Refuse Rx to HIV/HEP patients?

[spenac]

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.

And we did it on the cheap. Some even did it for free. :roll:

Big risks should bring big pay, but thats another thread.

[triemal04]

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.

I don't know that that is a fair comparison. A person waving a gun around is a definite threat to your well-being and is doing it intentionally; they are creating the threat by choice. It's something that needs to be resolved before care can begin. Someone with HIV is still a threat to your well-being, albeit a much lower one, but what are they actively doing to make the threat a reality? Probably nothing (unless they're say, spitting blood at you in which case it would be very appropriate to back off rapidly). Even if you want to consider it a threat, it's contained; same as after a violent patient has been restrained and you've got 2 cops in back with you. The only difference here is that our PPE and BSI are our restraints and cops.

[Dustdevil]

Ah, but do you really have any more idea whether or not that patient is going to spit blood at you than you do about whether the other patient is going to shoot, stab, or beat you or not? No, you don't. So, the risk is the same.

[triemal04]

Ah, but do you really have any more idea whether or not that patient is going to spit blood at you than you do about whether the other patient is going to shoot, stab, or beat you or not? No, you don't. So, the risk is the same.

Sort of. While the risk is there, with the calm, cooperative HIV pt that wants some help with their chest pain the risk isn't going to be the same as the deranged nutter waving a pistol around. Besides (think someone already said this) if that is how you look at it, then really we shouldn't be touching anyone, since anyone can have an infectious disease and not know it; the risk is there too. Or hell, we never do know when someone might take a swing at us, so no patient contact due to that either. But, we can use our judgement and decide what needs to be done to ensure our safety if that were to happen.

Like I said, a patient with HIV...if you've got the appropriate PPE and BSI precautions taken (to whatever level you find appropriate) then the threat/risk has been contained as well as it can be. Saying that someone with HIV poses a bigger threat to us than your average slob is true, but not on the same level that a armed person does, that's my point.

[Just Plain Ruff]

I've said it one time already in this thread, if you refuse to treat a patient due to their disease status then get out of my ambulance and give me someone who will.

[Dustdevil]

I've said it one time already in this thread, if you refuse to treat a patient due to their disease status then get out of my ambulance and give me someone who will.

Ah, but by saying that, aren't you advocating a right of "refusal" for yourself that you are denying your partner?

And, if you can refuse to work with this guy, would you agree that he would have the right to refuse to work with an HIV positive partner?

[Just Plain Ruff]

maybe so. see it's a two edged sword.

But no you should not be able to refuse to treat anyone. They call we haul.

[BVESBC]

Ok, I'm going to stir the pot. We as providers agreed to care for all comers. I agree with that 100%, there are provisions to inform us of potential exposures s/p (Ryan White Act) where as the recieving facility must notify us of any confirmed communicable condition. (My wording may not be exact on ryan white act feel free to correct me!) The question I pose is this, As a private sector ambulance at any level of care could we refuse to transport anyone with a communicable disease? (AIDS, HIV, Hep)?? Would this constitute discrimination if we did?

[VentMedic]

The question I pose is this, As a private sector ambulance at any level of care could we refuse to transport anyone with a communicable disease? (AIDS, HIV, Hep)?? Would this constitute discrimination if we did?

For that reason many patients are still afraid to be honest about their medical history in the year 2008.

I guess you haven't been in EMS that long. This has already be tried and trialed. When HIV first appeared, that is exactly what happened all over the country. In some areas, if the patient was transported at all, the EMT(P) would ride up front with the driver leaving the patient alone in the back. Then, a big deal was made out of it like it was a case of Ebola being brought to the hospital. Although, in all fairness, we actually knew more about Ebola than HIV at that time.

There was also the infamous case with the Ray brothers whose home was destroyed by an arson fire. The FFs of the community watched saying the "HIV" could be in the smoke and it was for the good of the town that it burned. It also got rid of "them" meaning the young boys who were hemophiliacs. Thank goodness they weren't gay. Who knows what might have happened to them if that had been the situation with the GRID association.

If you want to read more about these events and EMS reaction to HIV from the mid 1980s thru the early 90s, visit the archives of the EMS magazines.

Hopefully healthcare providers are better educated about HIV now. Although, I still see some reactions from a few providers that makes me wonder about that.

Hepatitis is very prevalent and many people don't know they have it until they become symptomatic.

[spenac]

But no you should not be able to refuse to treat anyone. They call we haul.

I say we should be able to refuse anyone that does not need the ambulance. I hate the you call we haul mentality. I am a healthcare professional not a taxi driver. As far as refusing treatment or transport of someone because of there health condition such as TB, HIV, Hep, as a healthcare professional I say treat them. Perhaps extra precautions are warranted, but you still treat.