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How AIDS changed emergency medicine

The AIDS outbreak in 1981 struck fear into emergency medical professionals and led to a range of changes in how we treat patients

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Viles of HIV specimens sit in holders at the Aaron Diamond AIDS research Center in New York in 1996. In the three decades since the initial outbreak of AIDS and HIV, much has changed in the ways responders treat infected and potentially infected patients.

AP Photo/Mark Lennihan

In 1981, if you looked into the stock of most ambulances you would find only one pair of gloves, and it would be doubtful whether or not you would find a sharps container or face mask anywhere on the vehicle.

Also back in 1981, a very rare form of pneumonia was identified in five gay men living in the Los Angeles area and was reported to the Centers for Disease Control (CDC) in Atlanta. This concentration and reporting of such a rare disease lead to the discovery of the Human Immunodeficiency Virus (HIV).

With the identification of HIV all healthcare personnel were required to take mandatory HIV training. For the very first time we were introduced to HIV and the Acquired Immune Deficiency Syndrome (AIDS).

We also learned about Kaposi’s Sarcoma (KS) a tell tale lesion often on the extremities — and Pneumocystitis Carinii Pneumonia (PCP) — the original rare pneumonia mentioned above. These were called opportunistic infections (another new term) and were hallmarks of HIV and AIDS.

At the time we also learned that this disease could be caught through any form of sexual contact, exposure to blood or any other bodily fluid. Blood transfusions were another known source and there was also a risk from dental or surgical procedures should a blood exposure occur. Initially it was not known whether it could be transmitted through mosquito bite (as there was an initial concentration around the Everglades) or if it could be caught performing CPR training on a mannequin.

Also at the time — a diagnosis of HIV was a death sentence. People were afraid to donate or receive blood. People began donating blood for their exclusive use. People put off elective surgery and dental procedures for fear of contracting the virus. A headline out of Florida where an HIV positive dentist infected several patients made this all the worse. In fact people were afraid to have necessary life-saving procedures performed.

At the service I was with at the time, a crew was dispatched to a hospital for a routine patient transfer. Upon arrival the patient was found out to be HIV positive. The crew called in — so afraid of the patient, so afraid of a mistake that would lead to death, to being labeled — quit rather than completing the transfer.

This became known as FRAIDS (Fear of AIDS). Fear of the disease was as rampant as the disease itself. All ''high risk’’ groups were targeted for extreme bigotry and even violence. Many believed that AIDS was God’s way of punishing homosexuals.

At the same time as fear ruled another disturbing behavior surfaced. For so long we (EMS providers) had no protection, no eyewear, no respirators — not even simple gloves. This was the world we knew and how people expected us to perform. As a result no one wanted to be first to glove up as this would show weakness — it would show fear. For many, wearing gloves and other protective equipment was delayed from a desire to not appear weak or a wimp. It was a weird time to be in EMS.

Every day there was something new reported about HIV and AIDS. One week a potential treatment pointed to removing the patient’s blood via a bypass machine — heating it to a point that would kill the HI virus and reintroduce this to the body. This ultimately failed.

We heard that HIV existed in apes as SIV (Simian) and that it crossed species. This conjured up many negative connotations and was eventually dispelled.

There was talk of a Miami prostitute who was HIV positive but had no signs or symptoms — did she possibly hold the key to surviving the disease? Then basketball superstar ''Magic’’ Johnson announced he was HIV positive but vowed not to let the disease beat him using the power of positive thinking.

We heard that a possible cure or treatment was to be found in Cobra venom. That a specific dose would kill off the HI virus but not the human host. This too proved to be false. We also heard rumors that HIV was a biological warfare experiment gone horribly wrong, that this was not a true disease rather a man made holocaust.

I remember when I used to teach HIV and other bloodborne pathogen training. I would ask the question if there were a vaccine that would guarantee protection against HIV — and there were next to no side effects to the vaccine — how many would get it? I ask that same question now.

As we progressed, a ''significant exposure’’ was better defined to allow for more appropriate treatment. We learned of the Post Exposure Prophylactic Protocol (PEPP).

Years later I got that phone call that as a manager I hoped never to get. An employee called me at home to tell me he was recently diagnosed as HIV positive. We talked through the known and the unknown — most importantly was there a documented exposure. Could we be sure? By this time, we knew more than we had initially, including that HIV infected healthcare workers had rights too — including the right to work. I am happy to say we supported this employee in exercising this right.

There are many reasons to remember the history of HIV and AIDS. One is that what we went through was amazing, and if a new, deadly disease does emerge — I imagine it will go much the same. I think the media, in its effort to enlighten and inform, will help to create a paralyzing fear.

Another more powerful reason to remember HIV is that it is still out there and has the potential to continue to infect healthcare workers. So too is HBV — Hepatits B Virus. Remember my previous question whether if there were a vaccine would you take it?

HBV is more common, infects and kills more healthcare workers per year, yet many of us are not protected — never got the complete vaccination series. Often we are not getting regular TB tests or fit testing. Unfortunately, we still fail to glove up or mask up or take necessary precautions.

There is both good news and bad news in this piece. The bad news is that often lifestyle choices are more dominant risk factors. And while no longer known as “Gay Man’s Cancer”, HIV still carries the stigma of being related to a gay lifestyle. While certain sexual acts or use of an infected syringe are more common risk factors, it only takes one quick on-the-job mistake to have a life altering exposure. The bad news is that this disease continues to utterly devastate many third world countries.

The good news is that a diagnosis in the U.S. and other modern countries is no longer a death sentence and that both Magic Johnson and my former employee are still alive today.

Remember:

  • Learn about diseases you may encounter.
  • Take necessary precautions, in your person and professional life every time, not just some of the time.
  • Get your vaccines and encourage others to as well. Every year we used to give out flu vaccines. Every year we had a secretary tell anyone who would listen that the vaccine causes the flu. Get and know the facts. Ignore prejudice and bigotry — disease affects us all.
  • Report significant exposures early.
  • Don’t wait for a leader to emerge on scene — be a leader and talk the talk and walk the walk.
Jim Love
Jim Love
Jim Love began his EMS career in 1974. Since that time he has worked providing direct patient care, has been an FTO and has been an EMT instructor. He transitioned to management and has held many positions over the years including operations, later focusing on training, safety and risk management. He was the National Director of Safety and Risk for AMR. Jim has enjoyed consulting on EMS safety. Jim is currently the Program Manager for the ACETECH (A Ferno Group Company) family of products. He maintains an EMS Safety site and blog, Emsafety.net, and can be contacted at drjlove007@gmail.com.
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