The 12 firefighters from B shift at Los Angeles County Fire Station 8 in West Hollywood sat around the long rectangular table in the station's kitchen drinking coffee and sodas and talking. The subject was AIDS.
The conversation turned to the recent well-publicized story out of Sonoma County in Northern California--where a volunteer fire brigade had refused to answer an emergency medical call because the patient was a baby with acquired immune deficiency syndrome.
"At this station, rather than ask who has treated a person with AIDS, a better question would be, 'Who hasn't?' " one young man said.
A Common Experience
"Everybody here has worked on somebody with AIDS," confirmed Glenn Mutch, captain of the B shift firefighters, several of whom are also paramedics. "From somebody in full (cardiac and respiratory) arrest to somebody who was hit by a car. Some of them tell us they have it; some of them don't. But that doesn't mean they won't get treatment like anybody else."
Most L.A. paramedics and firefighters acknowledged, directly or indirectly, an undercurrent of concern about contracting AIDS--as well as hepatitis and other serious communicable diseases--from the people they are trying to help. The fear is there, they say, but it hasn't translated into the hysteria and incidents of outright refusal to treat patients that have been reported from other parts of the country.
(Although both county and city fire departments have firefighters and paramedics who have been exposed to the HIV virus and are being monitored through periodic blood tests, none has tested positive for the virus that causes AIDS. In fact, according to national statistics, no emergency medical worker in the United States has ever contracted AIDS on the job.)
Two experiences offered by firefighter/paramedic Rodney Cooper may typify the daily challenge of emergency rescue work in West Hollywood, a city with a large gay population.
Cooper, who has been at Station 8 for three years and has worn latex gloves routinely on most rescue calls since 1983, said, "One guy refused to let me treat him because I had gloves on."
Another time, Cooper had not yet put on his gloves when he reached a patient. "The patient said to me, 'I have AIDS. You should be wearing gloves.' It was very kind of him and I appreciated it." All in all, Cooper said, the incidence of notification that someone has AIDS is "almost 50-50. Some are cooperative and tell us, others won't."
Despite the risks, the B shift firefighters said, no one in their purview has been refused medical aid. And, while there have been earlier, scattered incidents of panic among paramedics, police and fire emergency personnel, the difference in Los Angeles, they said, has been an aggressive education program for emergency personnel.
Educational Programs Stepped Up
Both county and city fire departments have recently stepped up their AIDS educational programs. They have made AIDS awareness videos to be shown at fire stations, issued guidelines on protection against various communicable diseases and are currently equipping all paramedic ambulances and fire trucks with communicable disease kits containing goggles, masks and gowns.
The county Fire Department, through the office of health programs coordinator Marguarite Jordan is now planning management training courses about AIDS that will be conducted by physicians. "Those will be for battalion chiefs and assistant chiefs," said Jordan, a nurse employed with the department since 1985. "Then the information will be filtered down through the captains to the firefighters."
Both departments distribute pamphlets on AIDs awareness and protection to their personnel.
City and county paramedics, Jordan pointed out, receive far more extensive information on AIDS and other communicable disease than do firefighters because the county requires paramedics to have 64 hours of continuing education in emergency medical health care during a two-year period.
"I would say there is some general apprehension on everyone's part (about AIDS)," said Chief Lyle Burkhart, who sat in on the discussion at Fire Station 8. "And justifiably so. . . . But here (in Los Angeles) it's not going to be the way it was up north because our people are educated about it. The bottom line is there is not one person I have ever witnessed who has received second-rate care."
For example, engineer/paramedic Dave Barros said, "On Saturday, there was a guy hit in the car wash next door. He was pinned up against the wall and his legs were opened up. There was a lot of blood, but everybody had gloves on. We don't know if he had AIDS or not, but he got as good treatment as the President of the United States would get."
Even, or perhaps especially, at Station 8, such calm acceptance of the risks of duty has not always been the rule.
Until a month ago, according to Burkhart, "there was a large vacancy factor in this station. We had a mass exodus here for a while, but now the influx is back because of the awareness and educational programs we've had in the last six months."
"A lot of guys just wouldn't work here," firefighter specialist Richard Bodmer confirmed.
"Definitely true," added firefighter/paramedic Richard Robinson, who came to Station 8 the beginning of January. "I thought about it long and hard. I wanted to come here to get an education in high-rises (fighting high-rise fires). But I was hesitant at first. I called and talked to some of the guys who worked here. I read the available information about AIDS and decided to come."
Shift B's crew noted that there is a risk of contracting the HIV virus that causes AIDS with any patient.
Although the disease began among homosexuals, Barros said, "it's branching out. You have a 14-year-old kid who just got hit by a car. You don't know if he had a transfusion a year ago and has it. Now the issue is anybody."
The biggest concern for all medical care givers, B shift members said, is the inability to learn whether a patient has been diagnosed with AIDS unless the patient later signs a consent form permitting them to know.
"You can find out of they have hepatitis or syphilis, but you can't find out if they have AIDS," Burkhart said. "We just want to know in order to protect ourselves and our families."
Both county and city fire departments will have personnel monitored with blood testing if they fear an exposure to AIDS, and make available psychological counseling to the firefighter or paramedic and his or her family.
Waves of Fear
But Robinson and other firefighters all recalled previous incidents that created small waves of fear.
In 1985, a county fireman had administered mouth-to-mouth resuscitation to man in a car crash who was later found to have AIDS. There was considerable concern that the firefighter had been exposed to the HIV virus. He has been monitored through county health authorities and has tested negative.
"He is a personal friend of mine," Robinson said of the firefighter. "When it got out, he was treated very poorly by firemen, and his neighbors. A firefighter being treated like a leper because of misinformation."
City paramedics cited two similar situations to the county episode, where possible exposure to the virus caused near hysteria at each paramedic's fire station, where firefighters and paramedics sleep, eat and share bathroom facilities while on duty.
In 1983, a paramedic accidentally got an AIDS patient's blood into a cut on his hand when he inserted an intravenous tube. He also has been monitored at the hospital and tested negative for the virus, as has the woman paramedic who was stuck with a needle inadvertently while treating an AIDS patient in 1985.
"I think continuing education has helped alleviate the fears and helped us to avoid more AIDS hysteria," said Fred Hurtado, a Los Angeles city paramedic supervisor and president of the city paramedics union, United Paramedics of Los Angeles.
(Under the county fire system, all fire personnel are firefighters and can also train to be paramedics; in the city, the two are separate entities.)
"I was on a call on a traffic accident recently and a lady was stuck in the car and bleeding heavily," Hurtado said. "Afterward I found out that she had a history of IV drug use. It concerned me. Not that I ran to the hospital thinking I had gotten AIDS, but it's something you think about. Continued education about AIDS is crucial."
"In my opinion," Hurtado added, "that Sonoma caper was inexcusable. If you volunteer for fire service, you're there to save life and property, just as we are. If there are certain things you choose not to respond to, then you ought not be a volunteer. The solution is education. . . . We have responsible medical folks sit down and spell out the risks and what you can do to minimize them. When you come into this kind of work, certain risks come with the territory."
In response to firefighters and paramedics concerns, Los Angeles county and city fire departments in the past few months have issued protocols to be followed when treating injured or ill persons.
Both departments advocate the use of latex gloves, and have equipped fire trucks and paramedic ambulances with a new antiseptic solution for firefighters and paramedics to clean their hands.
Hypodermic needles are not to be resheathed in their covers after being use. The county Fire Department has a special box where they are to be placed; city fire officials currently are field testing a sponge box where used needles can be stored until they can be disposed of.
City and county fire departments are currently issuing communicable disease kits containing protective goggles, dust masks, gloves and coverall suits made from nonporous material for firefighters and paramedics to use if they are treating a person who has considerable bleeding or is losing body fluids.
In addition to the balloon-like breathing devices called ambu-bags that firefighters and paramedics long have used, the departments have provided small plastic units with one-way valves to minimize exposure to communicable diseases when giving mouth-to-mouth resuscitation.
"Most everyone is using gloves, but they don't take time to put on the suits," said city paramedic Dave Radcliffe, who works Fire Station 33 on South Main Street, the busiest station in the city. "The cops ask us for gloves all the time now. The police are now going through what we went through probably three years ago."
(On Tuesday, the Los Angeles Police Department began an AIDS education program for its officers and officials announced that the department soon will be issuing protective plastic gloves to be used in emergency situations by LAPD officers.
(Since last July, the Los Angeles County Sheriff's Department has equipped its radio cars with a communicable disease packet, including disposable plastic gloves and bags, towels, dust masks and disinfectant spray. As part of a continuing educational program for deputies, this week the department approved the release of an AIDS educational video for all sheriff's facilities.)
"There is lots of new clothing coming on the scene because of AIDS and hepatitis," added city paramedic Michael Kwiatkowski, who is currently working on a stress-management program for the Los Angeles City Fire Department. "I haven't worn the suit yet, because I haven't needed to use one. But they're not much different than what people see in an emergency room. It must look intimidating to people, but it's prudent management of contagious diseases."
"It's human nature for people to react in a variety of ways," said Dr. Bruce Haynes, director of the State Emergency Medical Services Authority, which regulates emergency medical service in California. "Some overreact, some underreact. But I think the public understands the nature of the problem. It may even have a silk lining. If watching health-care workers protect themselves leads to the public taking more care in their private lives, then that's going to be good."
Haynes office is currently sending out AIDS educational booklets for California's emergency medical personnel and said that the Red Cross is now developing trainers in police and fire departments around the state who can conduct education and prevention courses.
Radcliffe said that because he works in an area of high crime--with gangs and IV drug users--he and other paramedics have a greater fear of being shot while answering a rescue call than of contracting AIDS.
"We've all had guns pulled on us," Radcliffe said. "You never really know what's going to happen. We all have so many things to think about that AIDS just takes its place with them."