HIV Exposure: What Emergency Response Agencies Need to Know About Accessing Information

Objectives Upon completion of this training, agencies will be able to: 1. Communicate current process for accessing patient HIV information after occupational exposure 2. Update policies and procedures to implement this new process 3. Educate emergency responders regarding policy and procedure

History of Ryan White Law Federal Law passed in 1990 Applied to Emergency Response employers (EMS, Fire, Law Enforcement) Employers required to have “Designated Officer”

“Designated Officer” The Role of the Designated Officer in original Ryan White guidance: Field calls from emergency responders regarding possible exposures to communicable diseases including human immunodeficiency virus (HIV) infection Obtain disease status of the patients in those exposures from hospital providing treatment to the patient

Changes in 2006 Reauthorization of Ryan White Law left out Emergency Response Designated Officer language This means no federal provisions in place for sharing of information Absence of federal provisions allows a more up-to-date approach in New York State

New York State Regulation NYS Regulation [Section 63.8(m) of Title 10 NYCRR] still allows emergency responders to access HIV test results on a patient when there has been a bona fide risk exposure

At a Glance Comparison Ryan White – Past DO required (response agency and hospital) Request must be in writing 48 hours to respond No mention HIV test of source patient NYS – Present DO optional but in reduced role No written request required Response should be as soon as possible Source patient testing is provided for

Definition of “Exposure” 1. Must involve exposure to blood, semen, vaginal secretions, tissue or the following body fluids: cerebrospinal, amniotic, peritoneal, synovial, pericardial, pleural 2. Contact with EMR mucous membranes, non- intact skin, or vascular system Examples, needlestick injury, open wound, splash to eyes, nose, mouth 3. The exposure occurred in performance of employment or professional duties (includes emergency medical responders)

Occupational Exposure Exposure Occurs First Aid –Needle stick, cut – wash with soap and water, don’t squeeze –Splash mucous membrane – rinse with water Go to Emergency Room (ER) Notify personal healthcare provider or agency healthcare provider For occupational exposure guidelines see:

Emergency Responder’s Responsibilities Call supervisor and notify them of exposure While in emergency room consent to HIV testing, request a rapid HIV test Notify your healthcare provider Submit an incident report documenting details of the exposure to appropriate supervisory staff at emergency response employer

Responsibilities of the Emergency Responder’s Healthcare Provider Request disclosure of HIV status from patient’s primary care physician or to ER where patient was treated Confirm the information is necessary for immediate decisions regarding initiation or continuation of post exposure prophylactic treatment of the emergency responder, and; The emergency responder’s status is either HIV negative or he/she consented to an HIV test, and; If such test result becomes known as positive prior to receipt of patient’s HIV status, no disclosure of the patient’s HIV status will be made to the emergency responder

Emergency Room or Hospital’s Responsibilities Review, investigate, and evaluate the incident Determine that a risk of transmission has occurred or is likely to have occurred then the patient’s HIV status may be released, if known If unknown, may approach patient and request rapid HIV test Source patient must consent to HIV testing Patient’s name will not be released nor will re- disclosure of the patient be permitted except when in compliance with NYS Public Health Law Article 21, Title III

Local Health Department Role May be contacted by emergency responder’s primary care physician or the ER to: 1. Determine if a risk of transmission exists 2. If consultation occurs, both the provider and local health officer must be in agreement that risk occurred 3. Information may be released

Documentation Documentation of request is filed in emergency responder’s medical record at primary care physician’s office

Recommendations Emergency Response agencies should review and update their policies and procedures to ensure compliance with Section 63.8(m) of Title 10 NYCRR Emergency Response agencies should notify their emergency responders of new procedures to be followed in cases of possible HIV exposure

Recommendations continued… Designated Officer : Current Role – Serve as agency resource for blood borne pathogens pathogens – Update policy and procedure –Provide staff education –Maintain hospital contact information and relationship –Maintain records

More Information NYS DOH Bureau of EMS (518) ext 2 NYS DOS OFPC ( 518) NYS Division of Criminal Justice Services (518)

Clinical Resource For Specific Incident: NYS DOH HIV Clinical Education Initiative's Post Exposure Prophylaxis Center of Excellence – –(212) – –education and technical assistance for the emergency response employer – –(888) – –clinician consultation line for the management of PEP For Policy, Procedure, General Questions: Lyn Stevens, NP, ACRN, Associate Medical Director or