Infectious Diseases and the Pre-Hospital Practitioner

Abstract

Ambulance officers and other emergency service personnel may be exposed to the body fluids of their patients due to the unpredictable nature of their work. As it is not possible to predict which patients may have a communicable disease, standard precautions must be practiced at all times. This is part of an occupational health and safety strategy that includes appropriate immunisation, education, and post-exposure counselling of staff. The actual risk of acquiring blood-borne viruses or other communicable diseases is less than is generally perceived, and post-exposure prophylaxis is available for several of these. Hepatitis B is the most transmissible of the blood-borne viruses but there is very effective pre- and post-exposure prophylaxis available. There is effective post-exposure prophylaxis available for HIV but not for hepatitis C. An ambulance officer exposed to tuberculosis or meningococcal disease should also be offered post-exposure counselling and protective therapy as appropriate, although the risk of subsequent disease is very small. Education of staff about the actual risks involved following an exposure and the correct procedures to follow will allay fears and allow the safe and efficient management of patients outside of the hospital.