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In another effort to combat Hepatitis C in the fire service, the Miami-Dade Fire Rescue Department has announced a cooperative national pilot program with the Florida-based Hep-C Alert organization to determine the prevalence of the Hepatitis C virus among firefighters and medics. Part of the program calls for Miami-Dade Fire Rescue personnel to participate in Hepatitis C screenings and educational workshops. Miami-Dade will consider personnel newly diagnosed with Hepatitis C as exposed in the line of duty. Traditionally, as is in the Philadelphia Fire Department outbreak, the burden of proving line of duty exposure is shifted to the employee.
On Oct. 16, 1998, the U.S. Centers for Disease Control and Prevention (CDC) published its "Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease." The CDC has determined that health workers, which includes firefighters and emergency medical personnel, are at occupational risk for acquiring Hepatitis C infections. The CDC guidelines recommend that departments implement policies for follow-up of HCV infection in emergency workers after a documented exposure to blood. These policies should include:
- Baseline testing and follow-up testing (six months) for the exposed rescue worker.
- Confirmation of positive HCV status by supplemental anti-HCV testing.
- Discussion regarding current treatment recommendations against the administration of immune globulin or antiviral agents.
- Education of emergency workers about the risk for, and prevention of, blood-borne infections.
- Procedures for continued medical follow-up of persons with the potential for chronic liver disease. The International Association of Fire Fighters has recommended the following actions to address Hepatitis C:
- Evaluate the fire department's blood-borne pathogens exposure control plan for compliance with the CDC's recommendations for follow-up of occupational exposure to the Hepatitis C virus.
- The IAFF/IAFC Joint Labor Management Wellness/Fitness Initiative recommends baseline testing of all uniformed personnel to check for previous infection or to establish absence of infection.
- Testing for Hepatitis C should be part of a comprehensive infectious disease prevention program at each fire department, supervised by a physician. Home testing products for Hepatitis C are available, but do not afford support services for medical evaluation, in- person counseling and treatment.
- Anyone with Hepatitis C or currently involved in a treatment regime should not drink alcohol. Individuals who are anti-HCV positive should refrain from donating blood.
- The local president should contact the IAFF Department of Occupational Health and Safety if the local requires additional information or assistance.
Hepatitis C should not be the only disease we in the fire service concern ourselves with. Other diseases, whether air-borne or blood-borne, can also cause severe illness or even death. Infectious disease in the fire service should never be taken lightly. Whether a fire professional dies from infectious disease or by falling through a floor, it is still recorded as a line-of-duty death.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is the vice chairman of the EMS Executive Board for the International Association of Fire Chiefs. He has lectured nationally and internationally on fire-based EMS topics and operates The Ludwig Group, a consulting firm specializing in EMS and fire issues. He can be reached at GaryLudwig@aol.com.