19 CSR 30-40.047 - Mandatory Notice to Emergency Response Personnel of Possible Exposure to Communicable Diseases

PURPOSE: This rule establishes an inquiry and notice procedure to be followed by receiving medical facility personnel concerning the possibility of exposure to communicable diseases by emergency response personnel and good samaritans.

(1) The following definitions shall be used in the interpretation of this rule:

(A) Aerosols mean tiny invisible particles or droplet nuclei usually less than ten (10) micrometers in diameter, which float on air currents and are capable of being suspended in air for a considerable period of time and are not to be confused with droplet as defined in subsection (1)(F) of this rule;

(B) Airborne transmission means person-to-person transmission of infectious organisms through the air by means of droplet nuclei;

(C) Bloodborne transmission means person-to-person transmission of an infectious agent through contact with an infected person's blood or other body fluids;

(D) Communicable disease means an infectious disease transmitted by a significant exposure as defined in subsections (2)(A)- (E) of this rule, and examples of likely communicable diseases for investigation for possible significant exposures are-

1. Airborne diseases-pulmonary tuberculosis (Mycobacterium tuberculosis) and measles;

2. Bloodborne diseases-Hepatitis B and C and human immunodeficiency virus (HIV) infection including acquired immunodeficiency syndrome (AIDS);

3. Droplet spread diseases-rubella, Corynebacterium diphtheriae, and Neisseria meningitides; and

4. Uncommon or rare diseases-hemor-rhagic fevers including Lassa, Marburg, Ebola and Congo-Crimean; plague (Yersinia pestis); and rabies;

(E) Designated officer means a city or county health department officer, or his/her designee, appointed by the director of the Department of Health or his/her designee. The designated officer's designee may be, at local option, a person associated with an ambulance service, fire department or other enforcement agency; the designated officer may appoint multiple designees as needed;

(F) Droplets mean large particles of moisture that rapidly settle out on horizontal surfaces and originate from talking, sneezing or coughing;

(G) Droplet spread means brief passage of an infectious agent through the air, usually within three feet (3') of the source;

(H) Emergency means a sudden or unforeseen situation or occurrence that requires immediate action to save life or to prevent suffering or disability; the determination of the existence of the emergency can be made either by the patient/victim or by any emergency response personnel (ERP) or good samaritan on the scene;

(I) Emergency response personnel (ERP) means firefighters, law enforcement officers, paramedics, emergency medical technicians, first responders and other persons including employees of legally organized and recognized volunteer organizations-regardless of whether the individuals receive compensation-who, in the course of professional duties, respond to emergencies;

(J) Exposure or significant exposure means an ERP or good samaritan has experienced a possible risk of becoming infected with a communicable disease(s) including those identified in paragraphs (1)(D)1.-4. of this rule by a means identified in subsections (2)(A)-(E) of this rule;

(K) Good samaritans mean individuals that are not ERPs that provide emergency medical assistance or aid until ERPs arrive;

(L) Medical facility means a health care facility licensed under Chapter 197, RSMo or a state medical facility;

(M) Pathogen means any disease-producing microorganism;

(N) Patient means the victim of an emergency who has been aided by an ERP or good samaritan;

(O) Potentially life-threatening communicable disease means an infectious disease which can cause death in a susceptible host; and

(P) Universal precautions means an approach to infection prevention and control that requires all human blood and certain human body fluids to be treated as if infectious for HIV, hepatitis B virus (HBV), and other bloodborne pathogens.

(2) Means of transmission of communicable diseases are-

(A) Any person-to-person contact in which a commingling of respiratory secretions (saliva and sputum) between the patient and ERP or good samaritan may have taken place;

(B) Transmittal of the blood or bloody fluids of the patient onto the mucous membranes (mouth, nose or eyes) of the ERP or good samaritan or into breaks in the skin of the ERP or good samaritan;

(C) Transmittal of other body fluids (semen, vaginal secretions, amniotic fluids, feces, wound drainage or cerebral spinal fluid) onto the mucous membranes or breaks in the skin of the ERP or good samaritan;

(D) Any nonbarrier unprotected contact of the ERP or good samaritan with mucous membranes or nonintact skin of the patient; or

(E) Sharing of airspace by an ERP or a good samaritan with a patient who has been determined by the treating facility to have an infectious disease caused by airborne pathogens.

(3) The designated officer shall have the following duties:

(A) Collecting, upon request, facts surrounding possible exposure of an ERP or good samaritan to a communicable disease or infection;

(B) Contacting facilities that received patients who potentially exposed ERPs or good samaritans to ascertain if a determination has been made as to whether the patient has a communicable disease or infection and to ascertain the results of that determination;

(C) Notifying the ERP or good samaritan as to whether s/he has been exposed within forty-eight (48) hours of receiving the patient's diagnosis report, medical information or necessary test results and providing information regarding the exposure, importance of appropriate medical follow-up and confidentiality; and

(D) Upon request of the receiving medical facility or coroner/medical examiner's office, notifying the ERP or good samaritan of potential exposure to a communicable disease.

(4) The receiving medical facility personnel shall notify the ERP or good samaritan or the appropriate designated officer as soon as there has been a determination that there may have been a significant exposure-as defined in subsection (1)(J), of this rule-to communicable diseases including those identified in paragraphs (1)(D)1.-4. of this rule, by those means identified in subsections (2)(A)-(E) of this rule, thereby creating a risk of infection from a patient transported or assisted during the possible time of communicability of the particular disease. Information provided shall include to the extent known the type of disease in question; date, time and place of possible exposure; and recommendations regarding appropriate followup. The receiving medical facility or coroner/medical examiner's office shall make a commitment to faithfully implement the procedures provided for by section (4) of this rule, to assign appropriate personnel to investigate cases that appear to have involved a significant exposure as defined in subsection (1)(J) of this rule to an ERP or good samaritan and to provide the notification to the ERP or good samaritan or designated officer. If the receiving medical facility has determined that contacting the appropriate designated officer was better than notifying the ERP or good samaritan directly, then the designated officer shall employ previously developed policies and procedures governing the dissemination of information to the ERP or good samaritan and shall direct them to seek appropriate medical care. Nothing in this section shall be construed to imply that a medical facility has absolute knowledge as to the communicable disease status of all its patients at all times. Neither shall this section be construed as eliminating or reducing any preexisting duty under the common law or sections 2681-2690 of the Public Health Service Act (PHS) in 42 U.S.C.A. 300ff - 81 - 300ff - 90 to determine the communicable disease status of any patient.

(5) An ERP or good samaritan may submit a request for a determination whether s/he has had a significant exposure to a communicable disease, preferably within twenty-four (24) hours but as soon as possible.

(A) Upon receipt of a request from a designated officer, an ERP or good samaritan, the medical facility or coroner/medical examiner's office shall evaluate the facts and determine if the ERP or good samaritan may have had a significant exposure to a communicable disease.

(B) If a determination is made of a possibly significant exposure-as defined in subsection (1)(J) of this rule-to a communicable disease(s) including those identified in paragraphs (1)(D)1.-4. of this rule, by a means identified in subsections (2)(A)-(E) of this rule, the ERP or good samaritan shall be notified as soon as possible, but not later than forty-eight (48) hours after receiving the patient's diagnosis report.

(C) If the information provided by the ERP, good samaritan or designated officer is insufficient to make a determination, the ERP, good samaritan or designated officer shall be notified in writing, by telephone, or by electronic transmission as soon as possible but not later than forty-eight (48) hours after receiving the initial request.

(D) If the ERP, good samaritan or designated officer receives notice that insufficient information was provided, the ERP or good samaritan may request the designated officer to evaluate the request and the medical facility's or coroner/medical examiner's office response. The designated officer shall then evaluate the request and the medical facility's or coroner/medical examiner's response and report his/her findings to the ERP or good samaritan as soon as possible but not later than forty-eight (48) hours after receiving the request.

1. If the designated officer finds the information provided is sufficient to make a determination of exposure, s/he shall submit the report to the medical facility or coroner/medical examiner's office.

2. If the designated officer finds the information provided was insufficient to make a determination of exposure, s/he shall contact the ERP or good samaritan to gather the additional needed information, contact the medical facility or coroner/medical examiner's office, or both, to collect any additional available relevant information. If sufficient facts are then collected by the medical facility or coroner/medical examiner's office, the ERP or good samaritan shall be notified of any change in status.

3. If there was not a significant exposure, the medical facility, coroner/medical examiner's office or designated officer shall notify the ERP or good samaritan, or designated officer (who shall notify the ERP or good samaritan) within forty-eight (48) hours.

(6) If the ERP, good samaritan, designated officer and medical facility or coroner/medical examiner's office are unable to achieve satisfactory resolution to questions or issues under the procedures in subsections (5)(A)-(D) of this rule, a request may be made to the Department of Health, through its director or the director's designee, to resolve the issues or questions, preferably within seventy-two (72) hours, but as soon as possible.

(7) The Department of Health's Communicable Disease Exposure Report (form MO 580-1825, 4/94) shall be used by ERPs or good samaritans to notify medical facilities or coroners/medical examiner's office or designated officer regarding suspected exposure. The ERP or good samaritan shall retain a copy of the form and shall send one (1) copy to the designated officer and one (1) copy to the receiving medical facility or coroner/medical examiner's office.

(8) The designated officer and the local health department shall assure that an adequate supply of reporting forms is provided to all receiving medical facilities or coroner/medical examiner's offices within the geographic area served.

(9) The notification process established by the receiving medical facility or coroner/medical examiner's office to deal with reported exposures to ERPs or good samaritans shall be as comprehensive as that for employees of the medical facility or coroner/medical examiner's office.

(10) Receiving medical facilities or coroner/medical examiner's offices and designated officers with information regarding the significant exposure-as defined in subsection (1)(J) of this rule-of an ERP or good samaritan to a communicable disease(s) including those identified in paragraphs(1)(D)1.-4. of this rule by a means identified in subsections (2)(A)-(E) of this rule, shall provide information directly to the affected ERP. In the case of a good samaritan the designated officer or his/her designee shall provide the information directly to the good samaritan. All information shall be in a manner that protects the identity and confidentiality of the possibly infected individual and the ERP or good samaritan.

(11) A sending medical facility in advance of the transfer of a patient to another medical facility or back to the patient's residence shall notify the ambulance personnel of the existence and nature of any communicable disease(s) including those identified in paragraphs (1)(D)1.-4. of this rule by those means identified in subsections (2)(A)-(E) of this rule and appropriate precautions and procedures to follow. If the information supplied by the sending medical facility is unclear to the ambulance personnel, the ambulance personnel may make a specific inquiry as to whether there are any known communicable disease(s) involving a possible significant exposure that might occur during the transport of the patient. Nothing in this section shall be construed to imply that a medical facility has absolute knowledge as to the communicable disease status of all its patients at all times, but neither shall this section be construed to imply that a medical facility has absolute knowledge as to the communicable disease status of all its patients at all times, but neither shall this section be construed as eliminating or reducing any preexisting duty under the common law or sections 2681-2690 of the PHS Act in 42 U.S.C.A. 300ff - 81 - 300ff - 90 to determine the communicable disease status of any patient.

Notes

19 CSR 30-40.047

AUTHORITY: sections 192.020, RSMo 1986 and 192.806.1, RSMo Supp. 1993.* Original rule filed Feb. 2, 1994, effective Aug. 28, 1994.

*Original authority: 192.020, RSMo 1939, amended 1945, 1951 and 192.806, RSMo 1992, amended 1993.