# I got bitten.



## Sasha (Dec 23, 2008)

I had a combative, BLS, IFT non emergent nursing home to ER for abnormal labs patient today. Generally I could keep him calm and he only got combative when I tried to take vitals, so I figured there was no need to restrain him, just don't touch him. IFT, I could handle that. 

Well at the hospital I was giving the triage nurse my report, standing by the patient, out of the blue he raised a hand to smack me, I grabbed his hand, and he bit my arm. Really hard, and he had really nasty, gunky teeth. He broke the skin. I cleaned it out really good, but darn it, it still hurts! What the heck!?


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## FF894 (Dec 23, 2008)

Yikes, did you get it checked?  Bloodwork?


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## Chimpie (Dec 23, 2008)

FF894 said:


> Yikes, did you beat the crap out of him?



Fixed.  h34r:


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## Sasha (Dec 23, 2008)

Haha. I told my supervisor on duty, he said to let him know if it starts to get infectiony. 

And no, I didn't beat the crap outta him, my partner said he would have, though. He was confused and scared!


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## KEVD18 (Dec 23, 2008)

Sasha said:


> Haha. I told my supervisor on duty, he said to let him know *if it starts to get infectiony*.
> 
> And no, I didn't beat the crap outta him, my partner said he would have, though. He was confused and scared!


 

nothing quite like locking the barn door *after *the horse gets out.......


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## Sasha (Dec 23, 2008)

KEVD18 said:


> nothing quite like locking the barn door *after *the horse gets out.......



Well, he's a new supervisor.. He probably doesn't know how to handle it, so I'm gonna call tomorrow and talk another supervisor.


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## NJN (Dec 23, 2008)

My partner got bit by an extremely combative post-ictal seizure pt. Pt was a kickboxer and doing what he did best so we were restraining him, as soon as that happened the pt had 5 guys on top of him, well 4 at any given point with one tying whatever limb. He got blood work and everything, even got a wristband.


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## MJordan2121 (Dec 23, 2008)

Sounds like a night I had. Well, I was not bit, but a pt with low blood sugar was very combative and ended up punching me in the cheek. I almost dodged it, but damnit, it left a nice mark on my face.


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## mycrofft (Dec 24, 2008)

*You need to do some stuff immediately then at once. Also now.*

1. Immediately clean the wound well, scrub with peroxide and hibiclens is about right, then paint with betadine and bandage.
2. While doing that, contact your supervisor who has a limited amount of time to complete the workman's comp paperwork. Do this. If it required you to be hospitalized or get antibiotic tx,, you might not get the Comp money and ahve to pay out of pocket while your insurer tried to get it. If your employer takes over a certain time (I think it's 48 hrs) they are prone to get a multiple thousand dollar fine.
3. Then you go to the work comp doctor or, if they allow, your private physician right away. You may need antibiotics, a tetanus shot, even wound debridement if you delay.

People bugs like to live in and on people. Get on it!


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## Redemption (Dec 24, 2008)

I feel like I shouldn't be posting because I'm not an EMT yet.

Anyway, my previous job in an ISL home with 4 DDMR adults, one gal was 26, had a 21q+ chromosone... problem. Can't remember the exact terminology, well she also had a seizure problem, and every time she was getting ready to have a seizure she became very aggresive and would attack staff. My 3rd or 4th night shift that I was working alone, she just appears around the corner, and I look at her (I'm cooking dinner at this time) and she tells me "I love you." And I said, I love you too hon. And I turned back around to stir the food, and the next thing I know I have this sharp intense pain in my left arm, I look, and she has stabbed me with a pair of scissors. Long story short, five minutes later she's on the floor seizing... great great night.



I hope you don't get an infection or anything.


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## DT4EMS (Dec 24, 2008)

Sasha said:


> Haha. I told my supervisor on duty, he said to let him know if it starts to get infectiony.
> 
> And no, I didn't beat the crap outta him, my partner said he would have, though. He was confused and scared!



Thank God no one did. In this type of a situation, "IF" the patient is truly confused, it is understandable when a person has an intrinsic reaction to an aggressive action. However, anything after that "reaction" may be seen as an assault.

So my question is this............... What would your actions have been if the person was drunk or high and did the exact same thing to you?

This unfortunate incident ( I hope everything goes well) is a perfect example to help teach people the difference between a "patient" and an "attacker".


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## Sasha (Dec 24, 2008)

DT4EMS said:


> Thank God no one did. In this type of a situation, "IF" the patient is truly confused, it is understandable when a person has an intrinsic reaction to an aggressive action. However, anything after that "reaction" may be seen as an assault.
> 
> So my question is this............... What would your actions have been if the person was drunk or high and did the exact same thing to you?
> 
> This unfortunate incident ( I hope everything goes well) is a perfect example to help teach people the difference between a "patient" and an "attacker".



Uhm.. My response probably would have been the same, which was a screetch and get away. I don't hit people, period.


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## DT4EMS (Dec 24, 2008)

Sasha said:


> Uhm.. My response probably would have been the same, which was a screetch and get away. I don't hit people, period.



Anytime you can do your job and not have to lay hands on a person in a defensive manner is a good day.

The point I am trying to make with this one is pretty cut and dry. My hope is to help draw a more clear line between an attacker vs. an uncooperative patient.

It sounds like in this incident, your person was a patient and you didn't feel threatened. The keys here are 1)Your Perception and 2) Culpable Mental Status of the person you are dealing with.

We should treat ALL  patients with caring and understanding. If they are not in their right mind due to an altered mental status due to a medical reason they are a patient.

If a person is under the influence of an intoxicating substance (regardless of the substance) and they have an intent to do you harm, that is an attacker. All attackers should have a police report filed on them............ period.

Frequent fly-ers in EMS that assault EMS providers are similar to those involved with domestic violence. Each time they will get worse, not better. So documentation of their actions in police reports show the pattern.


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## Desert Ranger (Dec 24, 2008)

In addition to the workers comp form, there should be a form to do that identifies a potential blood borne pathogen incident. It's mandatory where I work and the supervisor and employees responsibility to complete.


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## mikie (Dec 24, 2008)

Desert Ranger said:


> In addition to the workers comp form, there should be a form to do that identifies a potential blood borne pathogen incident. It's mandatory where I work and the supervisor and employees responsibility to complete.



Similar.  

I had a patients vomitus exposed to my mouth and filed (immediately after the call) expose protocols (got blood drawn from me and the dead guy).

If you suspect exposure, report it!  You do not want to find out in 2 weeks that you have MRSA and could've had treatment before!


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## Airwaygoddess (Dec 24, 2008)

When was your last Tetanus shot??  And I am being serious.


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## Desert Ranger (Dec 24, 2008)

And file a written complaint against your supervisor for not doing his/her job.


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## BossyCow (Dec 25, 2008)

I can't believe no one has yet asked the most obvious question......Did anyone ask the pt "Is Sasha as sweet as we all believe????"


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## Scout (Dec 25, 2008)

in chat, no reply


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## ffemt8978 (Dec 25, 2008)

BossyCow said:


> I can't believe no one has yet asked the most obvious question......Did anyone ask the pt "Is Sasha as sweet as we all believe????"



Or, "Did she taste like a pickle?"  

In all seriousness, there's been some good advice in this thread and I hope that you follow it, sasha.


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## Scout (Dec 25, 2008)

Pickle like bitter and not tastey, green, slimey and boily like a deseased thing?


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## mycrofft (Dec 27, 2008)

*Desertranger, I work alongside LE. Heck yeah there's a form there!*

In fact, Calif state law (according to our County Counsel) enables an unwilling blood draw to establish whether or not the bite-er (or other blood or fluid flinger/donor) has passable diseases.


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## ffemt8978 (Dec 27, 2008)

mycrofft said:


> In fact, Calif state law (according to our County Counsel) enables an unwilling blood draw to establish whether or not the bite-er (or other blood or fluid flinger/donor) has passable diseases.



I believe that is the Ryan White Law and it is actually a federal law.


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## reaper (Dec 27, 2008)

Actually, the Ryan White Law was rescinded this year! Got to love our Congress!


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## ffemt8978 (Dec 27, 2008)

reaper said:


> Actually, the Ryan White Law was rescinded this year! Got to love our Congress!



Hmmm...gotta link for that, because I missed it.


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## KEVD18 (Dec 27, 2008)

reaper said:


> Actually, the Ryan White Law was rescinded this year! Got to love our Congress!


 

not so sure about that.

http://en.wikipedia.org/wiki/Ryan_White_Care_Act

i know wiki isnt the best source to cite, but im lazy and the real cites are at teh bottom.


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## reaper (Dec 27, 2008)

Well I guess it goes through 2009. 

There was a post about it, by Vent I think. I cannot find it in the search.

It was about how congress voted not to fund it any longer. They stated that each state has policies in place, that match it, so there is no need to fund it further.

Maybe Vent still has the article, since I can not find it here?


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## danguitar12345 (Dec 27, 2008)

*Wow*

that is freakin scary as anything


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## FF894 (Dec 27, 2008)

Are you still with us?  Getting arm amputated?  Should we send flowers?


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## fortsmithman (Dec 28, 2008)

So far i've not yet been assaulted in an EMS setting.  I have been bitten assaulted had death threats against me while working as a security guard and bouncer.


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## Sasha (Dec 28, 2008)

Haha. Sorry, I forgot about this thread. 

My last tetanus shot was less than three months ago when I stepped on glass outside. 

The supervisor higher than the one who was on duty when I got bitten called and chewed me out for not calling her directly when it happened (because apparently it's written in the handbook that I never read that that is what you're supposed to do. ) and we filled out the paperwork. Popped into a centracare to have a doctor look at it and professionally clean and dress the bite (Apparently my copious amounts of peroxide, neosporin, and soap did not suffice for the doctor.)

The patient's history didn't indicate any infectious diseases, but I'm getting a blood draw to make sure soon.


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## Veneficus (Dec 28, 2008)

For the benefit of all bitten in the future:

Human bites are infectious, usually in 24 hours.  Prophylactic antibiotics should be administered according to all the literature.

Amoxicillin is a good broad spectrum to use, but the most infective agent: _Eikenella_ is immune to clindamycin (which I wish dentists would stop giving to females anyway as they almost always seem to develop a UTI shortly after) and erythromycin.


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## Sasha (Dec 28, 2008)

Veneficus said:


> For the benefit of all bitten in the future:
> 
> Human bites are infectious, usually in 24 hours.  Prophylactic antibiotics should be administered according to all the literature.
> 
> Amoxicillin is a good broad spectrum to use, but the most infective agent: _Eikenella_ is immune to clindamycin (which I wish dentists would stop giving to females anyway as they almost always seem to develop a UTI shortly after) and erythromycin.



Well it's been about five days, and I still don't feel sick, septicy, feverish or anything. Doesn't hurt anymore, isn't red or inflamed, temp is wnl. I don't think it's infected ^_^


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## VentMedic (Dec 28, 2008)

Your company's Policies and Procedures are written to protect both you and the public. READ THE MANUAL or HANDBOOK. Take an update on infectious diseases with each license renewal. Subscribe to your State EMS office newsletter. There is no excuse not to be knowledgeable about these laws in your state. 

When I initially posted info about the Ryan White act, only 1 or 2 people offered any comment. To some it is just boring legislative stuff which few have any interest in....until something happens. 

Update for Florida:

http://www.med.miami.edu/med/education/cme/documents/HIVAIDSUpdatedAugust2008.pdf

The Florida Bill for testing a patient without their consent became effective in 2008.
http://www.flsenate.gov/data/session/2008/House/bills/analysis/pdf/h1035.HQ.pdf

California Bill AB 682 (2007) signed to allow testing.
http://www.aegis.com/news/PR/2007/PR070918.html

New York, EMS and HIV update
http://www.health.state.ny.us/nysdo...ure/letter_to_first_responders_2008-08-01.htm

Summary of guidelines for healthcare workers with HIV.
http://www.ohioaidscoalition.org/documents/Pos_healthcare_workers_rts_20080418.pdf

NAEMT and Ryan White ACT
http://www.naemt.org/advocacy/news/08-10-21/Update_on_Ryan_White_Act.aspx

Summary of the Ryan White Act and extension till Fall 2009.
http://www.jems.com/news_and_articles/articles/restoring_exposure_reporting_rules.html


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## VentMedic (Dec 28, 2008)

*Ryan White HIV/AIDS Treatment Modernization Act of 2006 *

*H.R.6143*


http://www.natap.org/2006/newsUpdates/121206_04.htm

http://www.kff.org/hivaids/upload/7531-03.pdf


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## reaper (Dec 28, 2008)

Thanks Vent, I searched for the thread you posted on it, but could not find it.


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