search terms: AIDS warning, hepatitis, infectious disease cases, infectious disease confidentiality, confidentiality issues, New York State AIDS confidentiality Law, disclosure, HIV-related information, The Ryan White Comprehensive AIDS Resources Emergency Act (CARE), universal precautions, infectious disease precautions, 1995, Dispatch, MPDS protocols, emergency dispatch, code words

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

Infectious Disease Confidentiality---Quiet and Careful

The last Academy newsletter (Winter 1995 issue) contained an editorial entitled PAIs and Disease Risk. This editorial concludes with the strong statement that EMDs employing advance warnings about patients who are HIV positive or who may have AIDS "would not promote better or safer patient care." The Academy is officially opposed to including any form of "AIDS warning" in the MPDS protocols. After the Academy published this opinion, several questions arose regarding the handling of Hepatitis and other infectious disease cases, especially those involving AIDS patients.

Most of these recent inquires relate to whether or not dispatchers should "air" that a patient has AIDS, is HIV positive, or should employ "code words" for this condition. This same question is often asked of me while I'm teaching EMD certification courses. I have a dispatch textbook that advocates using code words to alert the field crew of this possibility. There are also those people, particularly in the pre-hospital emergency care field, who feel the need for this information is vital prior to their arrival. While there are strong feelings both pro and con, there is very little reason for debate. This is a confidentiality issue that we must not breach. It is unethical and illegal.

New York State has some very specific guidelines within their government. While not mentioning dispatch per se, these guidelines are particular concerning the confidential nature of AIDS, even after an exposure has been determined. The New York State AIDS Confidentiality Law (2786), effective February 1,1989 includes several protections. This law was enacted to "prevent the unfortunate events which have accompanied disclosure of HIV-related information, particularly discrimination in health care, insurance, employment, and housing." (A Prehospital Care Provider's Guide to AIDS, N.Y. State Department of Health, January 1990)

The Ryan White Comprehensive AIDS Resources Emergency Act, or CARE (Public Law 101-381), does not require nor allow the release of the patient names, even after an exposure to one of the listed diseases. The Act allows only notification that an exposure has occurred. In a legal opinion the NYS Department of Health Legal Counsel, the emergency personnel who receives this information are themselves bound by confidentiality restrictions on redisclosure. According to 300ff-99 ( c), this statute "may not be construed to authorize or require any medical facility, any designated officer of emergency response employees, or any such employee, to disclose identifying information with respect to an emergency response employee." (Federal Register, Vol. 59, No. 54, 3-21-94)

If emergency personnel are unable to mention the patient name or address after and exposure, how can anyone suggest the possibility that these be mentioned beforehand?

While the New York law may seem strict, we are obligated to protect this information. There are severe individual financial penalties for those who fail to comply. In my research I could not find a consensus on individual state laws regarding confidentiality; however, in 1990 there were 38 states with relatively identical confidentiality laws. The interested reader should research their own state laws as to their exact nature and corresponding penalties.

I am aware of one communications center whose policy was to tell responders to "take universal precautions" whenever an AIDS exposure was suspected. This center was later contacted by a State official, who commended them for reminding field responders to employ universal precautions that they should be using on all calls. This same official then told the center that if they did not tell this to each and every responder on each and ever call, that they would be guilty of discriminating against certain calls. They were advised to immediately stop using any type of code words.

Consider the flip-side. We read all too frequently of crew calling "out of service" when dispatched to a residence where the patient is known to have an infectious disease. If not our of service, perhaps their arrival is slowed or delayed. Some may take the extreme of fully encapsulating themselves and their gear in Tyvek, only to find that the patient no longer resides at that address, or that the call is for some other family member. As EMDs, we don't want to send more victims to the scene. We make attempts to ensure the safety of our field personnel. Contrary to some opinions, dispatchers are not "out to get the Paramedics and EMTs." Personally speaking, when a caller volunteers information concerning an AIDS patient, I ask the caller to notify the field personnel upon their arrival. Legally, there is nothing else that I can do.

As a volunteer field responder, I try to take "universal precautions" whenever I respond. I have treated a handful of know AIDS and Hepatitis patients. Those patients were only 4 or 5 who told me. How many other patients did I treat who didn't tell me or didn't yet know? What if I become infected with one of our current infectious diseases or the next one that comes out in five to ten years? Will I be required to ring a bell and call out my sins as I walk through the public square? That is the way we mistreated disease a century and a half ago.

Please stress to field personnel the importance of infectious disease precautions. It is very important, both in the field and on the telephone, that we treat our patients the way we would like to be treated.