Occupational Blood Contact Among Prehospital Providers

Study objective: To assess the nature and frequency of blood contact (BC) among emergency medical service (EMS) workers. Design: During an 8-month period, we interviewed EMS workers returning from emergency transport calls on a sample of shifts. We simultaneously conducted an HIV seroprevalence survey among EMS-transported patients at receiving hospitals served by these workers. Setting: Three US cities with high AIDS incidence. Participants: EMS workers. Results: During 165 shifts, 2,472 patients were attended. Sixty-two BCs (1 needlestick and 61 skin contacts) were reported. Individual EMS workers had a mean of 1.25 BCs, including .02 percutaneous exposures, per 100 patients attended. The estimated annual frequency of BC for an EMS worker at the study sites was 12.3, including .2 percutaneous exposures. For 93.5% of the BCs, the HIV serostatus of the source patients was unknown to the EMS worker. HIV seroprevalences among EMS-transported patients at the three receiving hospital emergency departments were 8.3, 7.7, and 4.1 per 100 patients; the highest rates were among male patients 15 to 44 years old who presented with pneumonia. Conclusion: EMS personnel regularly experience BCs, most of which are skin contacts. Because the HIV serostatus of the patient is usually unknown, EMS workers should practice universal precautions. Postexposure management should include a mechanism for voluntary HIV counseling and testing of the patient after transport and transmittal of the results to the EMS. [Marcus R, Srivastava PU, Bell DM, McKibben PS, Culver DH, Mendelson MH, Zalenski RJ, Kelen GD: Occupational blood contact among prehospital providers. Ann Emerg Med June 1995;25:776-779.].