On Nov. 14, 2009, firefighter Ramon E. Hain died at age 50 from complications following an exposure in 1997. On a cardiac arrest call, he came into contact with the patient’s body fluids through a wound on his own knee.
Within a few days of the exposure Ramon developed a raging infection in his leg that led to a weakening of his heart muscle. The damage was so extensive that he required a heart transplant.
Unable to return to work he stayed at home to raise his children. The doctors told him his life expectancy would be 10 years. While he made it a bit longer, his story is a tragic reminder of the dangers we face. With his story in mind, I want to focus on what we need to do by way of prevention to protect us and our families from exposure to the toxins we find in our patients and the environments where we work.
All of us have been in training scenarios that begin with us displaying that we put on our gloves before approaching the patient. Personal protective equipment (PPE) and body substance isolation (BSI) are phrases and acronyms with which we are all familiar.
Ramon’s story makes it clear that we really need to think broadly about limiting our exposure and understanding how diseases are transmitted.
Pathogens can enter the body through several routes.
Oral transmission involves the ingestion of contaminated material. Eating food or drinking water that has been contaminated are examples. This includes food that has been prepared in unsanitary conditions. We should keep in mind that whatever we get on our hands, even if we are wearing gloves, can still make it into our mouths.
Think about how many times a day you touch your face. If your gloved hands have contaminants on them and you brush your mouth, you may be ingesting those contaminants. Smokers need to keep this in mind when they light up at a fire scene or after handling patients.
Small globules of saliva called “droplets” are expelled when people cough or sneeze. These can travel in the air and be inhaled by rescuers. Masks on patients and rescuers can prevent this. It is inappropriate to put masks on some patients, so masking ourselves is the best protection.
Direct contact is what happened to Ramon. He had an open wound and the patient’s body fluids came into contact with the wound and were directly absorbed. This can also occur with needle sticks.
Exposing any break in the surface of the skin to body fluids can allow transmission. This is also the process by which disease is transmitted through unprotected sexual activity.
Eliminating risk through diligent observation and protective measures is imperative to reduce the risk to our families and ourselves. Through the use of gloves, protective eyewear, masks, face shields and gowns we can minimize risk.
The removal of this personal protective equipment should also be done in a manner that prevents exposure to the contaminants that may be on their surfaces after patient contact. Remember that one of the best defenses is frequent hand washing. A further preventative measure is immunization.
While employers should ensure that personnel receive immunizations before starting work, it is the personal responsibility of each of us to make sure our records are up to date and that we have the immunizations we need to protect us and our families.
Check your status regarding the following: screening for tuberculosis (PPD or chest x-ray); measles, mumps or rubella; hepatitis B; hepatitis A; diptheria-pertussis-tetanus; polio; chickenpox; influenza (annual immunizations) including H1N1; rabies (if appropriate to your risk).
It is our responsibility to protect ourselves, and to prevent the spread of disease. Toward that end we should all:
- Avoid work when we are sick or present exposure risks to others.
- Keep personal immunizations and records up to date.
- Approach all patients with regard to possible infectious conditions.
- Maintain control of the scene.
- Use PPE and BSI.
- Watch for signs and symptoms that hint at infection.
- Recognize immunosuppressed patients both as being at risk for exposure and a possible exposure risk to you.
- Disinfect equipment after each patient.
- Prevent exposure to body lice.
- Check your clothes often for cleanliness and whether they are intact.
- Wash hands thoroughly and often.
Remember it is important to be suspicious and cautious, but we must always be compassionate and professional to our patients. Do not treat them differently than others, just with more care.
Editor’s Note: Will Chapleau, who has more than 30 years of EMS experience, is the Advanced Trauma Life Support (ATLS) program manager for the American College of Surgeons. He is the former chief of the Chicago Heights (Ill.) Fire Department, has served since 1996 as the chairperson for the Prehospital Trauma Life Support (PHTLS) program of the National Association of Emergency Medical Technicians and has been a member of its international faculty since 1984. He is a board member of the National Association of EMS Educators.