Search Terms: Pre-arrival instructions (PAIs), potential AIDS transmission, risks, HIV from doing CPR, Preventing Disease Transmission, AIDS warning, disease risks, risk of infection, 1995, Dispatch

Dispatch!, the official NAEMD newsletter, Winter 1995
Steven M. Carlo, EMT-I, EMD

PAIs and Disease Risk

During 1994 the Academy received several phone calls and letters regarding potential HIV risks in relaying Pre-Arrival Instructions. There was even a request to add a "disclaimer" or "warning" in the MPDS to notify callers of potential AIDS transmission risks prior to providing CPR, giving mouth-to-mouth, or controlling bleeding. In a world where a hamburger restaurant can lose a major lawsuit to a customer who accidentally gets coffee spilled on their lap, such liability-based concerns are probably not unreasonable.

In March of 1992, the American Red Cross issued a formal statement to answer the question, "Can I get AIDS myself if I do CPR on someone who had AID?" Their answer was, "It is very difficult to become infected with HIV (the virus that causes AIDS). It requires sexual or blood-to-blood contact. As a layperson, your decision to help should be formed by your personal ethics." They continued, "The risk of becoming infected with HIV from doing CPR is so low that it has not been defined." Two 1986 studies published in the New England Journal of Medicine also reported that AIDS is rarely transmitted through saliva. Further supporting references include "Preventing Disease Transmission" The American Red Cross, Mosby Lifeline, 1993; and "Risk of Infection During CPR Training and Rescue: Supplemental Guidelines" The Journal of the American Medical Association, 1989, vol. 262, no. 19.

Since no one not with the victim (the EMD) or anyone with the victim (the caller) can possibly know whether an individual patient may be infected with any number of significant diseases, and the fact that no one can force a remote party to do anything they wish not to do, the decision whether to help or not, must be left to the caller to decide. We know of no cases in which a rescuer has contacted a significant disease from PAI efforts via phone, nor do we know of any suggested liability from such information on the part of dispatchers. While AIDS has perked the fears of everyone, a much greater risk of incurring an infection exists from contact with hepatitis B or tuberculosis, although they are less fatal than AIDS once actually contracted.

Including any form of "AIDS warning" in the MPDS would likely raise anti-Samaritan questions about the callerÔs participation from the outset (since we could never be "sure"). In reality, in those cases in which an EMD can actually succeed in delivering PAIs to the patient, the caller is likely a friend or relative of the victim.

It is the current position of the Academy that such warnings would not promote better or safer patient care. It is believed they would likely induce additional and unreasonable fear upon the majority of callers. As the "Spock Principle" implies, the good of the many should outweigh the good of the few or the one.

Until more official direction becomes forthcoming from medical ethicists and infectious disease experts in responsible positions, the Academy at this time has chosen not to make any additional recommendation beyond those of the American Red Cross and American Medical Association.