Paramedic Kardex

General Information

(For your quick reference, here are the accepted parameters for exposures.)

 

Blood or Bodily Fluid Exposure:

A significant blood or bodily fluid exposure is a combination of one or more types of bodily fluids and one or more of the injuries listed below, and will require immediate medical evaluation.

 

Bodily fluids:

• Blood, serum, plasma and all fluids visibly contaminated with blood 

• Pleural, amniotic, pericardial, peritoneal, synovial, and cerebrospinal fluids

• Amniotic fluid/vaginal secretions or semen 

• Saliva 

 

Injuries: 

• Percutaneous (needle stick, laceration, abrasion, bites, etc.) 

• Mucous membrane (e.g. eyes, nose, and mouth) 

• Skin (e.g. cut chapped, abraded skin.) The larger the area of skin and the longer the length of contact time, make it more important to verify that all the relevant skin area is intact.

 

Airborne or Droplet Exposure:

A significant airborne exposure is a combination of a subject (source) showing signs/symptoms of a suspected airborne illness plus an activity that would place you at risk of droplet or airborne exposure, and these occurrences usually do not require immediate medical attention.

 

Source of Exposure: 

• Any aerosolized exhalation, sputum, or saliva, either by source coughing, spitting, breathing 

• Any pulmonary (lung) secretions brought forth either by patient (source) themselves, or by suctioning while you were not wearing appropriate barrier protection.

 

High Risk Activities:

The following activate the gag/cough reflex.

• Manual suctioning of naso-pharyngeal airway

• Insertion of nasogastric tube

• Endotracheal intubation

 

Actions For Blood Borne Exposures From Individuals Whose Infection Status Is Unknown For:

HBV–HCV–HIV if the source individual cannot be identified or tested, decisions regarding follow-up should be based on the exposure risk and whether the source is likely to be a person who is infected with a blood borne pathogen. If the exposed person has not been vaccinated, then hepatitis B vaccination is recommended for any exposure regardless of the source person’s hepatitis B status.

 

Testing Information:

 

For Blood Borne Exposures:

The source patient should be tested for HIV and the various forms of Hepatitis as soon as consent has been obtained. If it is impossible to draw blood from the source individual or he refuses to do so, but some other sample of his or her blood was drawn for any other reason, this sample legally can be used and tested. If the source individual is unable or unwilling to give consent, consider seeking the legal authority to act without consent. This can be obtained through a court order. Concerning blood borne exposures, time is an issue.  A Rapid HIV test should be conducted in “hours, but not days” from the time of the exposure. The use of rapid HIV testing has become the standard and has eliminated the need to place healthcare workers on very toxic drugs even for short periods of time. The test takes approximately thirty minutes to one hour to complete. This test is able to identify the HIV-1 antibody as soon as two weeks after an exposure. After your Rapid HIV test, you will have baseline blood tests drawn for Hepatitis B and C. This should be done in the same Emergency Department where the source patient is whenever possible.

 

In Summary: Source patient and exposed person should both receive testing for:

• HIV – Rapid HIV testing preferred

• HBV

• HCV

 

Exposure:

Blood spray in the mouth

Action:

Have FF made PT at hospital where source PT is, do blood draw. 

Action - Have blood draw from PT with rapid HIV, HBV, HCB

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