HIV Exposure:

What Emergency Response Agencies Need

to Know About Accessing Information
 Objectives
Upon completion of this training, agencies will be
able to:

1. Communicate current process for accessing

patient HIV information after occupational
exposure

2. Update policies and procedures to implement

this new process

3. Educate emergency responders regarding

policy and procedure
History of Ryan White Law

Federal Law passed in 1990

Applied to Emergency Response
employers (EMS, Fire, Law Enforcement)
Employers required to have “Designated
Officer”
 “Designated Officer”
The Role of the Designated Officer in
original Ryan White guidance:

Field calls from emergency responders

regarding possible exposures to
communicable diseases including human
immunodeficiency virus (HIV) infection

Obtain disease status of the patients in

those exposures from hospital providing
treatment to the patient
 Changes in 2006
Reauthorization of Ryan White Law left out
Emergency Response Designated Officer
language

This means no federal provisions in place

for sharing of information

Absence of federal provisions allows a

more up-to-date approach in New York
State
New York State Regulation
NYS Regulation [Section 63.8(m) of Title
10 NYCRR] still allows emergency
responders to access HIV test results on a
patient when there has been a bona fide
risk exposure
 At a Glance Comparison
Ryan White – Past NYS – Present

DO required DO optional but in

(response agency reduced role
and hospital) No written request
Request must be in required
writing Response should be
48 hours to respond as soon as possible
No mention HIV test Source patient testing
of source patient is provided for
 Definition of “Exposure”
1. Must involve exposure to blood, semen,
vaginal secretions, tissue or the following body
fluids: cerebrospinal, amniotic, peritoneal,
synovial, pericardial, pleural

2. Contact with EMR mucous membranes, non-

intact skin, or vascular system Examples,
needlestick injury, open wound, splash to
eyes, nose, mouth

3. The exposure occurred in performance of

employment or professional duties (includes
emergency medical responders)
 Occupational Exposure
Exposure Occurs
First Aid
– Needle stick, cut – wash with soap and water, don’t
squeeze
– Splash mucous membrane – rinse with water

Go to Emergency Room (ER)

Notify personal healthcare provider or agency
healthcare provider
For occupational exposure guidelines see:
www.hivguidelines.org
 Emergency Responder’s
Responsibilities
Call supervisor and notify them of exposure

While in emergency room consent to HIV

testing, request a rapid HIV test

Notify your healthcare provider

Submit an incident report documenting details of

the exposure to appropriate supervisory staff at
emergency response employer
 Responsibilities of the Emergency
Responder’s Healthcare Provider
Request disclosure of HIV status from patient’s primary
care physician or to ER where patient was treated
Confirm the information is necessary for immediate
decisions regarding initiation or continuation of post
exposure prophylactic treatment of the emergency
responder, and;
The emergency responder’s status is either HIV negative
or he/she consented to an HIV test, and;
If such test result becomes known as positive prior to
receipt of patient’s HIV status, no disclosure of the
patient’s HIV status will be made to the emergency
responder
 Emergency Room or Hospital’s
Responsibilities

Review, investigate, and evaluate the incident

Determine that a risk of transmission has
occurred or is likely to have occurred then the
patient’s HIV status may be released, if known
If unknown, may approach patient and request
rapid HIV test
Source patient must consent to HIV testing
Patient’s name will not be released nor will re-
disclosure of the patient be permitted except
when in compliance with NYS Public Health Law
Article 21, Title III
 Local Health Department Role
May be contacted by emergency
responder’s primary care physician or
the ER to:

1. Determine if a risk of transmission exists

2. If consultation occurs, both the provider
and local health officer must be in
agreement that risk occurred
3. Information may be released
 Documentation
Documentation of request is filed in
emergency responder’s medical record at
primary care physician’s office
 Recommendations
Emergency Response agencies should
review and update their policies and
procedures to ensure compliance with
Section 63.8(m) of Title 10 NYCRR

Emergency Response agencies should

notify their emergency responders of new
procedures to be followed in cases of
possible HIV exposure
Recommendations continued…
Designated Officer : Current Role
– Serve as agency resource for blood borne
pathogens
– Update policy and procedure
– Provide staff education
– Maintain hospital contact information and
relationship
– Maintain records
 More Information
NYS DOH Bureau of EMS
(518) 402-0996 ext 2
http://www.nyhealth.gov/nysdoh/ems/main.htm
NYS DOS OFPC
(518) 474-6746
http://www.dos.state.ny.us/fire/firewww.html
NYS Division of Criminal Justice Services
(518) 457-2667
http://www.criminaljustice.state.ny.us/index.html
 Clinical Resource
For Specific Incident:
NYS DOH HIV Clinical Education Initiative's
Post Exposure Prophylaxis Center of Excellence
– (212) 604-2980
– education and technical assistance for the emergency
response employer
– (888) 448-4911
– clinician consultation line for the management of PEP
For Policy, Procedure, General Questions:
Lyn Stevens, NP, ACRN, Associate Medical Director
- 518-473-8815 or lcs02@health.state.ny.us