Omg the patient has aids!

Sasha

Sasha

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When you call in your radio reports, and your patient has an infectious disease such as AIDS or the more scary Hep C, how do you inform the hospital staff?

I know some people who call it in just as that, like
Im transporting a 48 y/o male with a history of AIDS and blahblahblah.
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Orrrrr called in like
Im enroute to your facility with a 48 y/o male. Patient does have a PMHX, patient is currently taking AZT, etc.
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Ive also run into people who just dont tell anyone til they get to the hospital.

Personally, I like listing the meds. Gives them a heads up with out causing a stir with the 50 other patients who flip when they over hear that someone with AIDS is coming to join them.
 
It depends. If it's something that's going to require isolation, then it gets called in via radio or cell, depending on the facility and condition. If it's something like AIDS, it can wait until we arrive and are transferring care. After all, what further protection do you use for a patient with AIDS?
 
Why is it necessaryto report such? One can be really on touchy and legal grounds by doing so. Why not tell that they have an auto immune defense or long term hepatic disease. There is NO difference in where they are going to be placed. Was it really necessary pertinent to have to give such during the radio report? Was it directly related to the incidence or illness or could it had waited until you arrived and given a more in-depth one?

Personally, my radio reports or no longer than 30 seconds. Alike me and the other nursing staff really cares to hear is just enough to know what is coming in and where to place them. The real report will be after you arrive.

As well, your radio report should not be heard by 50 other people!

R/r 911
 
This is an interesting topic for me-- I got in trouble for a related offense just a few weeks ago. The call came through as an "emergency" from a nursing home to an elective surgical hospital pretty far away. OS, we realized the pt was stable, and although VERY stinky, was stable for transport to that hospital.

PMHX included inactive TB, MRSA, and the normal alphabet soup (HTN, ESRD/CRF, DM, CHF, CAD, etc.)

Before leaving the nursing home, I called the hospital to see if/where we would be accepted, and was told to go to a certain department. The nurse I spoke to said she had recieved a report from the facility, and confirmed the patient was stable. I noted my understanding of the history, (which was limited), mentioned the inactive TB, and she encouraged me that she already had the medical records.

On arrival to the facility, I gave my report, and apart from the patient being VERY STINKY, mentioned the MRSA + status, and they freaked out.
I reviewed the call with my partner and FS, and while I realize that I should have taken advantage of the "Secure" phone line and given a report, the facility should have been able to accept a MRSA positive patient without notice. It would seem to be more important to me for them to know about the inactive TB then the MRSA.

The call was a good learning experience for me, and I will continue to review it to myself to improve in the future.

Do the hospitals that you feed to want to know infectious status before arrival? How about emergency calls? Do they want to hear about specific diseases via radio? Cell Phone? What about routine transfers? Do you need to notify superiors that you need to decon after specific patients?
 
Why would inactive TB (which, by it's nature, isn't very communable) be more important than a drug resistant contagious disease?

I did a discharge once where the RN giving me report told me the patient had AIDS under her breath with a kind of "watch out" tone. I think my response was something along the lines of "So?" MRSA I care about. Conditions/diseases that require airborn, contact, or droplet protection, I care about in the sense of requiring extra PPE. Something like AIDS or Hep is important, but not really a "Zomg, this patient HAS ____________!" condition.
 
Sasha, In the year 2008, there is no need to anounce an AIDS patient's arrival via the airwaves for all to hear. You place your location in Florida. With Florida still in the top 3 for HIV infection, healthcare workers are aware of the disease and all must take the state required CEUs for their license. This also includes cosmetologists and barbers.

What is the chief complaint?

A little review on HIV/AIDS for those in Florida or anywhere.
http://www.ems-ceu.com/courses/166/index_ems.html

A list of CEUs with full access to the information (HIV, Bloodborne Pathogens, STDs etc).
http://www.ems-ceu.com/courses/curriculum_ems_category.htm

emt-student
This is an interesting topic for me-- I got in trouble for a related offense just a few weeks ago. The call came through as an "emergency" from a nursing home to an elective surgical hospital pretty far away. OS, we realized the pt was stable, and although VERY stinky, was stable for transport to that hospital.

PMHX included inactive TB, MRSA, and the normal alphabet soup (HTN, ESRD/CRF, DM, CHF, CAD, etc.)
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You didn't mention what the chief complaint of the patient as to the reason for the transport to the hospital. There are quite a few things that can be considered as an emergent procedure if it involves the patient's only access for meds, nutrition or a blockage such as a urinary tract stone.

Hx of inactive TB and MRSA?

If the TB is not active why the urgency to report it on the air? MRSA will depend on the location of the infection. MRSA in sputum may require some distancing especially if they have a trach. Oozing wounds may require extra padding on the cot but that can be done if you are patient enough to wait a couple of minutes.

However, hospitals that have large surgical specialties are very, very cautious when it comes to MRSA. Testing centers such as Radiology, CT SCAN, GI Labs and MRI prefer to be forewarned about MRSA, VRE and C-diff. Most will just assume everyone is infected but it doesn't hurt to do a few extra precautions in covering their equipment. C-diff also requires a special bleach based solution instead of the usual antimicrobial can of wipes laying around the hospitals.

MRSA links:
http://www.emsresponder.com/web/online/Top-EMS-News/MRSA--Recommendations-and-Resources/1$6565

C-diff may need to be keep isolated from other patients whose immune systems are compromised such as the elderly. But, again just a simple word to the nurse and patience as they rearrange the ED...

Active TB, Chicken Pox and suspected meningitis cases may need earlier notification. The hospital may have to rearrange the patients for an isolation area. If you are taking precautions, have taken precautions with the patient and warn others before the approach as well as getting to know each ED very well will get you through those cases also. Know when to use the secure line. However, there are few cases that really need that line.

Hep C is also not an urgent report on the air.

Keeping your incoming information short and to the point will be the greatest help. It is annoying that you continue to chat away at stuff that you already have written down such as extensive med lists, pull into the driveway still yakking and giving the hospital little time to prepare because they were tied up listening to your report.

Just a little clarification: auto immune and immunosuppressed or deficiency are two different categories of diseases.

Edit: Active TB will require isolation. Atypical TB is just as bad or worse because it can be very drug resistant. Unfortunately in Florida, NY and CA, that is what we see a lot of even today. Florida still has a TB hospital for long term treatment.
http://www.doh.state.fl.us/AGHolley/index.html
 
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I go through this issue with every new volunteer. They all want to know what a pt has that might infect them which always starts a conversation about what is 'universal precautions'. Laws or protocols about the enforced reporting of infectious diseases don't work worth a hoot if the pt doesn't know what they have. The estimated numbers of undiagnosed HepC and HIV are enough to chase all our sweet dreams away.

Personally, I treat every single pt as though they have active cases of MRSA, HIV, TB, HepC, and every other nasty bug imaginable. As should we all.
 
BossyCow said:
Personally, I treat every single pt as though they have active cases of MRSA, HIV, TB, HepC, and every other nasty bug imaginable. As should we all.
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Taking it to its logical conclusion, do you wear a N95 mask for all patient contacts?

Don't get me wrong, universal precautions are universal for a reason. 95% (100% if there's anything icky, including blood) of the time I touch a patient I wear gloves. No, I don't think gloves necessarily need to be worn when dealing with a 12 year/old with a sprained ankle, but if there's a chance at all of coming into contact with a bodily fluid, then yes, the gloves go on.
 
Cut to the chase, DeMille!

1. If you work in health care with street people or penal inmates (the two sets overlap a lot) you are going to run a strong chance of testing TB postive before retirement, but an excellent chance of never becoming clinically ill and so not easily infective. If it isn't in a communicable state, it's not an issue. (Why don't ER's do PPD's on all incoming pts, or CXR's? Why doesn't the industry have a quick test for TB antibodies as it does for strep?).
2. Most strictly bloodborne pathogens don't require anything beyond what you are already doing if you are doing it right/consistently/thoroughly. If the exposure is exceptional, handle it properly. Be a center of calm in a sea of hysteria.
3. Unless it has bearing on the admit or the major malfunction, just jot it in the hx. But be sure you have it right. Not "Pt has AIDS" but "Nursing home nurse Ms A.B. stated 'the pt has AIDS' ".

That being said, there is one circumstance in which noting a bloodborne disease is important: exposure of another layperson or a provider/law enforcement/firefighter from the pt, such as during a fight, spitting, etc. In fact, some states (CA is one) have laws specifically providing for testing of "donors" when FD or LE gets exposed, whether then pt is willing or not, without a warrant.
 
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VentMedic said:
Sasha, In the year 2008, there is no need to anounce an AIDS patient's arrival via the airwaves for all to hear. You place your location in Florida. With Florida still in the top 3 for HIV infection, healthcare workers are aware of the disease and all must take the state required CEUs for their license. This also includes cosmetologists and barbers.
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Yes, but a lot of nurses at the hospitals I do clinicals at have gotten way too comfy and will often touch patients with out gloves on. ( I know, it makes me skin crawl!) and pop fingers to do IVs. Ickyickyicky. But if you give them a heads up that the PT does in fact have an infectious disease such as Hep C or AIDS, then they dont pop the finger and are gloved up to touch the patient.

And when your radio is smack dab in the middle of the ER, patients tend to overhear it.
 
With the volunteer service that I'm a member of our head of training says treat every patient as if they all have aids.
 
Sasha said:
Yes, but a lot of nurses at the hospitals I do clinicals at have gotten way too comfy and will often touch patients with out gloves on. ( I know, it makes me skin crawl!) and pop fingers to do IVs. Ickyickyicky. But if you give them a heads up that the PT does in fact have an infectious disease such as Hep C or AIDS, then they dont pop the finger and are gloved up to touch the patient.

And when your radio is smack dab in the middle of the ER, patients tend to overhear it.
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And that is why you keep you report simple and to the point. What is the chief complaint? If it is respiratory distress, they will still go to a bed set up for intubation. If it is a broken arm, they will go near the ortho area. You can give the HIV and Hep C report to the RN at the hospital. They will probably do a thorough history themselves also.

I may not agree with taking the finger off the glove during an IV but I touch HIV patients if they have no open sores where I am going to put my hands. I even hold their hands at a time of need...without gloves. I hug my close friends and co-workers who have HIV. I, as do the RNs, have known many of the HIV patients for 20 years and they have become our friends at least when they are in the hospital. There's something comforting when they see a familiar face in the ED. They are human beings. Commonsense should prevail sometimes.

I survived a time in EMS when it was cool if you had the most blood on you after working a scene. I also survived the most paranoid era of recent medical history when HIV come about in the 1980s.

Use commonsense and mind your universal precautions when doing procedures.
 
As Rid says... your report should be in the range of 30 seconds...

XXX ER, This is Jon with XXXXXX EMS, I'm coming to you BLS with a 26 y/o male, with a possibly fractured left leg after a skateboarding accident. Limb is immobilized, vitals are stable, and I'll see you in 3 minutes.

OR:

XXXX ER, this is Jon from XXXXXX EMS with an ALS notification. We're inbound to your faciltly with a 45 y/o male complaining of severe chest pain, no
 
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I never tell non-pertinent hx of a pt over the phone...basically because there's no point. When I get to the hospital I'll usually point out to the nurse on my PCR where it says +HIV/AIDS.
 
mycrofft said:
Why don't ER's do PPD's on all incoming pts, or CXR's?
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Probably because purified protein derivative requires a follow up visit 2-3 days after the injection and doing a CXR on everyone isn't worth the radiation exposure.
 
I keep it short and sweet on the radio. Pertinent info related to the reason the pt. is coming in. My radio reports really didn't last much more than half a minute (give or take).
 
JPINFV said:
Probably because purified protein derivative requires a follow up visit 2-3 days after the injection and doing a CXR on everyone isn't worth the radiation exposure.
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We will do an AFB if they have a productive cough in the ED. Their probability is weighed and then the decision is made whether they should be brought in to isolate until proven negative. People who are compliant may be sent home for a clinic followup later to get the results of the AFB or to do more tests.

Many of our jails do test for TB at the time of incarceration. Some are also instituting an HIV testing program. The state prison system has testing programs set up and if the inmate tests positive entry into or exit from the system they will be assisted in their healthcare.
 
jordanfstop said:
I never tell non-pertinent hx of a pt over the phone...basically because there's no point. When I get to the hospital I'll usually point out to the nurse on my PCR where it says +HIV/AIDS.
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That's the best way to do it, and the exact same method I practice. It's discreet and effective. That way it keeps certain ears from hearing things that shouldn't be heard.
 
JPINFV said:
Taking it to its logical conclusion, do you wear a N95 mask for all patient contacts?
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Okay, you got me there. But a pt with a productive cough gets a mask! Easier than masking everyone in the rig.

Personally, I'm not going to wait until I see bodily fluids. We have a lot of community acquired MRSA in our community. Also a ton of HepC. I glove up on my way to a call, change my gloves often and am borderline compulsive about handwashing.
 
jordanfstop said:
I never tell non-pertinent hx of a pt over the phone...basically because there's no point. When I get to the hospital I'll usually point out to the nurse on my PCR where it says +HIV/AIDS.
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same here. And we use the phone. No radio. Only me and the RN/MD who picks up gets the report. So if I need to mention AIDS, only that person knows. Nothing crazy need to be done.
 
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