Utah EMS Law Utah Code Title 34, Chapter Utah Code Title 78, Chapter

Purpose To protect the workers compensation benefits of EMS providers who become HIV infected and/or contract hepatitis B or C due to an exposure during their job duties To protect the workers compensation benefits of EMS providers who become HIV infected and/or contract hepatitis B or C due to an exposure during their job duties

Baseline Testing Applies to personnel hired after July 1, 1988 Applies to personnel hired after July 1, 1988 Must be tested for HIV, HBV and HCV Must be tested for HIV, HBV and HCV

Reporting Requirements All significant exposures must be reported All significant exposures must be reported Significant exposure means: Significant exposure means: –Exposure of the body of one person to the blood or body fluids visibly contaminated by blood of another person by: »Percutaneous injury, including needle stick or cut with a sharp object or instrument »Contact with an open wound, mucous membrane or non-intact skin because of a cut, abrasion, dermatitis or other damage »Any other method of transmission defined by the Utah Department of Health

Potentially Infectious Body Fluids blood blood amniotic fluid amniotic fluid pericardial fluid pericardial fluid cerebrospinal fluid cerebrospinal fluid vaginal secretions vaginal secretions or any other fluid visibly contaminated with blood or any other fluid visibly contaminated with blood peritoneal fluid pleural fluid synovial fluid semen cervical secretions

EMS provider documents on-the-job exposure EMS provider documents on-the-job exposure EMS provider becomes infected with HIV, HBV and/or HCV EMS provider becomes infected with HIV, HBV and/or HCV EMS law presumes the infection(s) is job-related EMS law presumes the infection(s) is job-related Employee can be compensated under the Workers Compensation Program Employee can be compensated under the Workers Compensation Program Presumptive Eligibility

Reporting Procedures EMS provider completes the Exposure Report Form (ERF) EMS provider completes the Exposure Report Form (ERF) EMS provider accompanies the patient to the receiving medical facility EMS provider accompanies the patient to the receiving medical facility EMS provider submits a copy of the ERF to an authorized person at the receiving facility EMS provider submits a copy of the ERF to an authorized person at the receiving facility

Reporting Procedures If EMS provider is unable to accompany the patient to the facility If EMS provider is unable to accompany the patient to the facility –EMS provider must call in the information needed to complete the ERF to the authorized person at the receiving facility –Telephone report must be followed by a hard copy of the completed ERF within 3 days of the incident –Hard copy is sent directly to the receiving facility

Reporting Procedures EMS provider notifies the Contact (designated person[s] within the EMS agency or their employer) EMS provider notifies the Contact (designated person[s] within the EMS agency or their employer) EMS provider submits a copy of the ERF to the Contact within 3 days of the incident EMS provider submits a copy of the ERF to the Contact within 3 days of the incident EMS provider may request testing EMS provider may request testing

Receiving Facility Responsibilities Receiving facility shall: Receiving facility shall: –Establish a system of receiving ERFs and information telephoned in by exposed EMS provider –Ensure that a designated person is available a 24-hour per day to receive the ERFs –Have trained pre-test counselors available or on call for counseling source patients –Complete the Source Patient Information section of the ERF

Receiving Facility Responsibilities Obtains permission from source patient to test for HIV, HBV and/or HCV Obtains permission from source patient to test for HIV, HBV and/or HCV –Patient, next of kin or legal guardian may consent –No consent required if under Utah Department of Corrections custody or if deceased If unable to provide counseling, provide the patient with phone numbers for trained counseling services within 24 hours If unable to provide counseling, provide the patient with phone numbers for trained counseling services within 24 hours Advise patient that they can refuse testing, but EMS agency may seek court order Advise patient that they can refuse testing, but EMS agency may seek court order Draw patients blood and sends it with the ERF to a qualified laboratory for testing Draw patients blood and sends it with the ERF to a qualified laboratory for testing

Laboratory Reponsibilities Receives the samples with the accompanying ERF form Receives the samples with the accompanying ERF form Tests the sample(s) for HIV, HBV and/or HCV Tests the sample(s) for HIV, HBV and/or HCV Sends test results by Case ID number to the EMS agency or employer Sends test results by Case ID number to the EMS agency or employer

EMS Agency/Employer Responsibilities Informs all EMS providers of law and procedures for submitting an ERF Informs all EMS providers of law and procedures for submitting an ERF Ensures that exposed EMS provider receives a confidential medical evaluation and follow-up according to OSHA regulations Ensures that exposed EMS provider receives a confidential medical evaluation and follow-up according to OSHA regulations Reports testing results immediately by case number, not name, to the exposed EMS provider Reports testing results immediately by case number, not name, to the exposed EMS provider Reports refusal of testing by the source to the EMS provider Reports refusal of testing by the source to the EMS provider Maintains records of disease exposures as per OSHA Blood Borne Pathogen standards Maintains records of disease exposures as per OSHA Blood Borne Pathogen standards

EMS Agency/Employer Responsibilities Assumes costs associated with: Assumes costs associated with: –Testing for HIV, HBV and HCV for both the EMS provider and the source patient »Costs must be within the Labor Commission fee schedule –Post-test counseling of the exposed EMS provider

Post Exposure Prophylaxis (PEP) CDC recommendations : CDC recommendations : –If indicated, start PEP as soon as possible after an exposure –Re-evaluation of the exposed person should be considered within 72 hours postexposure, especially as additional information about the exposure or source person becomes available –Administer PEP for 4 weeks, if tolerated –If a source patient is determined to be HIV-negative, PEP should be discontinued Source: MMWR June 29, 2001 / 50(RR11);1-42

Post Exposure Prophylaxis (PEP) Risk of HIV infection due to a percutaneous exposure is 0.3% Risk of HIV infection due to a percutaneous exposure is 0.3% Risk of HIV infection from blood exposure to skin and/or mucous membrane is >0.1% Risk of HIV infection from blood exposure to skin and/or mucous membrane is >0.1% PEP should be done in consultation with medical staff experienced in HIV care PEP should be done in consultation with medical staff experienced in HIV care Ideally treatment should begin within 1-2 hours after the initial exposure has occurred Ideally treatment should begin within 1-2 hours after the initial exposure has occurred Treatment can be given up to one week post- exposure if recommended by an experienced HIV medical provider Treatment can be given up to one week post- exposure if recommended by an experienced HIV medical provider

Contact Information Rebecca Fronberg, BS, CHES HIV Counseling & Testing Coordinator Utah Department of Health (801) State of Utah – Labor Commission Division of Industrial Accidents 160 E 300 S, 3 rd Floor—P O Box Salt Lake City, UT (801) —(800) —Fax (801)