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EMS Exposure Requirements
Emergency Medical Services (EMS) providers and employers must be aware of State and federal laws specific to an exposure to blood or body fluids that occurs while performing job duties. These laws were developed to ensure that EMS providers receive appropriate medical evaluation after an exposure to blood or body fluids of a type that has been demonstrated epidemiologically to transmit dangerous communicable diseases. EMS providers and their employers should become familiar with the following:
- Indiana Law - Indiana Code 16-41-10: Communicable Disease: Exposure Notification for Emergency Medical Services Providers
- Federal Law - Ryan White Comprehensive AIDS Resource Emergency (CARE) Act: Emergency Response Employees
- Federal Law - The Occupational Health and Safety Administration's (OSHA) Bloodborne Pathogen Standard
In addition to post-exposure medical evaluation, the OSHA Bloodborne Pathogen Standard requirements ensure that employees who handle blood or certain other body fluids are afforded the maximum protection from contracting a bloodborne pathogen.
Communicable Disease: Exposure Notification for Emergency Medical Services Providers (IC 16-41-10)
Public Law 212-2003 (PL 212-2003) made changes to Indiana Code 16-41-10 (IC16-41-10).
Definitions to use in developing policies to comply with PL 212-2003
IC 16-41-10-2 defines an emergency medical services provider as the following: a firefighter, a law enforcement officer, a paramedic, an emergency medical technician, a physician licensed under IC 25-22.5, a nurse licensed under IC 25-23, or other person who provides emergency medical services in the course of the person's employment. IC 25 is available at http://www.in.gov/legislative/ic/code/title25/.
Dangerous communicable diseases are defined in IC 16-18-2-91. A list of dangerous communicable diseases is found in the Communicable Disease Reporting Rule for Physicians, Hospitals, and Laboratories (410 IAC 1-2.3) and is available here.
General information about PL 212-2003
An emergency medical services provider who is exposed to blood or body fluids when providing emergency medical services to a patient may request notification concerning exposure to a dangerous communicable disease if the exposure is of a type that has been demonstrated epidemiologically to transmit a dangerous communicable disease.
- The law applies to a firefighter, a law enforcement officer, a paramedic, an emergency medical technician, a physician licensed under IC 25-22.5, a nurse licensed under IC 25-23, or other person who provides emergency medical services in the course of the person's employment.
- The exposed Emergency Medical Services (EMS) provider who is requesting notification must complete State Form 51467 (9-03), Notification of Blood or Body Fluid Exposure, and submit the Form to all of the following:
- His/Her employer's medical director;
- If the source patient was admitted to a medical facility either following the exposure or at the time of the exposure, the medical director of that medical facility’s emergency department;
- The Indiana State Department of Health
- The law provides for testing of source patients. For the specific information regarding testing, refer to PL 212-2003.
State Form 51467 (11-11), Notification of Blood or Body Fluid Exposure
This State Form was developed to comply with IC 16-41-10, Communicable Disease: Exposure Notification for Emergency Care Providers. The Form was designed to meet the requirements of the law. Employers of EMS providers may require additional information.
Part E of the Act addresses notification of exposure to life-threatening communicable diseases for emergency response employees. It allows for states to follow their own laws regarding emergency response employee notification when the state requirements meet or exceed those set forth by federal law. The requirements of this law include, but are not limited to, the following:
- The development of a list of life-threatening diseases by the U.S. Centers for Disease Control and Prevention (CDC) to which emergency response employees may be exposed and specific guidelines for determining exposure. This information was published in the Code of Federal Register (CFR), Volume 59, March 21, 1994. Volume 59 of the CFR is available at the following Internet site, http://www.gpo.gov/fdsys/. To obtain the document, search Volume 59 using the words "Ryan White" and select "Implementation of Provisions of the Ryan White Comprehensive AIDS."
- The state health commissioner must designate an officer from each employer of emergency response employees to handle follow-up of exposure to certain dangerous communicable diseases. Requirements of the designated officer include basic knowledge of disease transmission and knowledge of the epidemiology of the diseases covered by the law. (Note: Indiana Administrative Code, Title 836, addresses Indiana requirements for a medical director for each emergency services provider employer.)
- Medical facilities must notify the designated officer when an exposure occurs by airborne route or by aerosol. Those diseases include tuberculosis and some of the diseases listed as uncommon and rare life-threatening diseases.
- Providers for the local health officer to assist in follow-up in certain circumstances.
- The employer must inform the exposed emergency response employee regarding medically appropriate action resulting from the exposure.
Life-threatening Diseases and Guidelines for Determining Exposure
The CDC developed the list of life-threatening diseases covered by this law. The list was published in the Federal Register, effective March 1994. (The list has not been updated since 1994.) In developing the list, CDC used the following criteria:
- The disease is potentially life-threatening (carries a significant risk of death if acquired by a healthy, susceptible person), and
- The disease can be transmitted from person-to-person.
The following diseases meet the criteria:
- Airborne Diseases: Infectious pulmonary tuberculosis
- Bloodborne Diseases: Human immunodeficiency virus (including acquired immunodeficiency syndrome [AIDS]), hepatitis B
- Uncommon or Rare Diseases: Diphtheria (Corynebacterium diphtheriae), Meningococcal disease (Neisseria meningitidis), Plague (Yersinia pestis), Hemorrhagic fevers (Lassa, Marburg, Ebola, Crimean-Congo, and other viruses yet to be identified)