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It's one o'clock in the morning and you get kicked out for an auto accident. Typically, one or more of the occupants of the cars have hit their heads on the windshields. As is with many head injuries, there's lots of blood. The victims usually have blood streaming down their faces and on their hands, shirts and pants.
If you have been a member of the fire service for a long time, you may remember a time when you worked these calls with no protective gloves, face shields or gowns. You probably got blood all over your hands, maybe on your arms or uniform, and maybe some blood splashed in your face. Back then, some fire professionals considered that a badge of honor. The more blood on you, the more action you had seen. Some did not view it as a badge of honor, but the rigors of working a bad call.
Unfortunately, what you did not know back then may come back to haunt you.
A large proportion of firefighters and medics who have been in the fire service for many years are starting to show up with Hepatitis C in large numbers. Since AIDS came to light in the mid-1980s, professionals in the fire service have known about the dangers of blood-borne diseases. Since then, the standard practice has been to use universal precautions when dealing with blood- or air-borne diseases. Unfortunately, some of the departments where clusters of fire professionals are showing up with diseases have had "20 years of neglect with no education or intervention program," according to Rich Duffy, director of health and safety for the International Association of Fire Fighters (IAFF).
The issue of Hepatitis C came to light in the fall of 1999, when Philadelphia firefighters who don't receive physicals started showing up with Hepatitis C after donating blood. As of this writing, more than 130 firefighters have tested positive for Hepatitis C. This is more than triple the national average of people who have Hepatitis C. Since then, other large clusters of firefighters with Hepatitis C have shown up in fire departments such as Chicago and San Francisco.
Hepatitis C, once referred to as "Non-Hepatitis A and B," and now the "silent epidemic," affects an estimated 4 million Americans, most of whom are not even aware they have the disease because symptoms can take 10 to 30 years to develop. The primary method of transmission is through intravenous drug use, but the virus was also spread in blood transfusions given before the early 1990s, when blood banks began screening for it.
In the case of fire professionals who have the disease, it is believed they contracted it through "significant exposure" during the performance of their duties. "Significant exposure" refers to blood or body fluids getting into or on non-intact skin, the eyes or the mouth. Unfortunately, there is no cure or vaccine, but Hepatitis C can be brought into remission with drugs, if caught early.
In response to this issue, on Feb. 15, 2000, U.S. Representatives Robert Brady (D- PA) and Curt Weldon (R-PA) introduced H.R. 3659, the Emergency Response Employees Disease Protection Act of 2000. This legislation provides $10 million for a study and demonstration projects with respect to Hepatitis C among emergency responders. This legislation applies to volunteer and career firefighters, paramedics and emergency medical technicians (EMTs).
The legislation, if passed, would direct the Secretary of Health and Human Services, along with the Secretary of Labor, to conduct a study to determine an estimate of the prevalence of Hepatitis C and the likely means through which emergency responders became infected with the disease.
Additionally, the legislation provides for grants to be made to qualifying local governments to carry out demonstration projects for such programs as training emergency responders to minimize the risk of infection from Hepatitis C, test for infection and treat the disease. A report describing the findings of the study would be submitted to Congress no later than one year after passage of the bill.
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.