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

rfronberg@utah.rfronberg@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