Someone please help?

[EMT1972]

Yesterday, 08/24/07 I was running interfacility transfer from the ER to psych facility, upon making initial pt contact, I asked out pt if she had intents on harming herself or us. She stated "I am going to hurt you, if you don't stop trippin' and having sex with me", obviously with such a threat, she was placed in restraints.

When we got to the psych facility, one restraint was removed and before I could get to the other off, she started to remove it, it told her to hold on and I would remove it. As I was removing it, out of the corner of my eye, I saw her fist coming for my head, I blocked it and pinned her arm above her head... next thing I know she rotated herself and ended up biting my right index finger removing a nice chunk of skin and drawing blood.

Being an on the job injury, I went to the nearest ER for care and lab work. This pt has no known hx of HIV, but is a active meth and cocaine user by unknown means (I didn't see any track marks on her arms). The nurse in the ER told me that the pt has to consent to having blood drawn and tested for HIV, Hep B & C and that she can refuse to do so. I thought it was mandatory by CDC and that the pt couldn't refuse regardless whether or not they are a psych pt.

Can someone please elaborate as to whether or not this nurse is correct?

[spenac]

Nurse is wrong.

[Eydawn]

Nurse is wrong. Gotta agree there. If there is a high index of suspicion that the patient has a communicable disease such as those mentioned, like hepatitis, HIV, etc and you have been exposed to the patient's bodily fluids (especially due to something like a physical attack) they have to do testing.

Have you contacted your supervisor? I would do so immediately. He or she is the one who can help get the ball rolling on this so hopefully you can find out quickly. The worst part with anything like that is not knowing. But definitely get your supervisor involved ASAP. While the nurse can brush you off, she can't brush your company off as represented by the supervisor (at least, not as easily).

Wendy

CO EMT-B

[EMT1972]

Thanks for the replies, my supervisor was notified immediately and she was the one that sent me to nearest ER, I work for a very good company... so I know things will be handled appropriately, I already had my labs drawn right after it happened, I was just wondering if the nurse was right... I suspected she was wrong and even kind of (on a professional level of course) argued with her about it. Thanks again.

[itku2er]

She is wrong I am sure. Its a infection control issue which could endanger the public health. You can stretch it that far.

[AnthonyM83]

Go up the food chain.

Talk to one of the ER doctors, but preferably the nurse supervisor and infection control nurse at the hospital.

[tniuqs]

Well just from the Alberta / Kanukisanian present legal perspective:

I so hear your distress, I too was assaulted by a very similar patient (the right hook did connect and drew blood from both parties) going down the assault route when he was impaired and not responsible for his actions BS was a waste of time too.

So following company ID policy I reported to the ER and was told that the patient had to give permission to have their blood work drawn and (the individual was 3 sheets to the wind) therefore not capable of giving permission, soo long story short the original RN informing me of this while taking my blood work this was a pain in the ass and damn scary for me and she didn't even try to gain permission.... bitch.

Appears that this IS the law here and as a result our National Paramedic Association (not just in consideration of my my case either, their was over 12 cases presented in the debate one for each province) did some lobbing for the "BLOOD SAMPLES ACT" unfortunately the initiators of this proposed act (the police, firefighters and dentists) were defeated in their actions. (in passing the "Nursing Associations" did NOT get on board with this incentive) GOOD GRIEF what is wrong with them?

Any way, I did say this was the abbreviated version...right?

I did manage to find out from an MD (a good friend) in that ER, thank god I worked their in another capacity as well, that the patient was evaluated for "other reasons" for the patients well being. SO that sure made a huge difference for me as he phoned me at home and took a risk at breaching that patients/ bugeaters rights. I will always be indebted to him as the prospect of taking AZT ++++ just "in case" is just really not an good option and can screw one up ones body on its own. The forced to use "protection with my now ex spouse" did not side well either, she was wanting to replicate at the time as well, notice I said ex. But the thought of somehow infecting my children WAS the worst part of my short-lived nightmare.

Sometimes its who you know not what is the "Human Rights Protectectors/Liberal do gooders" that make the difference in Life, so take Anthony's advice GO UP THE FOOD CHAIN STAT!

The excuse in the debate on the floor and why the "Blood Samples Act" failed, was that safeguards and medications were made available at no cost to the Public Servants. This Act was not only for assault reasons but inadvertent cross contamination from needle stick or a ripped glove.

cheers

ps With a human bite your statistical chances of infection at the site of injury is your biggest concern.

[VentMedic]

This is the probably the easiest thing to look up in your state statutes. Many states now require health care professionals (including EMTs) to take at least 1 hour of HIV training to stay up to date on the new laws.

Many states may still require informed consent from the patient. If that is not obtained voluntarily then a court order may need to be issued. Some states are working on different legislative acts to bypass the consent. I believe NY is one of them. Human rights is still a big factor regardless of the events that occur.

examples:

http://www.hiv.va.gov/vahiv?page=prtyp-qa-testc

http://www.cdc.gov/hiv/resources/guideline...tm#occupational

http://www.oregon.gov/DHS/ph/hiv/data/oars333.shtml

[WANTYNU]

Yesterday, 08/24/07 ...She stated "I am going to hurt you, if you don't stop trippin' and having sex with me", obviously with such a threat, she was placed in restraints.

... biting my right index finger removing a nice chunk of skin and drawing blood.

Being an on the job injury, I went to the nearest ER for care and lab work. This pt has no known hx of HIV, but is a active meth and cocaine user ...... The nurse in the ER told me that the pt has to consent to having blood drawn and tested for HIV, Hep B & C and that she can refuse to do so. I thought it was mandatory by CDC and that the pt couldn't refuse regardless whether or not they are a psych pt.

Can someone please elaborate as to whether or not this nurse is correct?

Not clear cut at all, yet another point about working EMS.

First as many on this on this board have said, get your management involved ASAP.

Second, if this is a Federal VA job, the nurse might be correct {see the previous posts, links}), but you may still have rights.

Third, she bit you which I know for sure is battery, aka a CRIME, I would look into pressing charges, being on drugs is no excuse under the law for committing a crime. IF chargeable this would change her rights and allow for testing.

In the mean time, as much as you may not want to, consider starting the AZT prophylactically, as she is a in a high risk behavior group. You can allways DC if she's found Neg.

I seem to remember reading a news story that our rights nationwide have changed with suspected exposure, worth investigating. (If I can find it, I'll post).

Sorry to hear about his, a friend is on AZT 2nd to a needle stick through a confirmed HIV pt, it’s no picnic.

Best of luck

WANTYNU

[VentMedic]

Even in the case of sex offenses, testing can be a legal problem. In some cases the victim may have to pay for the testing. The same with a court ordered test. In the case of an LEO assaulted, their employer will usually pick up the cost if necessary.

http://www.nycagainstrape.org/survivors_factsheet_76.html

The informed consent for HIV testing due to occupational exposure is a protection for everyone even though one may not see it as such.

Many times the occupational exposure is due to "accidental" carelessness on the healthcare providers' part. The testing expense will be put on the patient's bill and many times insurance may not pay for it or 60/40 if not part of the original treatment. Also the patient has the right to counseling prior to testing. The ACLU has outlined the discriminatory practices that are associated with testing whether in actuality or not. It will be on the patient's medical record permanently and raise questions later possibly in your insurance coverage. The patient's medical information will now be disclosed to a stranger. The patient could be you just in for a routine physical and now you may be spending extra on a test that you did not want. This expense may be out of pocket for you. Granted, everyone should be tested for all the Hs occasionally if there is any chance of occupational or social exposure. However, getting tested at the state sponsored clinic is much cheaper than a hospital.

Again, each state has guidelines specifically outlined on their state's website. That is a Federal requirement. Your EMS licensing website may have the link. If you want to prove a point, make a copy of that statute or policy and not rely on heresay. If informed consent is required in your area, then you need to move quickly to your other options or alternative means of obtaining a specimen from that person. The non-invasive testing now makes court orders much easier. Anyone in healthcare that has the potential of occupational exposure should be aware of the laws in their state and employer. That is also why mandatory education and EMT refreshers are important.