KCM1 Zone 3 Exposure Algorithm
Purpose:
The purpose of this document is to help provide support in the
event a Zone 3 Firefighter has a bloodborne, TB, or meningitis exposure.
King County Medic One has a working experience with infectious
disease exposures and assuring best care of exposed persons. In each of
these instances, the key initial contact is the King County MSO-1 or
MSO-10 as back-up. These individuals will be able to provide timely
and accurate information and facilitate any required work-up or care.
The following document outlines the issues and plan for each type of
exposure.
MSO 1 (206) 730-9450
MSO 10 (206) 730-9452
Updated 06/15/2012
Blood or Body Fluid Algorithm
Background
All exposures need to be dealt with in a timely manner; however, a
substantial bloodborne exposure is the most time critical. Persons
exposed to high-risk contaminated blood need to be offered HIV
prophylaxis medication as soon as possible, ideally within 1-2 hours.
Although most local hospitals can test for HIV, most cannot get the
results back right away. In contrast, Harborview Medical Center’s
Virology Lab reliably provides stat testing so results are back within a
few hours of sample submission 24/7. King County Medic One has a
working experience involving emergency blood processing at
Harborview Medical Center.
Procedures for bloodborne exposure
1. Have the exposed personnel wash site thoroughly with soap and
water. Flush mucus membranes with water only.
2. Contact MSO-1 immediately. 206-730-9450
3. If this is a BLS patient and Medic One is not on scene, coordinate
with MSO 1 on appropriate procedures. If patient care is not time
sensitive, do not let the patient leave the scene until MSO 1 can be
contacted and advised. MSO 1 will then make appropriate
recommendations based off of physician consult.
4. If applicable, paramedics will draw blood on source patient. If at all
possible, blood draw should be prior to hospital arrival. Securing a
blood specimen from the source patient becomes much more challenging
once the patient arrives at the hospital and is no longer in EMS care.
5. Obtain permission from source patient or patient’s family if possible
for infectious disease testing. This permission can be documented on a
MIRF.
Updated 06/15/2012
6. MSO-1 can coordinate care regarding the exposure. The MSO will
consult with the appropriate physician to determine if prophylaxis
medications are indicated. If indicated, Fire Department personnel may
receive initial doses of prophylaxis from KCM1.
7. If applicable the exposed EMT-firefighter will be taken to
Harborview Medical Center for evaluation. This evaluation includes
additional assessment of risk, coordination of downstream follow-up,
and a blood draw for confidential baseline blood work (for L & I
purposes).
8. After the exposure MSO 10 will follow up the Fire Department’s
infection control officer at 6 weeks, 3 months, and 6 months to assure
that follow-up testing and evaluation is proceeding according to medical
guidelines.
Updated 06/15/2012
Tuberculosis Exposure Algorithm
Background
Tuberculosis (TB) in an infectious disease that is spread via respiratory
droplets from persons with active pulmonary TB. MSO-1 or MSO-10 in
conjunction with an appropriate physician may assist in determining
whether the source patient has active TB. Potential TB exposures are not
as time urgent as bloodborne exposures but still need to be identified and
addressed as soon as possible after the event.
Procedure for possible TB Exposure
1. Contact MSO-1 or MSO-10 to report the potential exposure. The
MSO will work with physician and hospital personnel to determine if an
active TB exposure has occurred.
2. If personnel have an exposure to active TB, they need to have a
baseline PPD skin test performed within 2-3 days of the exposure to
obtain a baseline, unless previous PPD was done with in the last 90 days.
This test can be performed at the local hospital or by their primary
physician. Follow-up will require repeat PPD testing 6 – 12 months
later to determine if a reaction develops.
Updated 06/15/2012
Meningococcal Meningitis Exposure Algorithm
Background
Meningitis is a serious and sometimes life-threatening infection of the
fluid around the brain. One particular type of meningitis caused by
neisseria meningococcus – can be contagious. MSO-1 or MSO-10 in
conjunction with an appropriate physician may assist in determining
whether the source patient has this contagious type of meningitis and
help guide the exposed employee in the steps that need to be taken
following an exposure. Potential exposures are not as time urgent as
bloodborne exposures but still need to be identified and addressed as
soon as possible after the event.
Procedure for possible meningitis exposure
1. Contact MSO-1 or MSO-10 to report the potential exposure. The
MSO will work with physician and hospital personnel to determine if a
contagious meningitis exposure has occurred.
2. If a contagious exposure is verified, exposed personnel need to be
treated with a single dose of antibiotic – most often ciprofloxacin. This
preventative treatment needs to occur within 72 hours of the exposure.
This medication is available from KCM1or can be obtained thru
prescription from a physician.
Updated 06/15/2012