In February 2009, Firefighter/EMT Ferdinando "Fred" Pierno of Martin County Fire Rescue in Florida died from complications associated with Hepatitis C that he contracted on the job. Fred was surrounded by approximately a dozen brother firefighters at the time of his death and toward the end of his life they took shifts caring for him.
Nobody knows how Fred contracted Hepatitis C, but Florida has a presumption law. Basically, it says unless proven otherwise, it is presumed that firefighters, paramedics, EMTs and other emergency responders contracted the infectious disease on the job. Fred discovered that he had Hepatitis C in 2004 and he was diagnosed with liver cancer two years later. It is not uncommon for someone with Hepatitis C to come down with liver cancer or cirrhosis of the liver. Fred was 55 years old and became the 13th firefighter in the United States and the seventh in Florida to die in the line of duty from Hepatitis C.
In the February 2003 issue of Firehouse®, I wrote a column, "Paramedic in Fight for His Life," about Joe Tomaso, a paramedic working in Danbury, CT, who contracted Hepatitis C after moving an 83-year-old man who had been lying in his own blood, urine and feces for several days. Although Joe was wearing gloves at the time, his forearms came in contact with the body fluids when he slid his hands under the patient to move him. Unfortunately, the day before, he had trimmed his hedges and had scrapes on his forearms. At the time I wrote the column, Joe had become completely disabled from the disease and was unable to work. I recently heard from Joe, who tells me has a new liver and is making progress, but still has the Hepatitis C since there is no cure.
One danger of EMS work is being exposed to diseases. It was not until the mid to late 1980s that those performing EMS work became concerned about contracting infectious diseases. The big push that created awareness of contracting an infectious disease was when HIV came on the scene. Back then, HIV was mainly associated with male homosexuals, but we soon learned that anyone could have HIV. I clearly remember the immediate rush to get everyone to wear gloves when treating a patient. Before that, many firefighters, paramedics, EMTs and other emergency responders wore no protective items to create any body isolation between them and the patient. In fact, many considered that the more blood you got on you, the more of a "badge of honor" it was to show that you were in the middle of the action doing your job.
It is estimated that four million people in the U.S. have Hepatitis C, regarded as a silent killer since many people do not know they have it until they see signs and symptoms of other diseases that are secondary to the hepatitis. First reported in 1975, it was called non-Hepatitis A and B. It was not until 1989 that it was renamed Hepatitis C. No testing of blood products for Hepatitis C occurred until 1992. Hepatitis C usually is contracted via illegal drug use, blood transfusions, organ transplants, body piercing or tattooing, or sex with an HCV-infected person. There is also a high concentration of Hepatitis C among prisoners, HIV patients and IV drug users.
Being exposed to blood or body fluids is a daily experience for firefighters, paramedics and EMTs. It just takes one small drop of unnoticed blood or body fluid to be rubbed into an eye or exposed to chapped or scrapped skin to infect someone doing EMS work. The bad part of Hepatitis C is that there is no cure and there is no vaccine for it. There are treatments designed to keep the viral load down, but they are not always effective and vary from person to person.
The main reasons why researchers have been having trouble finding a vaccine for Hepatitis C is because Hepatitis C has different genetic variations, the genetic code mutates very easily and there is no real small animal model in which the disease can be replicated to see how it would perform with a human.
But all of that may be changing since a Hepatitis C vaccine may be on the horizon. Researchers at Rockefeller University have learned how to infect mice with Hepatitis C. Since researchers can replicate the disease in small animals, they can determine a clear path for developing a vaccine. Another clinical study, started at St. Louis University in 2006, has entered phase II trials. In the phase I trial at St. Louis University Medical School, all 45 healthy volunteers given the vaccine produced neutralizing antibodies to Hepatitis C. In all, there are at least a half-dozen other studies or trials under way that take many different approaches to eventually creating a vaccine for Hepatitis C.
I will continue to advocate that whether you are killed in the line of duty from a wall falling on you at a fire or by getting stuck with a dirty needle, it is still recorded as a line-of-duty death. Please take care of yourself!
GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 32 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at www.garyludwig.com.
