There is a fear that every Health-care worker has. Tonight that fear jumped up and slapped me in the face.
Second job of the shift, we were called to “50 year old male – collapsed in street”. Normally this is someone who is drunk – but we rushed to the scene anyway, just in case it isn't (we rush to everything it's the only way to be sure you aren't caught out). We reach the scene and see the male laying on the floor talking gibberish. He is bleeding from a cut on his face and possible from his jaw. Bystanders tell us that he “just dropped”. He then starts to vomit, and because it's dark we get him on our trolley and into the back of the ambulance.
Our basic assessment finds that he has no muscular tone on his right side, although all his obs are within normal limits. Decided against hanging around – we start transport to hospital. Halfway to hospital he starts to vomit and cough – part of this vomitus/blood flies unerringly across the width of the ambulance…
…right into my open mouth.
Pretty disgusting – but what can you do? The patient then starts to come around – now able to move all limbs and to talk. This is good – it means I'm able to get some history from him. So I get his name, date of birth, address. Then I ask this 50 year old if he is normally fit and well.
“No”, he says, “I have AIDS”.
Bollocks.
I've never had anything from a patient in my mouth before (apart from the odd chocolate when I was a nurse) – so of course the first time is with a HIV+ patient.
My crewmate looks in the rear view mirror, and _that_ look passes between us. Ambulance people will know what I mean – it's the “Oh shit” look that you give/get when something goes horribly wrong.
We get to the hospital and the patient is looking a lot better, fully orientated, full strength and starting to feel the pain from a probably busted jaw. So I get to hand over to the nurse, which turned into a bit of a comedy moment…
Me:“Patient witnessed collapse, had right-sided hemiparesis, now resolved. Previous history includes AIDS”.
Handover Nurse:“Fine”
Charge Nurse:“You can't say that”
Me:“Pardon?”
Charge Nurse:“You can't say AIDS – People will be prejudiced against him”
Me:“Well they shouldn't be, and this is medical stuff. It's a syndrome like any other”
Charge Nurse:“You have to call it something else”
Me:“I don't really care for political correctness – besides I'm a patient as well as I swallowed some of his blood”
Charge Nurse:“Oh…Well lets get you sorted out then”
I then went through the rigmarole of having blood taken, then I asked to be put on PEP, which the Charge nurse agreed I should be put on.
PEP is “Post Exposure Prophylaxis”, basically a cocktail of antiretroviral drugs that taken over a four week period will hopefully reduce any live virus to non-infective amounts. Common side effects include…
Nausea, vomiting, headache, diarrhoea, cough, abdominal pain/cramps, muscle pain, tiredness, flu-like symptoms, difficulty in sleeping, rash and (I love this one) flatulence.
Other more uncommon side effects are – Pancreatitis, anaemia, neutropenia, peripheral neuropathy, and other “metabolic effects”.
I'm in for a barrel of laughs for these next four weeks…
The Charge nurse looked really sympathetic when he offered me stuff to look after the side effects – He used to work in a HIV clinic so I guess he knows better than me what I'm in for…
Then we talked about rates of infection, which is why I'm feeling kinda relaxed here. HIV is a tough virus to catch (compared to Hepatitis which is the one that worries me) If I were to stab myself with a needle after drawing HIV positive blood I would have a 0.004% chance of catching the virus. Swallowing a bit of blood/vomitus is less risky than that – especially as I have no mouth/stomach ulcers. With the PEP my chances of “seroconverting” are as close to zero as you can get. I knew all this before I set foot in the hospital – which probably explained why I wasn't a quivering wreck.
So far “only” two medical workers have sero-converted after needle-stick injuries. I greatly doubt that I'll be the third.
So “The Plan” is that I go to see occupational health on Monday, and they will advise me on what happens next. I've been told already that I'll have to avoid sexual contact for the next three months (not a hardship – I've managed “no sexual contact” for two years before now), and that I'll probably need to take four weeks off work due to me feeling too ill from the side effects of the anti-retrovirals.
We'll see about that… I don't “do” ill.
Anyway if I do need to take time off it'll give me a chance to read some books I've got sitting on my shelf – and complete “Zelda – Windwaker”.
Gotta go now, I feel flatulent already…
As an ex fisherman I am used to swallowing my own vomit but I kinda draw line the line at swallowing the vomit of others. As a tip I would say, in future, keep your gob shut when transporting patients.Politicians make me sick too.
GR.
I had a similar scare three years back after being stabbed by a #11 blade by a surgeon who was looking the other way while handing it back to me, point first, without warning. The prophylaxis was nasty, nasty stuff, and I got hell for calling in sick. My supervisor even tried to convince me to break off of it because of missed work, if you can believe it. But hey, at least I got a decent lunch break and a doughnut out of it. (I quit that hell-hole shortly after.)
Keep that positive outlook because it will be of great comfort to you in the coming weeks. Chin Up!
here is an idea for all medical staff exposed to people with unknown medical history: wear a mouth cover when in contact with a patient that's out of control or uncontious or umpredictible. For the nurses who risk their lives every day giving humanity their precious help: wear arm protection, something that would stop a needle from being accidentally stuck in tour arms. Maybe some kind of plastic sleeves. Would this work? Why not? Thank you for being their for everyone.
Oh, Dude! That SUCKS! As if getting hit with yuk in the mouth wasn't bad enough.I got to start my HEpatitis series while working in the ER – a nice sweet little 105 year old man decided he needed to shake my hand for helping him with his bloody nose. With all those blood-thinners, he was running like a fountain. AND he still had leftovers on his hands when he grasped mine warmly.
RATS!
THEN after the second shot in the series I found out I was pregnant.
Isn't EMS just a wonderful job. 😀
I'm glad you have such a positive outlook, lots of people I know would be terribly unhinged by this type of situation, most likely me included. While it's a hazard of the trade that we face everyday it is not something we ever expect or are fully prepared for.If there is anything I can do for you (from this side of the pnd) let me know. In the meantime I'll be thinking of you and hoping for a good outcome.
Regards
Man that's scary. I've stuck myself a few times with needles after it being in the pt, but they have never had anything for me to worry about. Im sure you will be ok though. Good luck
Been there… Done that. I feel for you for the next few weeks.
I hate that this happened to you. Goodness, I would be a nut case. You seem to be handling this better than I would.I got blood in my mouth once but thank goodness the patient didn't have anything.
I hope that the PEP isn't too hard on you.
This is exactly why HIV positive people should be tattooed and confined to camps.
Erm, no they shouldn't.Because (despite any moral argument) once you start doing that, then you may as well start rounding up all those with TB, Chlamydia, Herpes,Hepatitis, Alcoholism, Influensa, CMV and Leprosy. Do we stop at these diseases?…
You are a twit, 'camps' went out with the…well I _was_ going to say Nazis, but there are 'camps' all over the world…
Vomit is vile
The first time I was exposed to serious infection was when I transported my next door neighbours Mother-in-law to St Andrews Hospital. She had recently returned from a holiday in India and as it turned out, she had contracted typhoid and was now feverish. My crewmate and I found out about this three days latter from a report in the local paper. Panic! Straight on the blower to occupational health. A doctor called back some hours later and told me, as long as you didnt stick your un-gloved finger up her arse and put it in your mouth youll be all right!Second time was my own fault. One of those five-to seven jobs on the first of a set of seven nights (At a earlier Newham Ambulance Station we used to do this rotation every four weeks) Adult male unconscious. My crewmate of the shift was experienced and an arse-hole, who went on to become a senior officer in the PTS. When we arrive on scene, nigh on twenty minutes later, blue lights applied just round the corner from the house. On arrival approached by a woman in state of hysteria, I rushed back to the house with her to find an unconscious young male lying on his bed not breathing. I drag him off and onto the floor, about to perform CPR when I realise no bag! Which means no bag and mask? Does something his mother scream and you are buggered. Down I go and have give head, he vomits euck! Back to it. Tree minutes later the old hand (25 year old ex cadet) turns up with the resus equipment and we get on with it. Salutary lesson. Meningitis. Two weeks urinating orange juice. Remember your old Boy Scout motto. Be Prepared—for any thing.
Last occasion was after being bitten on the arm by a hysterical and very hot African woman. Test for HpB, negative (well I thought it was, what they said was my blood had high levels of Hep anti-bodies) The Aids test was too frightening, —to much experience of un-protected sex.
Its not Aids, Hepatitis or BSE you should worry about! Its all that negative stress that will eventually do for you. Either you will drop dead a few months after that rather questionable retirement party or the guardians of Waterloo Tower wills oft you at the first opportunity. It is amazing how many of them are escapees from the front line and a bunch of back stabbing arse licking bastards. I can remember being in the training school and been told by people like Mr Flaherty that we shouldnt develop Old hand syndrome, or driver mentality. I and some of my younger colleagues spent years at Newham complex discouraging this sort of negative attitude. Where was Flaherty and company in the bunker with their heads hung low and moaning, gutless bastards— nothing changes!
I always thank patients that tell me that they have HIV or Hep and I ask their permission to pass it on to the triage nurse at hospital. Of course there are those that don't tell you and you never find out (thats why we take precautions right), but the vast majority are open about it and seem happy to make sure those around them are aware. I really hope it works out for you.
Like it was a concious decision to swallow vomit…………