Refuse Rx to HIV/HEP patients?

[firedoc5]

I know that not all of us are not doctors, but is there anything in the Hypocratic (?) Oath that can be relevant to this? That if someone is in need of care, medical or traumatic, shouldn't they be treated. Sure you might take extraordinary measures, but you need to do something. Way back when when they first started to take more precautionary practices to the extreme we had a few, especially one nurse, in particular, take things to the absolute extreme. She would glove up, mask over, put on a gown, etc. to see someone come in while she was in the same exam room with them, even a child. We thought she would ease up after a while, but she didn't. Eventually she transferred out of the ER.

I totally agree with spenac and Ruff.

[Dustdevil]

I know that not all of us are not doctors, but is there anything in the Hypocratic (?) Oath that can be relevant to this?

No, but there is something very relevant in the first day of EMT school. The part where they tell you that YOUR safety comes first, above all others. There is no arguing the fact that, when you are talking the possibility of contracting a fatal disease from your patient, it is a fair comparison to "scene safety." If you are justified to walk away from an armed and potentially violent patient, then why cannot the point be fairly made that you may be justified to walk away from a patient that presents a deadly health risk to you too?

In that sense, Doug's question is fair and valid.

[Just Plain Ruff]

Dust I agree to a point, you can walk away from a violent patient and allow PD to handle it. In the end, it's gonna get handled one way or another.

But to walk away from a patient who has the deadly disease. Can't do that because their medical issue is not gonna get handled one way or another.

sure they can get a ride to the hospital by family and friends but let's discuss the end of life HIV patient who has no other way to get to the hospital but you in your ambulance. How is that patient served by your service?

I like your earlier suggestion of dividing patients by type for one to handle and another to handle. The pediatrics, I was always the one taking care of kids because they always seemed to do better with me rather than other people at my service.

If your partner wants to take care of all the HIV and HEPB patients, then by all means, let him but we don't really have that luxury especially if you work in a one emt and one medic truck. As the medic you are gonna get stuck with every patient unless your service has a option of allowing emt's to treat and medics to drive on the Bls patients.

I still think and won't change my tune on this one either, you either treat every patient you come across or you don't work. simple as that.

You treat the dregs of society to the hooker, to the elderly to the hot chick in the wreck. Every patient means every patient regardless of their illness (infectious disease) status.

And Vent brings up a great point - do we really know who's infected?

[WelshMedic]

Just think about this for a second:

Let's all refuse to treat a pt with a deadly transmissible disease. In fact, if the risk is so great then why don't we just refuse these people admission into hospital. That way we can make huge savings in our healthcare budgets - well, let's face it, these pt groups usually cost the most. And we'd protect the lives of thousands of healthcare workers

Let's get real here folks. We live in a civilized society, and with that comes a duty of care to all. The risk of transmission of HEP/HIV is minimal when good practice is used. What are we talking about? The transport of one sick, infected individual where contact is minimized? Put yourself in the shoes of a hematology nurse, or a transfusion technician, or a phlebotomist, or even a surgeon for that matter. And yet I've yet to hear the same conversation from any of these professions. Why is that, I wonder?

WM

[VentMedic]

You may have more of a chance of getting infected with something from a child.

1. They look cute and innocent. You relax your precautions too much.

2. Not all children have Junes and Ward Cleaver for parents. And, especially with the June and Wards, one can let their guard down too much.

3. They can be infected with Hep and/or HIV.

4. Varicella (also adults) and Pertussis are prevalent in some areas.

(How many EMTs and Paramedics keep their vaccines up to date?)

5. CMV positive for some.

6. Wiggle like greased whatever even in the restraining devices. It is very easy to get stuck while sticking them.

7. They can bite and scratch if given the opportunity also.

8. Our policy is to mask and glove, gowns recommended, for a child presenting with a respiratory illness and/or needing a neb in our ED. If caught giving a neb without a mask, you get verbal, written and termination. If you come up with some infection, workmen's comp does not have to cover. The same policy applies to the resuscitation and trauma rooms.

As I mentioned before, I have been exposed to more stuff in the ED by EMTs and Paramedics bagging a patient than from acts committed by the patients themselves. That can also include partners on both ground and air ambulances. Luckily, our ED isn't cheap with supplying us what we need for universal precautions.

[medic_texas]

These words come to mind..

Negligence

Abandonment

Discrimination

Uneducated

Lack of training

The "seasoned" medic that told you to stop starting the IV should be reported. Withholding treatment due to someones HIV/HEP-C status isn't smart. If that came under question would the excuse of "they have HIV" going to bail you out? If you are not trained well enough to start a IV on someone who is infected with a bloodborne disease then you are not well trained at all.

This just goes back to paramedics not being educated enough, trained enough, or have their eyes opened up enough.

[vs-eh?]

You guys can refuse to prescribe medications to HIV/HEP patients prehospital in the USA?

What medication can you prescribe to the normals?

What a country...

:wink:

[Doug]

In this instance the Rx stands for treatment...not enough space in subject line to write "treatment."

On another point...some of you seem o be directing anger toward me when in fact we may agree...i would never, in fact HAVE never refused treatment for a patient for any reason, I have treated HIV pts. I have started lines, bandaged wounds etc. I find that the people who know they have HIV are forthcoming with their status the only time I've done anything out of the ordinary is by their request (one HIV pt asked me to pull over to the side of the road to start an IV, because "If we hit a bump and you stick yourself I could never forgive myself")

Again my point was certainly not to advocate this practice but suggest a new angle to the arguement that HIV+ healthcare workers be kept from practice, I apologize if I didn't make that clear in my initial post.

[Freaknuggetz_chick]

i disagree with discrimination. if a HCW has an infection, and takes reasonable precautions, they can work. i had a horrendous flu a few weeks ago, so i wore a mask on car for a tour as i didnt want to spread it.

if a patient requires treatment, irregardless of blood borne illness, etc, i will treat to the best of my ability, utilizing reasonable precautions.

[firedoc5]

When you stop and think about it, we accepted the possibilty of being exposed to diseases that are communicable and the possibility of being injured when we signed up for this gig.