Exposure ?

[paramedicmike]

You don't really know what you may find in the ER either. Or are you saying you've never been surprised or had a patient suddenly decompensate in the hospital? It doesn't take more than a second to put a pair of gloves on and you should always have a (fresh, new) pair with you, so what's the issue?

Chances are I'm not going to be the first person to see someone in the ER. Triage nurses, ER nurses and techs have likely seen the patient before I do. If there's an issue I'll know before going in. If by chance I am the first person to see a patient I have gloves on. If I don't know what I'm going in to see I put gloves on.

I agree, he should have had gloves on for the given situation, and should have followed his infectious policy (even though the risk was minimal). But...

In this case there are no "buts". There was blood on the patient. He knew it was there. He chose not to wear gloves anyway. Was it an exposure? It's hard to tell because he's presented different stories and withheld information. Should he have had gloves on? We agree that he should have. No "but" involved.

ETA: When I go in to see a patient if there are any body fluids, dried or otherwise, I have gloves on. Like the OP should have had.

Edited August 8, 2013 by paramedicmike

[MariB]

When we walk into a house on a 911 call, we don't always know what we are seeing, the patient fell? OK well they didn't mention the blood all over the place. Or the pt not feeling well that just had the mrsa scrapped from their knee yesterday. Its unknown.

On a inter facility transfer, with no open wounds or body fluids present, there is no reason to treat them any differently that anyone you just shook hands with, even if they do have HIV or hep c.

[triemal04]

Chances are I'm not going to be the first person to see someone in the ER. Triage nurses, ER nurses and techs have likely seen the patient before I do. If there's an issue I'll know before going in. If by chance I am the first person to see a patient I have gloves on. If I don't know what I'm going in to see I put gloves on.

In this case there are no "buts". There was blood on the patient. He knew it was there. He chose not to wear gloves anyway. Was it an exposure? It's hard to tell because he's presented different stories and withheld information. Should he have had gloves on? We agree that he should have. No "but" involved.

ETA: When I go in to see a patient if there are any body fluids, dried or otherwise, I have gloves on. Like the OP should have had.

So you're playing the odds then? Assuming that someone will let you know if something is wrong...or that they will have noticed... And, for the record, if you are examining someone with no fluids leaking out or other issues, do you put gloves on each and every single time? Not being a dick, but trying to make it clear.

I agree. For the given situation the OP should have had gloves on, and should have reported it, minimal risk or not. The "but" comes in because people are freaking out and losing it because apparently you must always wear gloves in EMS...NO MATTER WHAT AND FOR EVERY SINGLE PATIENT YOU SEE. That is not accurate.

When we walk into a house on a 911 call, we don't always know what we are seeing, the patient fell? OK well they didn't mention the blood all over the place. Or the pt not feeling well that just had the mrsa scrapped from their knee yesterday. Its unknown.

On a inter facility transfer, with no open wounds or body fluids present, there is no reason to treat them any differently that anyone you just shook hands with, even if they do have HIV or hep c.

I'm sorry, but that is not an excuse, or a reason. And not accurate. While you should have gloves on in the first situation (blood present), it takes a second to put a pair on. If you don't need them...why? Not knowing what you are about to see as the only reason...naw.

Stop being so hypocritical. A patient on an interfacility transfer that is not feeling well may also "just had the mrsa scrapped from their knee yesterday" and you just don't know about it. So why would you treat a transfer patient different than a 911 patient?

Unless it's because you don't understand what you are dealing with.

Edit: Hell, depending on where that transfer patient is coming from, they may have a much higher risk of having an infectious disease THAT THEY DON'T KNOW ABOUT than the average person off the street. So why is ok to not wear gloves on a transfer, but wrong for 911? Diseases don't just decide to act different due to the location or type of responce. If it's safe in one situation, it's safe in the other.

Edited August 8, 2013 by triemal04

[Just Plain Ruff]

Triemal quotes "What is the difference between a patient in the ER and one in the field? Do they somehow magically get cured of whatever you are afraid they have once they set foot in the hospital? Somehow become less infectious (if that is what you are worried about)?"

NO not at all, what I was saying is this, if I'm discharging a patient then the blood and body fluids should have been dealt with. If there is still fluids then that's a discussion to be had with the person who said they were ready to go. In my mind someone being discharged is ready to go and should be clean and not have blood/fluids on their hands so I will not wear gloves to have them sign a piece of paper discharging them. If there's any hint of gunk, then I glove up. I have pretty good eyesight and like to think I can see the fluids and or blood. (I'm sure you will refute that or turn it around to "You can't see all fluids)

If I'm going to go talk to someone in the ED and not touch them then gloves are to me unnecessary to wear during a discussion.

[MariB]

I would know if my patient on a transfer had mrsa scrapped from their knee yesterday. It would be in their history paperwork.

Not knowing what I walk into is one of several reasons to wear gloves upon first contact with my 911 response. Along with policy.

I would know what I'm transferring my patient for on a transfer. I have the whole history work up. We aren't going from one major hospital to another here, ours are all one networked. So I have all the info on this patient.

You are arguing for the sake of arguing, like usual

[triemal04]

Ruff-

As far as fluids then I think we are on the same page. Where we differ is that you have made it sound very much like you should have gloves on for every call, and every time you touch a patient...no matter what. That is what I take issue with because...to be blunt...it's bullshit.

It's just another one of those things that get's beaten (as someone else put it, which is a very accurate term for it) into everyone's head until nobody actually stops and THINKS about it. And then when some heretic dares to <gasp> question the gospel, they are immediately reviled and get the equivalent of being burned at the stake.

I would know if my patient on a transfer had mrsa scrapped from their knee yesterday. It would be in their history paperwork.

Not knowing what I walk into is one of several reasons to wear gloves upon first contact with my 911 response. Along with policy.
I would know what I'm transferring my patient for on a transfer. I have the whole history work up. We aren't going from one major hospital to another here, ours are all one networked. So I have all the info on this patient.
You are arguing for the sake of arguing, like usual

No, I'm not. I'm argueing because you very clearly don't understand what you are talking about.

Do you really actually think that every patient knows what is wrong with them and tells the facility they are at? Do you really think that every facility tests every patient for every possible infectious disease? Do you really think that every facility actually knows what is wrong with every patient they send out? Fuckin' A...

Edited August 8, 2013 by triemal04

[Just Plain Ruff]

Ruff-

As far as fluids then I think we are on the same page. Where we differ is that you have made it sound very much like you should have gloves on for every call, and every time you touch a patient...no matter what. That is what I take issue with because...to be blunt...it's bullshit.

It's just another one of those things that get's beaten (as someone else put it, which is a very accurate term for it) into everyone's head until nobody actually stops and THINKS about it. And then when some heretic dares to <gasp> question the gospel, they are immediately reviled and get the equivalent of being burned at the stake.

No, I'm not. I'm argueing because you very clearly don't understand what you are talking about.

Do you really actually think that every patient knows what is wrong with them and tells the facility they are at? Do you really think that every facility tests every patient for every possible infectious disease? Do you really think that every facility actually knows what is wrong with every patient they send out? Fuckin' A...

Fair enough, I get you and I do believe that gloves should be worn on every call. It's a personal decision and one that most of the agencies I've worked at required. Plus I know from past experience from co-workers who were exposed, a couple of them did not wear gloves and their claims were denied because it was against policy. That's where I come from.

Clarification, as I have provided, allows for leeway in certain situations I digress. It should. I am not disagreeing with your argument, I'm really not.

But I also personally wear gloves on all ems calls as I have that dermatitis issue I said I had and I get splits in my fingers and without gloves I put myself at significant risk. HELL even with gloves, I put myself at significant risk.

But, I'll give you the win for this battle that not every single patient contact requires gloves, but you just never know do you. Even you yourself admit that not every patient knows what they have, thus there should be at least gloves on in the initial patient contact.

I can remember one time when I didn't have gloves on, I reached under a patient and my hand slid right into a nice area of blood where the lab tech did not put enough pressure on the arm and it bled. Outward appearances showed no fluids or blood because the arm was covering the area of fluid. I was exposed. It's those times when you kick yourself in the ASS that you should have worn gloves.

[uglyEMT]

Yes triemal there are outdate protocols but if they are your protocols you follow them (ie the back board and C spine, my service and Med Dir state in the protocols that we must do it so I do.) But gloves for patient use, come on. Yes they should be used at all times. Look at it from a different perspective they also protect the patient from US. What if we have some nasties on us that you comprimise our patient? gloves are a way of stoping that. Now back to the OP he had non intact skin so he should have been gloved up no matter what. Why risk contaminating a patient?

At the end of the day I am the most important person right? We are number one priority right? So why not take that one second (as you stated) and glove up? What is the harm in wearing the gloves? Its a nonivasive preventative measure to insure both parties (you and the patient) are safe.

You asked about full PPE (mask gloves googles ect) if I have a trauma in the back you betcha. I dont want fluids in my eyes, mouth, ears, hair ect. Hell I even wear eye protection with drunks and EDPs. If they are spitters I will actually put a mask on them to insure my crews safety. Documented of course. Why not take the precaution? Is it now taboo to take PPE seriously for every patient? Like I asked OP about cleaning the cot and straps between calls. Is that not needed either? An ounce of prevention I say.

In my personal life outside EMS. Yes I try to be hygenic as much as possible. Sure I am not walking around in a biosuit but I try and avoid contamination as much as possible (Yes I will and do put gloves on when treating even my own wife and family for a cut. Again don't want to give them something I might have on my person) Washing frequently is always advised. I stay away from antibacterials and stick with plain old soap and water. We do have good bacteria so I try and not kill them.

I don't understand how this thread has turned into a PPE bashing thread. Are our soap boxes so high that the lack of oxygen has made us loonie?

[triemal04]

But, I'll give you the win for this battle that not every single patient contact requires gloves, but you just never know do you.

Aw shucks...

I'm not trying to win anything though. If someone makes a personal decision that they will wear gloves on every call, or there are extenuating circumstances (like your constantly cracked skin or other damage to their hands) that is one thing. My only point is that there is no legitimate NEED for gloves on EVERY call.

[Just Plain Ruff]

Aw shucks...

I'm not trying to win anything though. If someone makes a personal decision that they will wear gloves on every call, or there are extenuating circumstances (like your constantly cracked skin or other damage to their hands) that is one thing. My only point is that there is no legitimate NEED for gloves on EVERY call.

Actually I believe that there is a legitimate need for gloves on every call but they might not need to stay on for the entire call. I think that until you know there are NO bodily fluids or infectious disease hazards then gloves are on. ONce you determine in your "AWESOME" field evaluation and examination that there is no hazard, then you can consider taking the gloves off. I have done that myself.