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

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

3. 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”

4. “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

5. 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

6. 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

7. 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

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

9. 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:

10. 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

11. 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

12. 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

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

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

15. 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

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

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

18. 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