Who has done it?????

[GaEMT]

After many years. I had a first yesterday. I stuck myself while discarding a lancet. I must say the Combivir and Viread are interesting medications and it looks as if I am going to spend the whole month on them. Nothing out of the ordinary occured to cause it except for a bump in the wrong place. Who else has done this and if you did the anti HIV prophalxyis how did you react?

Thanks

 

[ffemt8978]

Sorry to here that you got stuck, and I hope that everything turns out well for you.

As a lesson learned for everyone, what could you have done different to prevent the stick?

 

[GaEMT]

I don't think there was anything I could have done I was discarding of it in the sharps container and the truck hit a bump in the road Bad timing more than anything.......

 

[akflightmedic]

Interesting that you started on the therapy after a lancet stick.

Not trying to shred you here but this is a good chance to use you as an example for safety at all costs.

You say it was unavoidable and the truck hit a bump. However, research has shown time and time again, there was always a human factor/error when a needlestick occur. In fact there is ALWAYS something that could have been changed to avoid what happened. There are no accidents, which is why we now call them MVCs and not MVAs. Semantics of course but it proves the point.

I want you to reexamine everything that you can recall and see if any of these could have been altered.

Since I was not there, tell me yes or no if this could have been changed.

Safety--
First, how did you get stuck by a lancet. Why does your department not have retractable lancet needles? ( Should this be a good time to complain to your service so that this may be avoidable in the future?)

If you are holding a lancet which is usually in your thumb and first finger, how in the world did you manage to stick yourself while disposing it in the sharps?(Does your rig need larger openings on the sharps?)

If you are handling a needle and going down a bumpy road, or any road period....did/do you alert your driver when you are handling a sharps?(This is very good policy for any tyoe of needle, have the driver slow or come to a stop..I have done this on even the most critical patients dont give me any lines)...

Were you wearing gloves?( I have seen many people not wear gloves cause it is only a sugar). Wearing proper gloves, it is very hard to get a lancet puncture. You had to come down with some force to achieve that which makes me curious as to where or how your hands were placed. If nothing else, a bump should have been a scraping action.

When in a moving ambulance, why do you not simply toss the sharps onto the floor under the heel of your boot as is taught in all my EMT classes when it is inconvienent to dispose of a sharps or there may be risk to injuring yourself while doing so? This simple manuever would have avoided the whole situation you are now enduring.

These are a few of the things that come to mind at this current time. Now that you have read this, could YOU have changed any of these to avoid this "ACCIDENT". I am sure you could have. Thank you for allowing me to use you as a case study. Hopefully this post will give some others ideas on how to prevent injuries from needles themselves in the future.

As for taking th actual medicine for 30 days, I commented cause it is an unusual course of action these days. Doctors and people with needle sticks alike agree the cost and side effects just are not worth it. They like to take a wait and see approach. Did your pt have any conditions that warrant you to take these medicines? You are allowed to know this information and should have been informed by your safety officer and primary doctor. If your pt did not have any of these conditions, why did you choose to undergo this therapy? I am just curious for my own personal knowledge. If you look up the statistics, you may be pleasantly surprised to find out how low the actual transmission rate of HIV via lancet is. You need to remember, the lancet is not hollow like a catheter, so it does not have the ability to inject blood iinto you. It is solid, so that greatly reduces your rate of transmission there. I mean do what makes you comfortable, I was just tossing out food for thought. I have been stuck before(yes it was MY fault) and after gathering all information I declined any therapy.

Well, that is all for now ...good luck

 

[GaEMT]

Maybe accident is an improper word. It happened becuase I did something stupid (I am not afraid to admit it) I was disposing of the lancet with one hand and holding the lid which covers the sharps container with another. The opening is plenty big enough, so that is not the issue. When I was moving my arm the "bump" occurred and wham there goes the lancet tip in the palm of the other hand. (through the glove)

Retractable lancets are uder research at this time to be used going forward.

As far as tossing needles on the floor, I have heard of this approach and I know of individuals who have stuck theirselves while picking them up, so a catch 22 theroy there.

Please do not insult my intelligence by asking if I was wearing gloves. I have been in this business long enough that I remember when there were only 2 pair of gloves on an ambulance and you had to break into an OB Kit to get them. So yes, I know what is out there. And yes I had gloves on!

As far as the 30 days on the meds, the source is known HIV positive and yes I have done the research. Funny you should say MD's and people agree the cost and side effects are not worth it and that "wait and see" is the attitude. That is funny. I know the risks are extremley minute. And I do undertand the mechanical aspects of hollow bore versus solid and I know the importance of the wound depth. But Buddy, you nick YOURSELF with a lancet with a known HIV+ patient and see what your reaction is then!

RESEARCH shows the earlier the meds start the greater the success. The combination of drugs I was given was prescribed via teleconference with the CDC within an hour of the event. Nothing personal, but I had already done one extremely stupid thing that day, not listening to the CDC as far as their RECoMMENDATIONS would have probably been even more stupid than the first. Hence the decision to go with the 30 day supply. Their decison is based on the current med I take for my blood pressure, as it has interactions with some anti HIV meds.

And you do not want to try and "shred" me. You cannot sit there and tell me you have never done anything stupid in the back of an ambulance. I know "accident" is not your choice of words. S*%$ Happens, ok?

 

[TheDoll]

GaEMT, i am sorry to hear that you got stuck, and i really appreciate your candor in sharing this experience. i am still a student who hopes to go on to medic school. so, this is something that i, as well as many others have spent a lot of time thinking about. hearing about your experience really does help me understand what to do and what not to do. hopefully, i always remember what TO do!
also, i don't think anyone is trying to beat you up for what you have gone through. i think anyone would feel bad that you have to go through this. i think that the previous post was just an attempt to help some of the rest of us avoid this situation. again, i'm sorry that you have to now endure the meds, etc, and i look forward to hearing what effects the meds have had on others.

Please do not insult my intelligence by asking if I was wearing gloves.

since i've started riding out, i am amazed at the situations i have witnessed where even paramedics didn't wear gloves when getting ready to stick someone. the one that i am specifically referring to seemed very intelligent and was otherwise extremely helpful to me. i think perhaps the last post was just an attempt to verify the scenario.
good luck, and again thank you for helping the rest of us by sharing your story.

 

[Jon]

GaEMT - I think AKFlightMedic was assuming that there WASN'T a known HIV risk. Since there is, the medication risk vs. benefit equation is different. Also, as AKFlightMedic mentioned, a "solid" lancet probably didn't have enough blood to cause an exposure BUT you won't know for sure until a year from now.

As for wearing gloves... I've seen plenty of "old school" medics start lines and check sugars on "little old ladies" without bothering to put on gloves.

The "lesson learned" part about how, exactly, you stuck yourself is a VERY good point.

All of our rigs have sharps boxes that have the flip-up doors like a mailbox, so you never have to open a lid for the sharps box, and nothing can fall out. Perhaps one of these would have helped.

In addition, this should really light a fire under someone's you-know-what to go to a needle-safe system.

 

[akflightmedic]

You reacted exactly as I had hoped you would not. Please do not knee jerk to my commentary.

If you re read my post, you will see that I had admitted to doing something stupid in the back of the ambulance. As I stated in my post, I was using your situation as a case study for anyone else that may come along, read this and learn from it...never to repeat the mistake you made. This is how we learn sometimes, trial by error.

You failed to address any of my scenarios and I really do not expect you to. My examples were more of pointing out ways for others to avoid this same situation. What you did has already happened and I assume you will never repeat it.

I was not insulting your intelligence about wearing gloves. Many seasoned people feel they do not need them.

I also shared some very useful techniques for sharps disposal which you countered with "I have seen people still get stuck that way". Well, if needle sticks are still occurring using those precautions, then it is the person's fault and somewhere they did not follow proper procedure.

Please do not get so defensive in the future when someone uses a story of yours for teaching. Sometimes this is the best method of learning. I myself have made many manymistakes over the years and I use them as examples for all my students over the years. I show them I am not perfect and I hope they learn and benefit from it. And yes, I still make mistakes however they are much more infrequent these days.

 

[akflightmedic]

Oops...I re read my post and I guess I deleted the paragraph where I admitted to my own personal wrongdoing. I remember writing it, maybe it didnt fit or was extremly relevant to the point I made. Anyways, yes I have made mistakes as no one is perfect.