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EMT1972

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From the NYS DOH Website:

Under what circumstances can HIV-related

information be disclosed without an approved

HIV release form?

For medical treatment:

• Medical professionals working on the treatment team with the

person’s existing provider may discuss a patient’s HIV-related

information with each other or with their supervisors, but only to

give necessary care. A general release is needed to disclose

medical information to a provider who is not affiliated with the

person’s current medical provider.

• With a general release, a hospital or health care provider may

share HIV-related information with a patient’s insurance company

if the information is needed to pay for medical care.

• Medical personnel and certain other supervisory staff may have

access to HIV-related information to provide or monitor services if

the person is in jail or prison or is on parole.

• Disclosure may occur without consent in certain cases of on-thejob

exposure to HIV when all criteria for exposure have been met.

• Parents or guardians of a minor or individuals who are legally

authorized to provide consent can be given HIV-related

information about the person if it is necessary to provide timely

care, unless it would not be in the person’s best interests to

disclose the information.

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Good information provided the HIV status of the patient is know. If not...

Here NY's 2005 guidelines for obtaining a specimen.

http://www.hivguidelines.org/GuideLine.asp...p;guideLineID=3

If rapid blood testing is available on site, it should be used to determine the HIV status of the source patient. Results are usually available within 30 minutes of testing. Rules regarding confidentiality and consent for testing are identical to those for other HIV tests.

If the preliminary rapid test result is positive, the result should be given to the source patient. To establish a diagnosis of HIV infection, the test must be confirmed by a Western blot assay, which should be performed as soon as possible.

If the result from testing the source patient is not immediately available and PEP is indicated based on assessment, the initiation of PEP should not be delayed pending the test result.

A special consent form for testing the source patient is available (see Appendix C). If the test result is not immediately available, the initiation of PEP should not be delayed pending the test result. When the source patient is tested, a rapid test may be particularly useful because a negative result would indicate that HIV PEP is not needed. If the result of the HIV test from the source patient is negative, the HCW should be informed of the small chance that it could be a false-negative result if the source patient has been recently infected (during the "window period"). PEP should be recommended in situations when a significant risk exposure has occurred and the clinician suspects that the source patient has a strong likelihood of having recently acquired HIV infection.

Also

http://www.guideline.gov/summary/summary.aspx?doc_id=5906

http://www.hivandhepatitis.com/hiv_and_aid..._test.html#S13X[align=center]

Florida:

http://www.doh.state.fl.us/Disease_ctrl/aids/

http://www.mecop.org/HIV3hr/chapter7.htm

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Also a little information on HIV transmission via saliva.

Hopefully it will help ease some of the stress while you wait.

http://www.thebody.com/content/art40621.html

Dr. Jeffrey Laurence explained that studies have shown that a reliable laboratory can isolate HIV in the saliva samples of about 25% of HIV-positive people. The same labs can isolate HIV in 100% of blood samples from the same people. In those saliva samples in which virus can be found, the concentration of virus is much lower than in blood, semen, or the already low concentrations found in vaginal or cervical secretions. The low concentration of virus in saliva may mean that saliva is less likely to cause infection than blood or other body fluids. This is certainly supported by test tube and animal studies of infectivity.

Why is saliva less infectious than other fluids? It is believed that there is a substance in saliva that inhibits HIV. The inhibition observed may be due to large sugar-protein molecules in the saliva called glycoproteins. These glycoproteins apparently cause HIV to form giant clumps which are not capable of causing infection.

Animal studies also suggest that saliva is an unlikely source of HIV transmission. In studies, concentrated SIV (simian immunodeficiency virus; a virus similar to HIV) was rubbed on the vagina, rectums, and gums of monkeys. Infection occurred in monkeys that had been exposed via the rectum or vagina, but not those exposed via the gums.

In a test tube study, chimp saliva blocked the ability of HIV to infect T4 cells. Experiments with human saliva showed that it was less effective than chimp saliva at inhibiting the virus but still quite effective. In one study, 10-60% of the saliva samples could inhibit the virus, not completely, but by a fair amount. (Patricia Fultz, et al., CDC). At least ten studies have shown that saliva can inhibit HIV. HIV is present in ejaculate, pre-ejaculatory fluid, vaginal secretions, and cells in cervical fluid. None of these fluids contain the glycoproteins that inhibit HIV in saliva and all are more infectious than saliva.

Again best of luck

WANTYNU

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I saw this article and remembered this thread. Again, it is very important to be familiar with you state and local laws. Updating EMS professionals on new laws should also be included in recertification classes.

http://www.emsresponder.com/article/articl...n=1&id=6255

Updated: September 28th, 2007 01:54 AM EDT

Paramedic Supports Massachusetts HIV Testing Bill

By Hillary Chabot

Sentinel & Enterprise (Fitchburg, Massachusetts)

BOSTON -- Lunenburg resident Darrell Demers had no idea what the gash to his hand would mean as he worked on a bloody car accident victim in Fitchburg nearly two years ago.

It meant a drug regimen that left the paramedic in constant pain to prevent possible HIV infection. It meant keeping his toothbrush away from his three young daughters and scrubbing the house with bleach if he cut himself.

"This whole insult to my body, my emotional well-being and my family could have been avoided with simple blood tests," Demers said at a hearing at the Statehouse Wednesday.

The car accident victim was in a coma, and unable to give consent required by state law to test for HIV infection. A bill filed by state Rep. Stephen DiNatale, D-Fitchburg, would allow blood testing of the patient if others could have been infected by them.

"This is a bill which will hopefully help others who help us," DiNatale said.

Demers, 39, said he still worries about getting infected or having to go through the month-long treatment and year-long waiting period that accompanies a possible exposure to HIV.

"I have been a public servant my whole life. I am a loving husband and devoted family man," Demers said, his voice breaking. "I do not want to see any other public servants or health care workers go through what I went through."

Seventeen other states have similar laws, DiNatale said.

State Rep. Jennifer Flanagan, D-Leominster, was also on hand to testify on behalf the bill, which was before the Committee on Public Health.

"It's important to understand we're not discriminating against any particular disease," Flanagan said. "What we're trying to do is make this right. We're trying to protect those who protect us."

But due to the six-month incubation period of HIV, those placed at risk could be infected even if the results are negative, argued Denise McWilliams, public policy director at AIDS Action Committee of Massachusetts.

"This is one of those unfortunate situations where technology has not caught up with people's needs," McWilliams said. "At this point, the test doesn't really give you all the information you need to make a decision."

Demers had to make a decision within 72 hours of possible exposure, and was strongly encouraged to take the anti-HIV medication. He believes the test results would have at least given him more guidance.

"I do not feel that it is right that I have no rights in this situation," Demers said.

http://www.emsresponder.com/article/articl...n=1&id=6255

Earlier article:

http://www.emsresponder.com/article/articl...p;siteSection=1

Updated: April 6th, 2006 01:25 AM EDT

Massachusetts Paramedic Seeks Recourse After Exposure

REBECCA FATER, Sentinel & Enterprise Statehouse Bureau

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We've had personnel bitten by patients, and as it was explained to me, the patient has little choice. Either way, medical condition or not, spitting is assault and biting is battery. You have the legal right to obtain the results to their blood test. You can subpoena the results, or get a court order if necessary.

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FYI: THIS IS GOOD NEWS:

Emergency workers protected

Sunday September 30, 2007

Kristin Thesen

ccnews@camrosecanadian.com

Camrose emergency responders will be better protected after new legislation is passed for compulsory testing for communicable diseases of individuals who expose police, firefighters, paramedics and other emergency responders to bodily substances.

Fear of infection

New rules to provide access to information that can help in assessing their risk of contracting communicable diseases when exposed to body fluids.

“We are extremely pleased that this new legislation has been passed, as we the police have supported the initiative from the onset. As first responders we sometimes have no control over the situations we are forced to deal with and whenever a transfer of body fluids occurs, there is always a fear that an infectious disease has transferred as well. This legislation provides us with the authority to obtain medical information about the person involved which then provides us with an area of comfort to allow us to take the necessary medical steps to ensure the health and safety of our first responders”, said assistant Chief Darrell Kambeitz.

As of October 1, Alberta’s Mandatory Testing and Disclosure Act will allow peace officers, firefighters, paramedics and “Good Samaritans” providing emergency assistance to apply for a court order to obtain a blood sample for testing from an individual who may have exposed them to HIV, Hepatitis B or Hepatitis C.

Health record

The court order will also enable Alberta’s chief medical officer of health to check the individual’s health record as a first step. Any pertinent information would be shared with the emergency responder’s designated physician.

Camrose EMS Manager Andy Postma agrees with Kambeitz, saying the new legislation will not only assist emergency responders but will provide relief for families as well.

“Were very happy about it, it helps put us on ease. It’s rare, but when it does happen, your on pins and needles the entire time. It effects the whole family too,”said Potsma.

The Act builds on the Blood Samples Act, introduced as a private member’s bill by Lukaszuk. Changes include additional notice and appeal provisions, enhanced privacy protection, expansion of categories of applicants who may apply, and the application of a court-based procedure.

“This legislation provides the appropriate balance of meeting the needs of emergency responders, while protecting the privacy and rights as much as possible of the individuals who are required to undergo testing,” said David Hancock, Minister of Health and Wellness.

Additional information regarding the act, the supporting regulation and associated forms, including the application for testing order and physician’s report, is available online at www.health.alberta.ca.

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as far as I would be concerned I would consider this patient to be HIV Positive and take the prophylaxis.

Better safe than sorry.

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