In response to the recent exposure of Los Angeles County firefighters to an AIDS victim, Fire Chief John Englund this week ordered that all county fire vehicles be equipped with manual mask respirators to ensure that rescuers do not have to perform mouth-to-mouth resuscitation on accident victims.
City fire officials said Tuesday they are considering buying similar resuscitators to protect firefighters from contracting acquired immune deficiency syndrome or other contagious diseases.
Under the county plan, all firefighting and paramedic vehicles will carry two "mouth-to-mask" respirators, which are already used by several large fire departments around the country. With the devices, also called "pocket resuscitators" because of their small size, rescuers blow air through a tube connected to a mask covering a victim's face.
Department officials said Englund authorized the purchase of up to 2,000 of the manual respirators at $10 apiece.
Prompted by May 19 Incident
The move was prompted by an unsuccessful attempt May 19 by four firefighters to revive a man whose car plunged off a Topanga Canyon cliff. One firefighter administered mouth-to-mouth resuscitation to the man, who was later found to have hepatitis B and AIDS, a usually fatal illness that destroys the body's resistance to disease.
Medical experts on AIDS said the rescuers face little risk of contracting the disease because research indicates it is spread only through a significant exchange of bodily fluids, usually from sexual contact or blood transfusions.
The Los Angeles County Health Department plans to periodically check the blood and physical condition of the firefighter who administered mouth-to-mouth resuscitation.
County and city fire officials said the Topanga Canyon incident illustrated a need for lightweight resuscitation equipment that can be carried into difficult rescue situations.
Soon after the incident, the city fire department announced it would purchase a manual respirator known as a bag mask, in which a bag is squeezed to force air through a tube into a victim's mouth.
100 Masks to Be Bought
Dr. Greg Palmer, the department's medical director, said the city will purchase about 100 of the $60 bag masks so that all fire engines and cars have one available. City fire engines and paramedic units now carry bulky mechanical resuscitators, and each paramedic team carries one bag mask, he said.
All county firefighting vehicles now carry mechanical respirators, and some also carry a bag mask apparatus.
As of June 10, there were 10,803 reported cases of AIDS in the United States, with 5,328 people having died from the disease, according to the Centers for Disease Control in Atlanta. There were 903 reported cases of the disease in Los Angeles, the Atlanta center said. Only New York City and San Francisco listed more cases.
County fire officials said the Topanga Canyon case made them aware of the need for more safeguards for rescuers.
Capt. Al Bennett, a paramedic coordinator, said the mouth-to-mask respirators, which weigh three to four ounces, will be packed in first-aid boxes carried to every accident. "We're not going to be caught short without one now," he said.
But county officials said rescue personnel would continue to use mouth-to-mouth resuscitation if mechanical or manual respirators are not available. "We're not going to allow someone to die because we don't have the equipment," Capt. Gordon Pearson said.
Local AIDS researchers had differing evaluations of the county's announcement.
"It seems to be a reasonable precaution," said Dr. Michael Gottlieb, an assistant professor of medicine and immunology at UCLA. He said that, in hospitals, doctors and nurses rarely use mouth-to-mouth resuscitation because equipment is nearby.
But Dr. Michael Roth, co-chairman of a state commission on AIDS, said the devices would make little difference because researchers do not believe mouth-to-mouth contact transmits the AIDS virus.
"It's probably a waste of money," Roth said. "All in all, I think we're protecting ourselves psychologically. Maybe that's enough."
Roth agreed, however, that the devices would protect rescue personnel from contracting more easily transmitted diseases, such as hepatitis B and tuberculosis.
In purchasing the respirators, the county is following the lead of other fire departments. But fire officials contacted in five cities could not recall a single case in which rescuers previously had administered mouth-to-mouth resuscitation to an AIDS victim.
In San Francisco, officials said firefighters and paramedics automatically take precautions, including the use of disposable gloves and masks, when treating accident victims.
"We treat every first-aid call that we go on as a potential exposure to a communicable disease," San Francisco Deputy Fire Chief Charles Cresci said. "We don't recommend mouth-to-mouth in any case unless it's urgent or an infant."
He said all firefighting vehicles carry mechanical and bag mask resuscitators and department cars carry mouth-to-mask respirators.
Dr. Victoria Countee, medical director of the Washington D.C. fire department, said that rescue squads there have carried pocket mask respirators for more than three years.