Poked with dirty needle...

[katbemeEMT-B]

I did not say we drive like idiots. utmost caution is used when driving. Speed limits are not broken. The lights and sirens are used to move traffic out of the way as the only access is a two lane road with lines of traffic that can be endless.. That doesn't mean the crew fly down the road faster than the speed of light. It also doesn't mean they fly through intersections like they are owners of the road. Even if we are on a run we approach every intersection with extreme caution and more often than not come to a complete stop before entering it.

The reason for the life threat is that there is a high incident of heroin use and have been many reported cases of HIV. It is a small liberal community with a great outreach program. I will say that I only know of one needle stick that has taken place and that was before we got the retractables. BTW: The lab tech rides with to care for the sample. The crew has no contact with it and no, the supervisor has no vehicle other than his personal vehicle. We are a city owned, hospital operated service. We are not connected to the fire department other than rescue helps with extrication. We have four trucks and run two per shift. The other two sit in the garage not being used. We are not taking a unit out of service or crew as many of the crew live close by.

[Just Plain Ruff]

You can drive like the safest driver in the world, obeying all the traffic laws and such but accidents still happen.

Your company has NO I repeat no defense if there is an accident and you are transporting the blood work.

this is a trainwreck waiting to happen.

[katbemeEMT-B]

So would it be ANY different if it were a courrier company and they had the accident? The only difference is they would be liable and they drive like sh*t. It falls under the same actions as if it were an organ being transported except they drive like raped apes to get there with that organ/s. I have seen that happen on more than one ocassion by the biggest service in our state. We take pride in our service and the fact that we are accident free and we intend to keep it that way. Yes, accidents happen but that is why we are taught to be proactive drivers not reactive drivers. We are always looking ahead for any dangers and approach everything with caution whether we have the right of way or not. As I stated, the driver MUST follow all traffic laws, stopping when required. Once the crew reaches the city limits the lights and sirens are turned off and they run routine. The main reason for the lights and sirens is to gain passage on the two lane road that is heavily traveled. It was something that was okayed through the State so apparently they agree that it is a neccessity.

BTW: Not that I don't want to continue this...but we are getting off topic from Anthony's original post and I don't want to be a post stealer. You can pm me if you would like to. I have no problem with that.

[Just Plain Ruff]

ok, fair enough but even though the state says it's ok you are ultimately still liable.

Not once did I criticise the driving, I did not say you all drove like idiots, I distinctly said that even if you follow all the rules of the road, all the preventive driving that you can, there is still the possibility that an accident can occur.

Plus your companies argument falls flat that when you run hot on the two lane road and then turn off your lights and sirens when you hit the city makes your companies arguments that the state said you could do it this way moot.

let's hope your company never has to defend itself in court for a accident caused or not caused by your driver while transporting a blood tube. I do not believe that you can defend this policy.

I'll stop arguing this point but I do want to see what others have to say about this particular policy your company has.

Anyone want to chime in?

[PRPGfirerescuetech]

Anthony,

I speak to you as an EMS OSHA designated officer, infection control officer, OSHA instructor in-house as well as an OSHA consultant in the EMS field.

When it comes to risk, Doc is right, to a point.

Looking back through history in regards to HIV and AIDS, your patient would have been 60 years old when a name was put to this disease. This disease, it should be noted, did exist well before this time (around 1980).

Your patient may have contracted it though several means, and does not fit the most likely age grouping to submit for a test after the disease was named and the full scope of the epidemic was determined.

Regarding other diseases.

HEP B, HEP C, and a number of other less potent diseases are probibly of more concern.

(AS medic ccjh noted)

Did your company offer you a blood test (on yourself) as well as medical blood test surveillence on yourself over the next 6 months?

They have to.

Did your company offer you counciling regarding the exposure with a psychologist?

They have to.

Did your company pick up the bill for the prophelactic medications?

They have to.

Did your company council you on the risks of the exposure before you were given the medication?

They have to.

Theres a lot more, but this is the basics. If your exposure was down to the muscle, then you really should be receiving three things.

Regular blood test medical surveilence, at thtime of the exposure, 6 weeks, 12 weeks, 6 months, and 12 months.

did you get a HEP B innoculation? Did your company offer it to you?

They were supposed to.

EMS is ages behind compliance in infection control and infectious diseases.

[katbemeEMT-B]

ok, fair enough but even though the state says it's ok you are ultimately still liable.

Not once did I criticise the driving, I did not say you all drove like idiots, I distinctly said that even if you follow all the rules of the road, all the preventive driving that you can, there is still the possibility that an accident can occur.

Plus your companies argument falls flat that when you run hot on the two lane road and then turn off your lights and sirens when you hit the city makes your companies arguments that the state said you could do it this way moot.

let's hope your company never has to defend itself in court for a accident caused or not caused by your driver while transporting a blood tube. I do not believe that you can defend this policy.

I'll stop arguing this point but I do want to see what others have to say about this particular policy your company has.

Anyone want to chime in?

My hope is that we don't ever have to worry about any needle sticks anymore. Let me say this much, if it happens to me, I WILL b*tch slap the medic that had the needle in his/her hand at the time. :twisted:

[Just Plain Ruff]

I totally agree. That medic sounds dangerous.

[PRPGfirerescuetech]

Most needlesticks can be avoided. It is truely a rare occurence where a mistake is made that couldnt be, and an even rarer mistake with a dirty needle that couldnt have been avoided.

PM me with his phone number. He needs an "in-service"

[medic001918]

I have to agree with you Ruff. There is no defense for driving a blood tube with lights and sirens. It doesn't matter if it's to get out onto the road, or all the way to the hospital. There is nothing that critical about that blood tube making it to the testing location that additional risk needs to be brought onto the crew and the general public.

I'd be willing to bet that while the state said "ok" to this practice, they would not be willing to back that up in court. The difference between your ambulance (especially with lights and sirens) and a courier is that a courier is not going to be running lights and sirens, so there is not that contributing factor to the crash. It becomes a simple traffic accident at that point that the police can investigate. Just as an FYI, more often than not when running lights and sirens and involved in a collision, the emergency vehicle is automatically considered to be "at fault" until proven otherwise. It's that whole "due regard" clause in the wording of the law in many states. If I recall correctly, there's a 70% greater chance of being involved in an accident while using lights and sirens as well. Is it worth delaying the transport of a blood tube by the time of a collision to run lights and sirens? I'm thinking not. A casual ride to the facility would do just fine.

You mentioned organ transplant teams, while they certainly should not be driving out of control their task is much more time critical than a blood tube for testing. They are often working within a specified window of opportunity that they have to meet. It's a bit more appropriate for them to use those lights and sirens.

Now having worked urban EMS for a while, I can tell you that quite often lights and sirens don't save a great deal of time when transporting. This goes for transporting patients or objects. It's merely a courtesy. At least with someone in the back of your ambulance, you'll have an easier time justifying their use.

Earlier you said that a needlestick is considered a "life threatening injury." May I ask why it's considered such? There's no immediate life threat from it. They can start the medications and wait for results of the testing. If a needle stick were "life threatening" (and enough of a threat to warrant lights and sirens), all hospitals would more than likely be required to have the rapid testing on site.

And a final question, does the hospital request emergent transport for a patient's critical tests? Or is it simply in the place of an employee of your service getting stuck?

Shane

NREMT-P

[UMSTUDENT]

I had an exposure to a patient of about the same age. My issue was sheer stupidity and a combination of being dazed and confused from lack of sleep. The call came out as a medical/diabetic emergency. Upon arrival, we found a lady down (supine) outside of a church. A towel had been placed under her head, which I of course thought was placed purely for comfort. Initially bystanders reported that she had fallen from ground level and the paramedic asked me to grab her head for c-spine precautions until he could assess further. I put my hand, with open cuts, directly into a pool of warm blood and tissue. The occipital region of the patient's scalp was bleeding profusely. Apparently it was later discovered, from the patient, that her internal defibrillator had fired causing her enough surprise to fall backwards and strike her head on the corner of the sidewalk.

Upon reaching the hospital I requested to be seen under our infection control protocol. The patient was unconscious, but the physician went ahead and preformed a rapid ELISE test. She came back negative. My physician “officially” advised me to begin taking the HIV cocktail, but “personally” advised me that given the test results and the patient’s age that taking it might not be the best thing to do. He explained some of the negative consequences of the cocktail. I declined. A month later, a follow-up visit revealed that the patient tested negative for Hep-C, B, and HIV. I was also negative. Protocol stated that I should have received follow-up testing every couple weeks up to six months. I never followed up, but for your own comfort I would suggest doing so given your situation. In my case, everything was totally covered by worker's compensation as should yours. Take advantage of the free care.

Honestly, I think only a thorough understanding of the virus can help you make an informed decision about your choices, but given the limited time you have to decide, I would probably start the cocktail. At least until her results are returned. Your exposure was a needle stick, which may be more serious than my open cuts.