient by themselves.

Now we can't have any disease as well because there is a 1 in 1 BILLION chance we could infect a patient?

EMS job ad - 18 to 35 year old male with clean bill of health, no glasses or contacts, all original limbs intact, must be athletic, BMI no greater than 16. Must have perfect immune system to avoid all viruses. Must retire by 50. All others need not apply.

[DwayneEMTP]

Going with this though; if you are sick with strep or another virus, or the common cold, do you think these could lead to complications quickly leading to death....certainly. There is probably a greater risk of these, droplet and airborne viruses and bacteria, infecting your patient than hepatitis or HIV..

Would you be held in the same irresponsible light?

Three things...First, I think when operating from your perspective you should feel obligated to answer the above question.

Second, I think you have gone completely insane.

Third, it seems obvious, unless you've simply skipped over posts such as VentMedic's, that you're bringing your personal fears and predjudices to this conversation. You and I often agree on things...but there is simply no logical/factual support for your point of view that I can see...at least none that has been shown to date.

Someone with the diseases that Lone Star mentioned should not be in EMS period!

Nice Don, way to go buddy! Do you just look up some days and think,"Oh my god! I haven't posted anything in a couple of days!" And then simply post the first silly thing that pops into your head?

Have you not noticed that many here actually support their thoughts and ideas with lines of logic? I completely disagree with LS, but at least he showed me the respect to explain where he's coming from.

In the future, please, take a minute to at least partially digest your thoughts before flushing them over the rest of us.

Thanks.

Dwayne

[NREMT-Basic]

Isn't this just common sense?

I seem to recall an old adage "First, do no harm"

Seems like someone with HIV or Hep-c or Hep-b could be a nightmare.

I have excema on my fingers. This causes the skin around the excema to split open and bleed slightly. I always covered those with liquid skin and then bandages and then gloves so I know the patient was protected.

I was more worried about patient to me versus me to patient infections but I was never 100% positive that I was completely protected.

Here is my list of conditions that either preclude you from working in EMS or would require you to sit out until you are better.

HIV(preclude)

Hep a - sit out till better

All the other heps - precludes you from workin in EMS

TB - precludes you from working

Ebola (if you survive you can work again) ha ha ha

That's just my starting list

What about MRSA/VRSA? :shock:

[LisaO925]

EMS job ad - 18 to 35 year old male with clean bill of health, no glasses or contacts, all original limbs intact, must be athletic, BMI no greater than 16. Must have perfect immune system to avoid all viruses. Must retire by 50. All others need not apply.

Well, Im screwed then :shock:

[Don1977]

Three things...First, I think when operating from your perspective you should feel obligated to answer the above question.

Second, I think you have gone completely insane.

Third, it seems obvious, unless you've simply skipped over posts such as VentMedic's, that you're bringing your personal fears and predjudices to this conversation. You and I often agree on things...but there is simply no logical/factual support for your point of view that I can see...at least none that has been shown to date.

Nice Don, way to go buddy! Do you just look up some days and think,"Oh my god! I haven't posted anything in a couple of days!" And then simply post the first silly thing that pops into your head?

Have you not noticed that many here actually support their thoughts and ideas with lines of logic? I completely disagree with LS, but at least he showed me the respect to explain where he's coming from.

In the future, please, take a minute to at least partially digest your thoughts before flushing them over the rest of us.

Thanks.

Dwayne

I don't know what you mean Dwayne, I thought I said it plain and simple.......