A Los Angeles County firefighter who gave artificial resuscitation Sunday to a man later found to have AIDS is not the first local rescue worker to be exposed to sufferers of the disease in the line of duty, a city official said.
Two city fire paramedics have been exposed to blood of people with Acquired Immune Deficiency Syndrome, said Dr. Gregory Palmer, medical director for the Los Angeles City Fire Department.
The Fire Department began grappling with the issue in early 1983, Palmer said, when a paramedic with a cut hand was called to the home of an extremely sick, dehydrated man found to have AIDS. The paramedic accidentally got the sick man's blood into the cut when it spurted out as he inserted an intravenous tube, Palmer said.
The episode caused considerable concern at the paramedic's fire station, where firemen and paramedics eat, sleep and share meals and bathroom facilities, Palmer said.
A second city paramedic apparently was exposed to AIDS about four months ago. The paramedic had given a man an injection and was putting the needle back into its protective cover when he accidentally stuck himself, Palmer said.
The discovery that the victim had AIDS caused worries for the rescuer in that case, too, Palmer said. "He was concerned: 'Am I going to take something home to my family? What about my wife? What about my kids? Does this mean I have to abstain from sex with my wife for two years while you guys make a diagnosis?' " Palmer recalled.
Palmer said medical tests conducted so far have found no evidence that either of the men has contracted AIDS. He said he could not release the name of either paramedic.
Medical authorities are now convinced that AIDS, which impairs the body's ability to resist infection, is caused by a virus, Palmer said. Blood tests for AIDS try to detect antibodies created by the body to fight the virus.
But Palmer said the latency period between exposure to AIDS and the time the disease manifests itself can vary from months to several years.
The two paramedics are being monitored by County-USC Medical Center hematologists, Palmer said.
"Generally, we feel that the chance of health-care workers being exposed to AIDS on the job and coming down with it is very remote," Palmer said. "On Dec. 31, 1984, the Centers for Disease Control began tracking 361 health-care workers exposed via mucous membrane or needle sticks from AIDS victims. None of them has shown any signs of coming down with AIDS."
The Fire Department has no formal guidelines for treating people with AIDS, Palmer said. In 1983, however, the department issued recommendations for handling people who might have any communicable diseases, including AIDS, tuberculosis, hepatitis B, and bacterial meningitis, Palmer said.
"The No. 1 health risk to the paramedics is probably hepatitis B," which can be transmitted with a single needle stick, Palmer said. Less severe forms of the disease, an inflammation of the liver, can incapacitate a victim for two to four months, he said.
Palmer said 20% of hepatitis B cases become chronic, with half of those cases leading to death.
Possible Ways of Infection
Although AIDS is usually transmitted by sexual contact or through blood transfusions, a paramedic could theoretically catch AIDS in a number of other ways, Palmer said. The rescue worker could be stuck with a needle or sharp object that has come into contact with an AIDS patient's blood, or could be be cut by small slivers of blood-spattered glass on the person's body, he said.
The 1983 recommendations strongly encourage rescue workers to wear gloves, be careful when handling sharp objects and wash their hands after treating any person.
Paramedics are also urged to carry devices that allow them to administer resuscitation without using their mouths. One such device is issued to each two-man paramedic unit. Should there be multiple victims, the paramedics would have to call another unit for help, Palmer said.
Palmer said use of the devices predated the AIDS scare. In fact, artificial resuscitation has long caused more concern about the spread of tuberculosis than AIDS, he said.