Should I have reported this as a bloodborne pathogen exposure?

[engine173351]

Okay, I know I'm going to probably get yelled at. Let's start from the beginning. I've been doing ride time with the local ambulance service for the past month as a first responder. Last week, we responded to a female who had slit her right wrist in an apparent suicide attempt. The laceration was approximately an inch long and was bleeding minimally. Upon our arrival, she had visible dried blood on the front of her shirt. As for her hands, I did not notice any blood because I didn't look. Because she had been sitting in the back of a police patrol vehicle (the officer found her and requested us), myself and an EMT-B utilized the extremity carry to move her to the cot, as she was ETOH and wouldn't move by herself. As the EMT-B took the legs, I placed my hands under her armpits and was proceeding to grab her arms, but instead, she grabbed my bare arms with her hands. As soon as we got her moved to the cot, I inspected both of my arms and looked for any visible blood, but didn't see any (I assumed that since she was bleeding from the laceration, she might have blood on her hands). Once we arrived at the ED, I washed both arms with hot water and soap, and then covered them in alcohol sanitizer. But since I didn't see any visible blood on my arms, and didn't have any open breaks of the skin, I didn't think anything of it (which was a really stupid move on my part), and therefore didn't report it to anyone.

A couple of days ago, an EMT-B from another shift cut his finger with a shard of glass that had a patient's blood on it. He was cleaning the ambulance and didn't see it. He reported it immediately to the ED, who placed him on medication and was able to get the patient to submit to a blood test. After that occurred, I began to think that I had made a mistake by not reporting the incident that I experienced. What should I have done, and what should I do know? Is it still worth it to report this? And who do I report it to?

[Lone Star]

Okay, I know I'm going to probably get yelled at. Let's start from the beginning. I've been doing ride time with the local ambulance service for the past month as a first responder. Last week, we responded to a female who had slit her right wrist in an apparent suicide attempt. The laceration was approximately an inch long and was bleeding minimally. Upon our arrival, she had visible dried blood on the front of her shirt. As for her hands, I did not notice any blood because I didn't look. Because she had been sitting in the back of a police patrol vehicle (the officer found her and requested us), myself and an EMT-B utilized the extremity carry to move her to the cot, as she was ETOH and wouldn't move by herself. As the EMT-B took the legs, I placed my hands under her armpits and was proceeding to grab her arms, but instead, she grabbed my bare arms with her hands. As soon as we got her moved to the cot, I inspected both of my arms and looked for any visible blood, but didn't see any (I assumed that since she was bleeding from the laceration, she might have blood on her hands). Once we arrived at the ED, I washed both arms with hot water and soap, and then covered them in alcohol sanitizer. But since I didn't see any visible blood on my arms, and didn't have any open breaks of the skin, I didn't think anything of it (which was a really stupid move on my part), and therefore didn't report it to anyone.

A couple of days ago, an EMT-B from another shift cut his finger with a shard of glass that had a patient's blood on it. He was cleaning the ambulance and didn't see it. He reported it immediately to the ED, who placed him on medication and was able to get the patient to submit to a blood test. After that occurred, I began to think that I had made a mistake by not reporting the incident that I experienced. What should I have done, and what should I do know? Is it still worth it to report this? And who do I report it to?

The biggest difference between the two situations is that your coworker actually had the integrity of the skin compromised by the laceration on the glass. Second, the glass that caused the laceration was covered in the patient's blood. This would amount to the same thing as being stuck by a needle that had been used to inject meds into the patient.

While your patient didn't get any blood on you, and didn't break the skin (you stated that you couldn't find any blood or broken skin, I would presume that your risk of exposure is negligible. Reporting this incident would amount to a 'comfort measure'. If you have strong concerns about it, find out who oversees the bloodborne pathogens exposures and have a chat with them. They will be able to decide whether or not to file a formal incident report, and co-ordinate follow up measures. In my opinion, it's always a good idea to report possible exposures, as it provides a record of the incident.

This is a 'wake up call'... it's very easy to become complacent in scene safety, as well as personal safety; in this business, carelessness can have life altering consequences.

[BEorP]

I thought there had been more replies to this thread before.... weird. Anyway, Lone Star has pretty much said it all. The only thing I would add is that if you choose to report this type of non-exposure exposure, it would vary depending on where you work. Where I worked, I would likely just put in an incident report describing what happened but not sounding any alarm bells by calling it an exposure (since it really wasn't as far as we know). This way though it is down on paper in case something does come of it (i.e. in case you didn't notice there was broken skin and something was transmitted and you get sick... all extremely unlikely).

[fiznat]

I thought there had been more replies to this thread before.... weird.

Its because he double posted....

http://www.emtcity.com/index.php/topic/20350-should-i-have-reported-this-as-a-bloodborne-pathogen-exposure/

[Richard B the EMT]

While your patient didn't get any blood on you, and didn't break the skin (you stated that you couldn't find any blood or broken skin, I would presume that your risk of exposure is negligible. Reporting this incident would amount to a 'comfort measure'. If you have strong concerns about it, find out who oversees the bloodborne pathogens exposures and have a chat with them. They will be able to decide whether or not to file a formal incident report, and co-ordinate follow up measures. In my opinion, it's always a good idea to report possible exposures, as it provides a record of the incident.

While reporting this "possible" exposure might just be a 'comfort measure', as Lone Star refers to it, in the FDNY EMS Command, even suspicion of exposure requires MANDATORY reporting. It may be an extreme off chance of BBP (Blood Bourne Pathogen) transfer, but you still want a "paper trail", just in case.

Years before the FDNY EMS Merger, we had an asbestos exposure in the EMS Headquarters building, a decaying wrap on a steam pipe in a bathroom. Stupid TV reporter actually slapped at it to create a dust cloud for his visual! Anyway, everyone who was then working in the headquarters building was ORDERED to fill out, at minimum, NY State Workers Compensation Board paperwork, from the newest EMTs and vehicle mechanics working in the place, up to the Chief In Charge of the Department.

To the best of my knowledge, nobody reported any ill effects from this possible exposure, probably made a moot point for members subsequently exposed to the World Trade Center dust, but it is on record as having happened. You should want such paper trail on your self, as at least a minimal documentation, and hope nothing happens that would require that documentation. Call it a segment of Murphy's Laws, If you don't need it, you have it. If you don't have it, THEN you'll need it.

[Just Plain Ruff]

When in doubt, report.

Nuff said

[fiznat]

It may be an extreme off chance of BBP (Blood Bourne Pathogen) transfer, but you still want a "paper trail", just in case.

There was no exposure! The lady touched his arm! That's it! There's absolutely no reason to suspect an exposure, no blood transferred, no broken skin, nothing!

Should we REALLY start generating a "paper trail" for every "exposure" of this level? What about if someone coughs in my direction, or shakes my hand to say thanks? That's the level we're talking about here...

...a decaying wrap on a steam pipe in a bathroom.....everyone who was then working in the headquarters building was ORDERED to fill out, at minimum, NY State Workers Compensation Board paperwork, from the newest EMTs and vehicle mechanics working in the place, up to the Chief In Charge of the Department.

You think this was the right thing to do? It sounds like a ridiculous overreaction to me. Asbestos isn't freaking VX gas, people. How can we expect public health officials to take "exposures" seriously if we constantly flood their offices with these unnecessary reports?

[Just Plain Ruff]

There was no exposure! The lady touched his arm! That's it! There's absolutely no reason to suspect an exposure, no blood transferred, no broken skin, nothing!

Should we REALLY start generating a "paper trail" for every "exposure" of this level? What about if someone coughs in my direction, or shakes my hand to say thanks? That's the level we're talking about here...

Actually let's discuss the coughing in your direction. Transported a patient a number of years ago from the VA to a nursing home. No info in the chart regarding his TB status. He was coughing inthe ambulance. I put a mask on him but it was too late. 3 months later got a letter from the VA regarding his TB Status. He was positive and contagious.

I converted less than 3 months to the day later and the only documented patient that I came into contact with who had confirmed TB was this guy. I did not get TB but I am now a permanent converter and I have to get a chest X-ray each year for my yearly TB Screening.

My partner also converted about 3 months after the transport also.

6 months worth of isoniazid, a permanent health department (state of missouri) record of my TB exposure and the inconvenience of having to go to the health department every week for my supply of Isoniazid.

So maybe a cough in your direction should be an exposure?

Maybe not but I for one say "if suspected then report".

[paramedicmike]

Have you (the OP) never had a blood borne pathogens class?

There are many available on line. I suggest you take one. In its entirety. Without cheating, fast forwarding or trying to skip sections you find boring.

[stcommodore]

Not an exposure