Congress may have inadvertently created the perfect opportunity for all factions of the fractured EMS community to join forces to restore provisions critical to prehospital employee safety, which lawmakers deleted from the Ryan White Act when they reauthorized it in December 2006. That move escaped notice until an article by EMS infection expert James Cross was published this March. (See Cross J: “Emergency responder provisions of Ryan White law repealed.”„JEMS. 33(3):136Ï137.)
Representatives of some national EMS and fire organizations are starting to meet with members of Congress to address their concerns, and the International Association of Fire Chiefs EMS Section voted April 20 to work with others to create “a committee of constituents and stakeholders to speak with one voice” on the issue and perhaps to develop legislation to rectify the situation. IAFC Government Affairs Manager Lucian Deaton subsequently contacted the EMS lobbying organization Advocates for EMS, which had already begun gathering information and working with members on possible solutions. Lori Moore-Merrell, DrPh, MPH, EMT-P, assistant to the International Association of Fire Fighters’ president, said IAFF was already working with IAFC on Ryan White.
When Congress passed the original Ryan White Act in 1990 (an HIV-program funding bill named for a child infected with HIV during a blood transfusion), it included provisions to protect first responders and ambulance staff. Those provisions (in Public Law 101-381, Part E, Section 2681-2690) required EMS and first response agencies to designate an infection control officer who would contact the receiving hospital and request the patient’s disease status following a responder’s needle-stick or other exposure to blood or body fluids. The law then required the hospital to test the patient and inform the ICO in writing within 48 hoursƒsooner when possibleƒthat the emergency responder had„or had not been exposed to an infectious disease.
A hospital’s failure to comply could result in a complaint to the Centers for Disease Control and Prevention and, ultimately, in an injunction preventing the flow of federal funds to the noncompliant facility. “No injunctions were issued, but the existence of that provision made a hospital think twice about not complying with the law,” said Cross, legal consultant for Katherine West’s Infection Control/Emerging Concepts in Manassas, Va.
“That language was included in subsequent reauthorizations of the Ryan White law until H.R. 6143 was passed in 2006 (Public Law 109-415). Subpart II was inexplicably stricken from the legislation that was signed into law on December 20, 2006,” noted Steve Isaacson, EMS chief and ICO, Overland Park (Kan.) Fire Department, in a briefing to the IAFC EMS Section.
Cross noted that many hospitals insisted that the Health Insurance Portability and Accountability Act prevented them from providing EMS and first response agencies with patient test resultsƒuntil the CDC provided official word that they were misinterpreting HIPAA.
“This legislation has been extremely important for emergency responders because it forced hospitals to cooperate with them in post-exposure treatment,” Cross said. Without rapid testing and notification, he said, many emergency responders will be forced to take unnecessary prophylactic HIV medications, which are costly and can cause severe side effects.
Although the federal Occupational Safety and Health Administration’s blood-borne pathogen standard aims to protect emergency responders, the National Association of State EMS Officials notes, “OSHA does not have jurisdiction over state and local governments in about half of the states” and “does not provide the clear coverage of volunteers that the Ryan White law provided.” Unlike the Ryan White Act, NASEMSO notes, OSHA’s standard also “doesn’t provide a clearly stated post-exposure procedure to be followed and does not give clear timeframes for testing and notification.”
The changes have taken effect
Some EMS leaders believedƒmistakenlyƒthat the emergency response provisions would remain in effect until Oct. 1, 2009, when the Ryan White Act would have expired if Congress had not passed the reauthorization bill in December 2006.
But Cross explained, “The Ryan White Act as reauthorized will be repealed [Oct. 1, 2009] if it is not reauthorized. The law as reauthorized does not contain the sections of the original law covering disease exposure to emergency responders. [Those sections] are already gone and [have] been gone since December 2006.”
“I just had an [employee] exposure in the past couple of weeks, and the word is out with the hospitals that they no longer need to give us this information,” Isaacson said.
“I recently got word from a hospital on the Missouri side [of the Mississippi River] saying, ‘I don’t have to give you that information anymore. In fact, I can’t give it to you anymore.'”
In early April, National Association of EMTs President Jerry Johnston, former NAEMT president Nathan Williams and Advocates for„EMS lobbyist Lisa Meyer visited the office of Sen. Mike Enzi, R-Wyo., ranking member of the Senate Committee on Health, Education, Labor and Pensions, which has jurisdiction over the Ryan White Act. “We met with Enzi’s office to discuss the issue in general and potential next steps,” Meyer said.
“We’re now in communication with the CDC and OSHA to figure out what’s in place, what language needs to be updated from the original law and what other blood-borne pathogens should be covered. We will then go back to [Capitol] Hill and discover what, if anything, should be done legislatively and what can be done via regulations,” Meyer said.
“All the different groups are starting to reach out and work together on a fix, and I’m hoping we’ll have a meeting with all the players within a month or so where we can put something together to talk with all those agencies,” Meyer added.
“This is a cross-cutting issue that affects us all,” Johnston said. “I think united, we can make something happen.”
For more information, visit www.advcatesforems.org, contact James Cross or Katherine West by e-mail at [email protected], Steve Isaacson at [email protected] or Lucian Deaton at [email protected] Organizations interested in participating should contact Lisa Meyer at„[email protected].