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Date:         Tue, 12 Jan 1993 02:42:28 -0500
From:         Daniel Burstein <dannyb@PANIX.COM>
Subject:      Upstate NY (Alb area) EMS/AIDS news

The following article appeared in "THE DAILY GAZETTE," an Albany,
NY, area newspaper.  It discusses some curious problems faced by
the local volunteer rescue squad in the era of AIDS.

Transcription courtesy Danny Burstein (dburstein@mcimail.com).  A
few editorial comments added at end.  Usual disclaimers about
spelling accuracy apply.  comments in <angle brackets> were added
by danny burstein to clarify some points for people outside the
Albany, NY area.

Headline: Waterford (NY) squads prepare for AIDS house calls
by: by Kevin Conlon, Gazette Reporter
date: Monday 12/11/1993

Waterford- A newly equipped third ambulance will allow the local
resuce swuad to comply with new decontamination regulations, even
if an AIDS shelter planned here increases demand for the
procedures, a squad official says.

Federal Occupational Safety and Health Administration regulations
effective Jan 1st require ambulances to be be (sic)
decontaminated and taken out of service for 24 hours if bodily
fluids spill inside, said Waterford Rescue Squad President Karen
Durrick.

Durrick said Sunday that the same precautions must be used for
patients with human immunodeficiency virus, which causes the
fatal and incurable acquired immune deficiency syndrome.

New OSHA regulations mandate that ambulance personnel wear rubber
surgical gloves, plastic eye shields, and protective gowns when
they might come in contact with someone's bodily fluids or
someone kown to have HIV disease.

"Support Ministries for Persons with AIDS Inc." plans to open in
the spring a transitional shelter to house up to 15 homeless
people with AIDS in a 15 bedroom home at 31 Sixth St. in the
village.

A federal magistrate Dec. 4th ordered the village to issue
permits for the shelter. The village has not decided whether it
will appeal the decision, and talks are under way to settle
damages the village must pay for discriminating against people
with AIDS.

In anticipation of the OSHA regulations, and with teh AIDS
shelter expected to increase teh number of cases in which
decontamination is needed, the Waterford Rescue Squad managed to
get equipment for its third ambulance, Durrick said.

"At all times Waterford will have two [ambulances] in service,"
Durrick said.

The third ambulance was purchased a year ago by the Waterford
Industrial Development Agency. The $10,000 worth of equipment
that was needed to gain (NY State DOH) certification for the
ambulance was raised from local businesses and events held by the
rescue squad.  More fund raisers are planned.

Durrick said some local residents say they would not call the
rescue squad for medical transportation if the squad answers
calls at the AID shelter.

"We're not going to let ourselves become infected," Durrick said.
"We've all had training.  We all know how AIDS is spread... I'm
going to be very careful when I go in [the shelter].  I have
loved ones at home, and I'm concerned abotu teh other people we
help."

She said fear of the unknown and concern for the safety of family
members has driven the worries of many local residents who
believe the shleter will pose a threat to the health of village
residents.

HIV can be spread by direct contact with infected bodily fluids,
including blood, semen, vaginal secretions and breast milek,
according to the <NY State> Department of Health.

Other bodily fluids do not present a risk unless visible blood is
present, DOH literature states,  There is no evidence that the
virus can be transmitted through air, water, food or casual body
contact, according to the DOH.

The most common methods of transmission are sexual intercourse
and use of infected intravenous drug needles. Women infected with
HIV can transmit the virus to their children during pregnancy or
through breast-feeding.

Durrick said she believes Waterford Rescue Squad personnel will
be willing to respond to medical emergencies at the shelter.

the Waterford fire Department this week plans to develop a policy
for precautions firefighters must take if they respond to a fire
in the building, said Fire Chief Paul Norton.

Norton said he consulted San Francisco and New York City fire
departments for advice.  A meeting of the Waterford firefighters
will be held sometime late this week to discuss the proposed plan
and the feelings of the volunteers who would have to fight fires
in the house.

the department will likely have to purchase surgical gloves and
facial shields to protect them from contamination by bodily
fluids.

While procedures for protecting firefighters from infection are
in the works, a plan for how firefighters will attack a fire
there has been in place for months, Norton said.

town officials could not be reached for comments Sunday to
discuss any special precautions, if any, they would take when
responding to calls for assistance from the Sixth Street
residence.

-----------------

A few quick comments from DB:

   1) there is NO requirement in any DOH or OSHA spec that says
an ambulance must be off service for 24 hours following an
infectious exposure.  They -do- require that the unit be cleaned
(not sterilized).  I don't know if this was a direct quote from
the Rescue Squad, or if she had mant that the physical cleaning
and re-stocking emant that the unit would be out for a day.

   2) It's not so much the person with KNOWN AIDS who is a danger
to EMS personnel.  ANYONE with the virus is just as infectious.
The survey numbers differ, but it's reasonable to assume that at
least half the people with measurable quantities of the virus in
their bodies don't know they have it.  This is why the Centers
for Disease Control and Prevention (new name for CDC) recommends,
and OSHA requires, UNIVERSAL PRECAUTIONS - i.e. treat EVERY
patient as infectious.

  3) An interesting point raised in the piece was the concern
that other local resident would refuse to call the rescue squad
for "medical transportation" if they knew the unit had been
working on AIDS patients.

   4) As an aside, and mentioned here ONLY TO START SOME
THINKING, it's of interest to note that there is NO
specific New York State legal requirement that a rescue squad
respond to a call for help.  Despite all the stories you've
heard, this "duty to respond" or "duty to act" is not directly
addressed in any legislation.  Accordingly, the squad would be in
its rights to refuse to handle calls to the shelter.

    There are quite a few other laws and regualtions which could,
in theory, be extended to cover the scene.  However, there is no
law, rule, or regulation directly addressing universal service.

   5) I wonder how the squad deals with more "normal" infectious
diseases like TB, pneumonia, influenza, hepatitis, chicken pox,
or any of the others which are far easier to spread.  The problem
is (in general, I DON'T know about this unit) that people are
accustomed to these diseases, and familiarity breeds complacency.

take care,

Danny Burstein

<dburstein@mcimail.com>
<dannyb@panix.com>