Case Review: Mystery Stick

When a dirty needle turns one patient into two, crews get a reminder that bloodborne illnesses require careful cleanup.

Attack One responds to a report of a “person ill” at a large industrial park at the far edge of its district. Heavy traffic makes it difficult to reach the call location in the late afternoon, but the crew finally arrives and makes its way through the factory complex to the restroom area where the patient is supposed to be. However, workers there report the patient has been moved to another office, and after searching two more offices, the Attack One crew finally finds the young man. Fortunately, the first responders had located him more quickly through a different access to the factory. They are working to finish their assessment when the Attack One crew arrives.

The man complains of weakness and has been vomiting for most of the day. He’s told the first responders he’s been ill for some time, but has been evasive about what the illness is. The patient is noticeably pale and speaks quietly. There are no signs of respiratory distress, he does not have a fever, and his vital signs otherwise appear stable. His blood sugar on fingerstick testing is 80. His mucus membranes look pale and dry.

“Sir, we understand you are feeling bad,” the Attack One paramedic tells him. “You appear to be dehydrated from vomiting, and if you are still nauseated, we should give you some intravenous fluids and medicine to reduce it. We will transport you to the hospital closest to us.” The medic notes the patient still seems uncomfortable and evasive.

“Would you please start my IV line in the ambulance?” the man requests. “Be happy to,” the paramedic replies. The crew loads up the patient and moves him into the ambulance. He vomits one more time while being moved.

“You need to protect yourself with gloves,” the patient tells the paramedic when she starts to set up the intravenous line. “I have some kind of infection I haven’t been able to afford the treatment for, and it is contagious to others.”

The paramedic stops and asks the patient to explain as fully as possible. After a series of questions, the patient reveals he has hepatitis C and had been undergoing treatment he’d now discontinued. He has been very fatigued and losing weight, and has missed some work because of his illness. He does not want his bosses or coworkers to know he’s ill, so he has avoided any discussion in their presence. He is afraid his illness will cause everyone to be afraid of him, and he will be fired.

The paramedic takes the usual precautions, starts the IV line, gives the patient a bolus of fluids and some antinausea medication, and transports him to the emergency department. He arrives there stable. The crew gives its report to the responsible nurse and physician and is doing its patient care documentation when a call comes from dispatch. The crew is asked to return to the incident scene and meet one of its department supervisors—and not to complete and close out the care report until that meeting is complete.

They return to the scene and are told over the radio to meet the supervisor in one of the offices where they’d been with the patient. There they find a woman who says she’s one of the man’s bosses. She was helping him when the first responders arrived. They had taken the man’s vital signs and used their glucose meter to check his blood sugar. They’d left some material on the desk in that office, and after the patient was gone, the woman had gone in to clean up. She’d stuck herself on the end of the lancet, enough to make her own finger bleed. She immediately cleaned the area with warm water and soap and applied some alcohol-based solution.

“I can tell this young man has some kind of medical problem,” she tells the crew, “and I want to know if I was exposed to something. I have completely cleaned the wound, and I have always been healthy. Can I get checked and treated for whatever that young man has?”

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