Refuse Rx to HIV/HEP patients?

[Doug]

This is a separate "response" to another topic about healthcare workers being banned for their HIV/HEP status.

Some argue that healthcare workers with HIV/HEP (in some cases even cold/flu) should no longer be allowed contact with patients. It seems to me that the logical extension of this argument would be that if the HIV/HEP status of a pt is known that the healthcare provider should be allowed to refuse treatment. I mean if one is so concerned that an HIV/HEP infected healthcare worker with no open wounds and taking proper precautions is kept from practicing then certainly we can't ask EMS personnel to enter into a car with open wounds/sharp edges and bone fragments, you can't ask a nurse/paramedic to intentionally pierce the skin of such a pt. by starting an IV and cause potential exposure, you can't ask a surgeon to possible expose themselves and end their career by coming in contact with a pt. who needs emergency trauma surgery.

[Doug]

wow...no response...now i'm scared.

[spenac]

Take proper precautions, just like you should for all patients, and take care of business. Would I prefer to not treat? Yes. But as a professional I will treat all patients to the best of my ability. Just as in the other discussion the risk is very small if you take proper BSI.

[Just Plain Ruff]

No, the reason why your getting no response is that your comparison is ludicrous.

You cannot refuse treatment to anyone regardless of their disease status. But what I have posited all along is that the ems worker or healthcare worker should not be allowed to work in the field because they know they are infected and by not allowing them to work in the field mitigates the risk to the patients that they are treating.

I will not discuss my responses to the original thread because I've made myself crystal clear but this discussion is assinine to continue.

You can mitigate the risk if you are infected but you take the risk as a HCW and you must make the assumption that every single patient you come into contact with is infected, hence universal precautions for yourself.

This in my opinion is a thread that was designed to be inflammatory and to feed the fire of an already hotly contested debate. AS a matter of fact, I think that this should be locked due to where this thread is destined to go.

[Dustdevil]

Good question. No easy answers, really. While it is tempting for us to say, "hey, it's part of the job, so do it or leave," that would be inconsistent with how we handle similar situations in medicine. Traditionally (in the medical professions OTHER THAN EMS), practitioners have been free to choose exactly what type of patients and procedures they want to practise. If you don't want to work with adults, you don't have to. If you don't want to work with kids, you don't have to. If you don't want to work with males, you don't have to. If you don't want to participate in abortions, you don't have to. In paediatrics, I refused to participate in circumcisions, and nobody had a problem with that (since there were plenty of female nurses around who loved it for some sick reason). So, it would seem hypocritical to insist that, in the case of AIDS patients, there is a different standard to be applied.

On the other hand, in the emergency specialties, including EMS, it's a little different. We sign on with the understanding that we have a duty to care for all comers. To take the good with the bad. For better or worse. And, since that is a universal standard for our particular profession, it is not inconsistent to insist that infectious patients are to be treated the same as any other patient that requests our help.

Now, of course, if you have a partner that is willing to work out an arrangement with you to take all those patients for you, great. I had an arrangement with a long time partner where I took all the pedi patients and he took all the Spanish speaking patients. Not because either of us was unwilling to care for them, but simply because that was what was best for the patients. Doing what is best for the patients is what it's all about.

EDIT: I guess Ruff and I were posting simultaneously. I could be wrong, of course, but I certainly didn't interpret the original post to be intentionally inflammatory. It seemed to be a logical spin-off from the other thread, and it was appropriate to start a new thread rather than further bastardise the original. That said, obviously I agree with Ruff's conclusions in both cases.

[ccmedoc]

...in the emergency specialties, including EMS, it's a little different. We sign on with the understanding that we have a duty to care for all comers.

There you go..question answered.....next?

[Doug]

Ruff, this was not meant to be inflammatory, to me it seems to be a logical conclusion to the idea posted in the other forum, it was meant to provoke thought not anger. Dust's response was logical and well thought out and like many he is unable to come to a conclusion.

I will tell you of one incident early in my career where I went to start an IV on a man who was having chest pain. The senior medic grabbed my arm and shook his head...not being well seasoned I just accepted it and since it was his turn to tech went to drive. He came to me later and said "I never start IV's on him he has HIV." So, Ruff, your suggestion that this is ludicrous is wrong...in fact i assure you it happens.

[Just Plain Ruff]

Dust, good salient points and well taken. Maybe not intentionally inflammatory but antime you post a thread that is similar to a thread that was so charged with emotion it becomes an inflammatory topic.

If this thread can stay positive then it's a valid thread but I've seen these thread spin-offs before and they get out of hand quickly and negatively.

Doug, the topic is not a bad one but it's a unfair comparison and to me it seemed like it was meant to stir the pot.

As EMS workers we don't have the luxury to not treat a specific patient population and if you advocate that position you are not right for this field.

Case in point, you are against abortion, you get called for a botched abortion of a 15 year old girl or 30 year old girl. Since you are against abortion would you refuse to treat that 15 year old because her illness is caused by abortion???

you can substitute drug use, alcoholism, assault, hiv, hepb, tb, ddt and xyz and still you have to treat the patient because you know as a EMS worker you might be called to treat someone sometime with that condition.

IF you refuse to treat the patient, then you should not be working in EMS. It's take care of every patient or get out of my ambulance.

[spenac]

IF you refuse to treat the patient, then you should not be working in EMS. It's take care of every patient or get out of my ambulance.

Perfectly summed up.

In my area I get patients that are treated by, for lack of better english word, witch doctors. I disagree with the practices, but I do not refuse to treat the patients that choose to try them before dialing 911.

So Ruff I'm with you. Treat em all or quit.

[VentMedic]

In any aspect of health care you will have patients with HIV/Hep including newborn and Peds. Many times most HCWs do not know what the patient has because the patient may not have been tested yet, labs aren't readily available or the treatment and precautions will be the same.

If you go for an outpatient lab drawn, the phlebotomist is not going to ask for your HIV or Hep status. He/she will just do business as usual with the same precautions for all. The same for the IV nurse, RRT or any other healthcare professional. Patients that are coughing will see me wearing a mask when I assess them regardless of it being the flu, allergies or TB.

We also do not allow religious beliefs to alter patient assignments. If your religion disagrees with the gay life style or you claim some white supremist group, too bad. If you are a nurse and your religion is Jehovah's Witness, you will still hang blood on patients if you are working in that area of the hospital. It is not fair to other staff members to keep picking up the slack for what another professional feels is wrong by religious belief when caring directly for patients.

The only exception is end of life support. Some RNs have trouble coping with the families and heavily sedating patients for the terminal wean protocol. Some RRTs also have problems when pulling the tube and watching a pt gasp for ventilation. Combine that with the families screaming at you to put the tube back in and you do have a difficult situation. But, this is the only exception I can think of right now.