Utah EMS LawUtah EMS LawUtah Code Title 34, Chapter 2-0-5Utah Code Title 34, Chapter 2-0-5
Utah Code Title 78, Chapter 29-102Utah Code Title 78, Chapter 29-102
PurposePurpose
To protect the workers compensation To protect the workers compensation benefits of EMS providers who become benefits of EMS providers who become HIV infected and/or contract hepatitis B or HIV infected and/or contract hepatitis B or C due to an exposure during their job dutiesC due to an exposure during their job duties
Baseline TestingBaseline Testing
Applies to personnel hired after Applies to personnel hired after July 1, 1988July 1, 1988
Must be tested for HIV, HBV and HCVMust be tested for HIV, HBV and HCV
Reporting RequirementsReporting Requirements
All All significant exposuressignificant exposures must be reported must be reported Significant exposure means:Significant exposure means:
– Exposure of the body of one person to the blood or Exposure of the body of one person to the blood or body fluids visibly contaminated by blood of another body fluids visibly contaminated by blood of another person by:person by:
» Percutaneous injury, including needle stick or cut with a sharp Percutaneous injury, including needle stick or cut with a sharp object or instrumentobject or instrument
» Contact with an open wound, mucous membrane or non-intact Contact with an open wound, mucous membrane or non-intact skin because of a cut, abrasion, dermatitis or other damageskin because of a cut, abrasion, dermatitis or other damage
» Any other method of transmission defined by the Utah Any other method of transmission defined by the Utah Department of HealthDepartment of Health
Potentially Infectious Potentially Infectious Body FluidsBody Fluids
bloodblood amniotic fluidamniotic fluid pericardial fluidpericardial fluid cerebrospinal fluidcerebrospinal fluid vaginal secretionsvaginal secretions or any other fluid or any other fluid visiblyvisibly contaminated with contaminated with
bloodblood
peritoneal fluidperitoneal fluid pleural fluidpleural fluid synovial fluidsynovial fluid semensemen cervical secretionscervical secretions
EMS provider documents on-the-job EMS provider documents on-the-job exposureexposure
EMS provider becomes infected with HIV, EMS provider becomes infected with HIV, HBV and/or HCVHBV and/or HCV
EMS law presumes the infection(s) is EMS law presumes the infection(s) is job-relatedjob-related
Employee can be compensated under the Employee can be compensated under the Workers Compensation ProgramWorkers Compensation Program
Presumptive EligibilityPresumptive Eligibility
Reporting ProceduresReporting Procedures
EMS provider completes the Exposure EMS provider completes the Exposure Report Form (ERF)Report Form (ERF)
EMS provider accompanies the patient to EMS provider accompanies the patient to the receiving medical facilitythe receiving medical facility
EMS provider submits a copy of the ERF to EMS provider submits a copy of the ERF to an authorized person at the receiving an authorized person at the receiving facilityfacility
Reporting ProceduresReporting Procedures
If EMS provider is unable to accompany the If EMS provider is unable to accompany the patient to the facilitypatient to the facility– EMS provider must call in the information EMS provider must call in the information
needed to complete the ERF to the authorized needed to complete the ERF to the authorized person at the receiving facilityperson at the receiving facility
– Telephone report must be followed by a hard Telephone report must be followed by a hard copy of the completed ERF within 3 days of the copy of the completed ERF within 3 days of the incidentincident
– Hard copy is sent directly to Hard copy is sent directly to the receiving facilitythe receiving facility
Reporting ProceduresReporting Procedures
EMS provider notifies the Contact EMS provider notifies the Contact (designated person[s] within the EMS (designated person[s] within the EMS agency or their employer)agency or their employer)
EMS provider submits a copy of the ERF to EMS provider submits a copy of the ERF to the Contact within 3 days of the incidentthe Contact within 3 days of the incident
EMS provider may request testingEMS provider may request testing
Receiving Facility Receiving Facility ResponsibilitiesResponsibilities
Receiving facility shall:Receiving facility shall:– Establish a system of receiving ERFs and Establish a system of receiving ERFs and
information telephoned in by exposed information telephoned in by exposed EMS providerEMS provider
– Ensure that a designated person is available a Ensure that a designated person is available a 24-hour per day to receive the ERFs24-hour per day to receive the ERFs
– Have trained pre-test counselors available or on Have trained pre-test counselors available or on call for counseling source patients call for counseling source patients
– Complete the Complete the Source Patient InformationSource Patient Information section of the ERFsection of the ERF
Receiving Facility Receiving Facility ResponsibilitiesResponsibilities
Obtains permission from source patient to test for HIV, Obtains permission from source patient to test for HIV, HBV and/or HCVHBV and/or HCV– Patient, next of kin or legal guardian may consentPatient, next of kin or legal guardian may consent– No consent required if under Utah Department of No consent required if under Utah Department of
Corrections custody or if deceasedCorrections custody or if deceased If unable to provide counseling, provide the patient If unable to provide counseling, provide the patient
with phone numbers for trained counseling services with phone numbers for trained counseling services within 24 hourswithin 24 hours
Advise patient that they can refuse testing, but EMS Advise patient that they can refuse testing, but EMS agency may seek court orderagency may seek court order
Draw patients blood and sends it with the ERF to a Draw patients blood and sends it with the ERF to a qualified laboratory for testingqualified laboratory for testing
Laboratory ReponsibilitiesLaboratory Reponsibilities
Receives the samples with the Receives the samples with the accompanying ERF formaccompanying ERF form
Tests the sample(s) for HIV, HBVTests the sample(s) for HIV, HBVand/or HCVand/or HCV
Sends test results by Case ID number to the Sends test results by Case ID number to the EMS agency or employerEMS agency or employer
EMS Agency/Employer EMS Agency/Employer ResponsibilitiesResponsibilities
Informs all EMS providers of law and procedures Informs all EMS providers of law and procedures for submitting an ERFfor submitting an ERF
Ensures that exposed EMS provider receives a Ensures that exposed EMS provider receives a confidential medical evaluation and follow-up confidential medical evaluation and follow-up according to OSHA regulationsaccording to OSHA regulations
Reports testing results immediately by case number, Reports testing results immediately by case number, not name, to the exposed EMS providernot name, to the exposed EMS provider
Reports refusal of testing by the source to the EMS Reports refusal of testing by the source to the EMS providerprovider
Maintains records of disease exposures as per Maintains records of disease exposures as per OSHA Blood Borne Pathogen standardsOSHA Blood Borne Pathogen standards
EMS Agency/EmployerEMS Agency/EmployerResponsibilitiesResponsibilities
Assumes costs associated with:Assumes costs associated with:– Testing for HIV, HBV and HCV for both the Testing for HIV, HBV and HCV for both the
EMS provider and the source patientEMS provider and the source patient» Costs must be within the Labor Commission fee Costs must be within the Labor Commission fee
scheduleschedule
– Post-test counseling of the exposed Post-test counseling of the exposed EMS providerEMS provider
Post Exposure Prophylaxis (PEP)Post Exposure Prophylaxis (PEP)
CDC recommendations :CDC recommendations :– If indicated, start PEP as soon as possible after If indicated, start PEP as soon as possible after
an exposurean exposure– Re-evaluation of the exposed person should be Re-evaluation of the exposed person should be
considered within 72 hours postexposure, considered within 72 hours postexposure, especially as additional information about the especially as additional information about the exposure or source person becomes available exposure or source person becomes available
– Administer PEP for 4 weeks, if toleratedAdminister PEP for 4 weeks, if tolerated– If a source patient is determined to be If a source patient is determined to be
HIV-negative, PEP should be discontinuedHIV-negative, PEP should be discontinued
Source: MMWR June 29, 2001 / 50(RR11);1-42
Post Exposure Prophylaxis (PEP)Post Exposure Prophylaxis (PEP)
Risk of HIV infection due to a percutaneous Risk of HIV infection due to a percutaneous exposure is 0.3%exposure is 0.3%
Risk of HIV infection from blood exposure to skin Risk of HIV infection from blood exposure to skin and/or mucous membrane is >0.1%and/or mucous membrane is >0.1%
PEP should be done in consultation with medical PEP should be done in consultation with medical staff experienced in HIV carestaff experienced in HIV care
Ideally treatment should begin within 1-2 hours Ideally treatment should begin within 1-2 hours after the initial exposure has occurredafter the initial exposure has occurred
Treatment can be given up to one week post-Treatment can be given up to one week post-exposure if recommended by an experienced HIV exposure if recommended by an experienced HIV medical providermedical provider
Contact InformationContact Information
Rebecca Fronberg, BS, CHESRebecca Fronberg, BS, CHES
HIV Counseling & Testing CoordinatorHIV Counseling & Testing Coordinator
Utah Department of HealthUtah Department of Health
(801) 538-6299(801) 538-6299
[email protected]@utah.govgov
State of Utah – Labor CommissionState of Utah – Labor Commission
Division of Industrial AccidentsDivision of Industrial Accidents
160 E 300 S, 3160 E 300 S, 3rdrd Floor—P O Box 146610 Floor—P O Box 146610
Salt Lake City, UT 84114-6610Salt Lake City, UT 84114-6610
(801) 530-6800—(800) 530-5090—Fax (801) 530-6804(801) 530-6800—(800) 530-5090—Fax (801) 530-6804
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