By KEITH MORELLI
Tampa Tribune (Florida)
TAMPA, Fla. — The face and hand protections are as much a part of a county ambulance’s equipment as oxygen and a backboard. Breathing masks guard against coughed-up blood and saliva; eye goggles and face masks do the same. Disposable rubber gloves are almost a part of the uniform.
Older paramedics remember a time when those safeguards weren’t there, when they dove in at traumatic scenes bare-handed and inhaled particles from infected lungs without worrying about the tiny pathogens in the blood of the people they treated.
Slowly, a small part of the old guard is dying because of it. A small percentage, to be sure, but enough to warrant concern.
Two Hillsborough County paramedics and one firefighter died last year because of complications of hepatitis C, a dangerous contagion contracted through their work more than a decade ago, before face masks and gloves were standard wear.
“Hepatitis C is a big iceberg out there,” said Hillsborough Fire Rescue Capt. Glenn Thompson, who supervises a crew in Dover. “There is a surprisingly high number of hepatitis C-positive people here.”
Active paramedics and emergency medical technicians don’t often die from work-related injuries or illnesses, he said. Three dying in one year — from an identical cause — has prompted concern.
Thompson said he wonders whether more are about to die.
“Hepatitis C is a real threat,” Thompson said. “It’s a heartier beast than initially envisioned.”
In the past several months, he has attended funerals of two co-workers — they were also friends — who died of hepatitis C, and there are rumors of more cases. When a police officer, firefighter or paramedic dies in the line of duty, much is made of it, Thompson said. When a paramedic with decades of service dies a slow, agonizing death from hepatitis C, there is little notice.
That’s not right, Thompson thought at a funeral for a good friend who died on Christmas Eve. He was 50 years old and had battled hepatitis C since 1999, Thompson said.
“He went through hell,” Thompson said. The victim, whose name is not being published because of privacy concerns, was exposed when he was stuck with a hypodermic needle in the late 1990s.
Federal health privacy protections mean that paramedics and firefighters do not have to publicly disclose whether they have contracted hepatitis C. Some do. Others don’t. Some die and the cause is never made public. Health officials estimate 3 percent to 5 percent of the county’s 900 firefighters and paramedics have the disease.
The virus is passed through contact with contaminated blood. Years — even decades — can go by before symptoms emerge. Health experts estimate that almost 4 million Americans are infected, and most don’t know it.
By the time patients become jaundiced and show other symptoms, the disease is often well-advanced. Long-term therapy may include Interferon, which requires frequent and painful shots, and strength-sapping medication.
One Stick Does It
“I had a needle stick in 1996 on a call we went out on,” said firefighter and paramedic Gus Garcia, who knows that a needle stick infected him with hepatitis C. “It was a stick that was documented, and someone else on that same call now has hepatitis C, too.”
Garcia said he never had symptoms.
About a year after the call, he was tested, along with about 300 other paramedics and firefighters.
“Two weeks later, they notified me to come back,” he said. “They said, ‘You got this thing going on.’”
Initially, he denied it, then admitted his infection and went on a hepatitis C fact-finding binge.
“I bogged myself down with information,” he said. So much so that he is now chairman of a hepatitis C support group in Tampa.
But back then, it took a year before he began treatment. “That was three injections and four pills a day,” he said. It lasted one year and at the end the treatment had failed to defeat the virus.
He began a different treatment. Another year of having daily injections and pills.
“It made you sick,” he said. “It was a lot like chemo. You have the nausea. Your hair thins out. You feel fatigued.” That treatment also failed to knock down the virus.
For the past two years, Garcia has been off all therapies, although the virus remains.
“I’m waiting to see if new research comes up with anything,” said the married father of four. “Either it’ll get me, or I’ll succeed.”
Before more strict precautions were taken, hepatitis C posed a real threat to paramedics, even though they weren’t fully aware of the danger.
“You’re in the back of a rig bouncing up and down. It was easy to get a needle stick,” said Garcia, 52, a firefighter and paramedic for 10 years.
“The older guys, with 25 to 30 years’ experience, these guys really are at risk more than the newer generation, which preaches glasses and gloves,” Garcia said. “The older generation didn’t have that. They worked a bad accident, they had their arms full of blood, hands full of blood, and afterward they lit up a cigarette and talked about the call.”
National, Global Problem
Hepatitis C, more serious than its better-known namesakes A and B, accounts for about half of cirrhosis cases, end-stage liver disease and liver cancers. Hepatitis C kills 10,000 Americans each year, health officials say.
Many of today’s patients were infected before 1990, when an effective screening test for hepatitis C became commercially available. The global total of those infected may be 150 million.
Hillsborough Fire Rescue spokesman Ray Yeakley said the ominous presence of contagious diseases is always at the forefront of paramedics’ minds when they respond to emergencies.
“It’s always a threat,” he said. “Every time we go out and respond, we don’t know if patients are infected with hepatitis C. We don’t know that. We have to assume that every patient we run on has hepatitis C.”
All contagious diseases pose threats, he said. “The biggest concerns are the ones that will kill us.”
Paramedics and firefighters every two years undergo training in ways to protect themselves from blood and airborne pathogens, he said.
“We preach it,” he said. “Through EMT and paramedic school, we preach universal precautions.”
Although precautions are in place now, at least four active paramedics are receiving treatment for hepatitis C, he said.
“Guys who are now testing positive for hepatitis C more than likely contracted it in the 1980s or late 1970s when it wasn’t understood what hepatitis C was,” Yeakley said.
Every two years, paramedics and firefighters have their blood tested, he said. “Even though we take all the precautions, there is always the possibility. ... It is a great risk they take.”
Robert Marschall, fire rescue training and infections control officer, said there is almost no way an infected paramedic can pass on the pathogen to a patient.
Because of the Americans with Disabilities Act, people with certain diseases cannot be prohibited from working, he said. Paramedics and firefighters with hepatitis C fall into that category.
With precautions in place, though, cross-contamination is virtually impossible. It would take an open, bleeding wound on a paramedic to pass along the pathogen.
And, Marschall said, “you can’t work with an open wound.” Scratches and cuts — even stitches — must be covered, he said. “That’s part of our exposure control plan.”
If the wounds are not covered, paramedics and firefighters are sent home, he said.
Fire rescue officials suspect that the percentage of emergency workers with hepatitis C mirrors that of the general population. The emergency response industry is aggressively addressing the problem, he said.
“Since the late 1990s, we have been screening all of our employees,” he said. “Early treatment could potentially save your life.”