How would you respond to this interview question?

[TheMightyAngus]

I was asked this question at my last interview, and it left me like a deer in the headlights:

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

I still don't know what the proper answer is, any suggestions?

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[dbhvt]

I was asked this question at my last interview, and it left me like a deer in the headlights:

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

I still don't know what the proper answer is, any suggestions?

Treat him. Then think about taking post exposure prophylaxis. Here's a dirty little secret that the public health community doesn't want the public to know (for good reason). The risk of contracting HIV from a one time exposure to a known HIV+ person is actually pretty low (low enough that it may actually be more risky to take the PEP).

But that kind of sidesteps the intent of the question with technical details. Ask a different question: patients life or yours? What's the ethical thing to do? Let the patient die.

There, now we can all ace that one. Too bad they don't ask you these questions at 2:30 in the am. Answers flow a lot easier then.

 

[themadchemist]

But that kind of sidesteps the intent of the question with technical details. Ask a different question: patients life or yours? What's the ethical thing to do? Let the patient die.

How do you figure?

 

[dbhvt]

How do you figure?

Here's one tack. Assume you have a family. You have more responsibility to your family than to this patient. Dying for the patient and leaving your kids without a parent is not ethical.

 

[Jon Davis]

Treat him. Then think about taking post exposure prophylaxis. Here's a dirty little secret that the public health community doesn't want the public to know (for good reason). The risk of contracting HIV from a one time exposure to a known HIV+ person is actually pretty low (low enough that it may actually be more risky to take the PEP).

But that kind of sidesteps the intent of the question with technical details. Ask a different question: patients life or yours? What's the ethical thing to do? Let the patient die.

There, now we can all ace that one. Too bad they don't ask you these questions at 2:30 in the am. Answers flow a lot easier then.

I agree with letting the dude die. If he were to be saved, he'd die later on anyway while you the healthy dude/dudette could get infected. The bigger loss is you getting HIV than him dying.

 

[Kimka83]

Call 911 at least!

 

[DrBowtie]

I don't really think there is a truly right answer in all cases. Some people would probably want the altruistic treat everyone no matter what while others would want the family first attitude. I would say just answer how you feel and stick with it.

 

[Law2Doc]

I don't really think there is a truly right answer in all cases. Some people would probably want the altruistic treat everyone no matter what while others would want the family first attitude. I would say just answer how you feel and stick with it.

There might not be a right answer, but probably is a wrong one (in this interviewer's opinion). I'm assuming you are a physician or at least a med student in this hypothetical -- if not, the prior poster who suggested calling 911/getting help is probably right. But if you are hypothetically a physician, I suspect the question is meant to shake out those people who don't have a significant committment to helping sick people -- honestly, as a doctor, you are going to have to put yourself into the first line of exposure to lots of stuff (usually before you even know what you are dealing with) and worry about it afterward. Sure, you'd normally wear gloves when treating someone in the hospital, but when you are on rotations or in residency, you can't not treat someone who comes into, say, the emergency room just because they can potentially expose you to something. Think about how many physicians examine patients every day who could potentially be carrying SARS, bird flus, or other airborn or antibiotic resistant bugs. Or as a surgeon, you might have to be elbow deep into someone HIV positive, and risk a variety of scalpel nicks and sticks that would give you far more significant exposure to HIV+ blood than in the present example. If you are going to be a good doctor, you are going to have to take some such risks. (So that's how I would answer that question).

 

[pseudoknot]

I don't think anyone with EMS experience would touch that person, or honestly say they would. Doctors seem much more cavalier about these things for some reason, so maybe some physicians would see that as a "wrong" answer.

Most of the time, interview questions like that are designed to see how you handle pressure and how you think about the problem. Don't get rattled; do think about your response and explain your thinking clearly, and then try to stay with your position. You will probably come off well if you can articulate your reasoning and not change your answer under pressure.

Or not.

 

[novawildcat]

What's the ethical thing to do? Let the patient die.

Yes. Why should 2 people end up dying from HIV instead of 1? The best thing you could do is call 911.

 

[Suppuration]

I was asked this question at my last interview, and it left me like a deer in the headlights:

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

I still don't know what the proper answer is, any suggestions?

Interesting question (yet somehow stupid at the same time). Assuming you have no open wounds on your hands the chances of contracting HIV are virtually nil. Autopsies were done without gloves until the 1970's, and unless the patient has Lassa you're in pretty good shape. If possible, call 911. Then I'd take my shirt off, place over the wound and apply pressure (gloves or no gloves). If it soaks through, there's always my pants. Hell, use your shoe to apply pressure, even if you have to put your hand in it. Belt = tourniquet. Just pray you're not doing this while on retreat in a nudist colony.

I suppose the interviewer can just keep throwing up hypothetical roadblocks that make it more and more dangerous for you to treat this guy, thus turning this from a problem-solving question to an ethical dilemma. In which case the answer is: "Bearing in mind the relatively low risk of transmission, if I can find a way to help this person without endangering myself too much then I will do it, but if push comes to shove I'm going to have to opt for my own self-preservation." Personally I'd be a LOT more concerned about his HepC status.

This harkens back to the old "would you perform surgery on someone with HIV" question. The answer was: "Assuming universal precautions are in place, absolutely."

 

[Anasazi23]

This interviewer probably was looking to see if you are indeed one of these "I'll impress everyone with my reckless altruism" med students. The correct answer is call for EMS backup, procure proper safety equipment for yourself, and then attempt to help the patient.

You do not put yourself at exposure to a deadly virus needlessly. Low exposure risk or not, it isn't worth it. ER physicians will walk away from a bleeding patient wheeled in to get gloves before they touch them. Safety protocols are just as much for you as it is for them. Putting yourself at unnecessary risk, I imagine, would be the incorrect answer in this scenario...at least for me.

 

[DoctaJay]

If someone is bleeding profusely in the street, whether you had gloves or not, there's not much you can do other than try to apply pressure.

So in that case, I would use my teeshirt first to apply pressure, and then wrap something around the teeshirt which is alot thicker to apply more pressure. Oh yeah, and before I do any of this I would check my arms for noticable cuts. The rest is left up to God.

 

[MrBurns10]

I'm not one to ever say there is a clear cut answer to almost anything, but I believe this is about as clear cut as you can get. I've been an EMT for the past three years and not once have I been told it is okay to stop someone's bleeding without gloves or perform CPR without a facial shield (particularly if there's blood or sputum). The question specifically stated that you're in front of the hospital. So, just yell at the patient to apply pressure while you run in and grab some gloves. Never put the safety of your patient ahead of your own. This doesn't mean you're selfish, this means you're being smart about it and know that, while you're able to save a lot of people throughout your career, you can't just put yourself at risk needlessly.

Besides, there are other things you can contract other than HIV...such as the chronic hepatitis C or the more acute but deadly Hepatitis B (my dad almost died because he got a needle prick from a Hep B+ patient). Always take care of yourselves first. And one more important note...sometimes you don't know if there are cuts or holes in your skin (which can be due to dermatologic conditions or just dry skin). If you want to see, rub alcohol wash in your hands and if it burns, your skin isn't intact.

 

[DoctaJay]

I thought when he said "outside the hospital" he meant like somewhere out of close range to the hospital. If i'm right outside the hospital, I'll probably show more caution, since his/her death is a little more preventable.

 

[MrBurns10]

I thought when he said "outside the hospital" he meant like somewhere out of close range to the hospital. If i'm right outside the hospital, I'll probably show more caution, since his/her death is a little more preventable.

Ahh, that might be more what he meant. But I still feel the same way...unless I have something as thick as a towel, there's not much I can do.

 

[WholeLottaGame7]

Haha my first thought when the question asked "outside the hospital" was that you could run in and get gloves, maybe a stretcher and wheel the sucker in.

Assuming we mean "far outside," it's a different story. EMS providers definitely know the drill. When it comes to safety, you have to protect yourself, your coworkers, then your patient, in that order. I know most pre-meds are all "Patient always comes first!," but that's a little too idealistic. If you go to the scene of a shooting or structure fire or something, with no FD or PD there, the sad fact of the matter is that people are going to be hurting while you just sit there. It sounds cruel, but a dead or injured health care provider doesn't do anybody any good. HIV is a little slower, but same deal.

Realistically, you're not going to know whether or not someone randomly bleeding in the street is HIV+ or not, so you should take the same precautions no matter what, hence the term "universal." If you'd take your shirt off to stop someone bleeding at their Hamptons mansion, you should take your shirt off to stop a homeless person's bleeding. If you wouldn't, fine, no one is going to fault you.

Personally, I'd probably do what someone (medjay?) said earlier: put pressure on with a t-shirt. If it soaks through, find something else. Repeat. If that soaks through and EMS hasn't arrived yet, then either A) you should have used your belt as a tourniqet by now, or B) it probably doesn't matter what you do for the person. Remember, all bleeding stops eventually.

 

[lexy10]

It is amazing to me that people who say to let a person die because they have HIV. Have you ever worked with an HIV+ patient? Most times, unless they have full blown AIDS, you would never know. People can live for a decade plus...and who knows how long now with new drugs. Although it has been said before, there is a low chance that you would contract the virus (unless you had huge open cuts exposed) and I'm all for the T-shirt method. Further, occupational exposure to HIV can be combatted with drugs (ie if you stick yourself with a needle that has HIV positive fluids on it). I'm with Suppuration, I'd be more concerned with the HCV status.

 

[MedicallyBlond]

Call for help from another medically trained professional.

If you don't have gloves, definitely try to look for some other kind of barrier to put between you and the blood - maybe t-shirt and a plastic bag. Obviously, you'd have to be creative with the resources in your immediate area.

Do what you can to stop the bleeding, apply pressure, make a turnicate, etc.

Try to contain the area where the blood has spilled. Ask others around to step away from the patient.

HIV is transmitted through contact with a mucous membrane, so if you don't have any open wounds, the risk is minimal, but then again, don't take chances (be careful for small cuts on hands or blood splashing in your eye, etc.)

That's how I might answer, just a thought.

 

[dbhvt]

It is amazing to me that people who say to let a person die because they have HIV. Have you ever worked with an HIV+ patient? Most times, unless they have full blown AIDS, you would never know. People can live for a decade plus...and who knows how long now with new drugs. Although it has been said before, there is a low chance that you would contract the virus (unless you had huge open cuts exposed) and I'm all for the T-shirt method. Further, occupational exposure to HIV can be combatted with drugs (ie if you stick yourself with a needle that has HIV positive fluids on it). I'm with Suppuration, I'd be more concerned with the HCV status.

True, true, (20+ years is not out of the question, assuming pharm R&D keeps up with the evolution of a retrovirus--which it has been doing). This is why I simplified the question to "patients life or yours" (an ethical question), rather than, "what to do with an HIV+ patient who is bleeding" (a practical question).

Incidentally, I think I should clarify my earlier post about the practical question. The likelyhood of contracting HIV from a one time exposure (ie, you have a big open wound on your hand) to an HIV+ person is really pretty low. An exposure=blood/blood contact, etc. Using direct pressure with your bare intact skin to stop blood flow is NOT an exposure, and the probability of contracting HIV from that experience = 0 (even lower).

This is not to diss standard precautions. Standard Precautions are ABSOLUTELY the way to go. Add up all the probabilities for all those exposures and the public health answer is that using standard precautions has a huge impact on reducing the spread of the disease.


Regarding HCV, the practical question is a whole different ball of wax.
1) HCV is scarier because the transmission rate with blood-blood contact is MUCH higher than for HIV.

2) HIV is scarier because it's not curable. HCV is curable (though the treatment is not fun, and doesn't always work).

3) Without careful treatment, both of them can kill you. With treatment, your quality of life can significantly decrease and you often feel like ****.

All of a sudden I am worried that this post is going to get misunderstood. Clarity is not my strong suit.

 

[Turkeyman]

If someone is bleeding profusely in the street, whether you had gloves or not, there's not much you can do other than try to apply pressure.

So in that case, I would use my teeshirt first to apply pressure, and then wrap something around the teeshirt which is alot thicker to apply more pressure. Oh yeah, and before I do any of this I would check my arms for noticable cuts. The rest is left up to God.

Yeah that's what I was going to say...take my coat or t-shirt off, fold it over an insane number of times, apply pressure, and call for backup.

 

[Bluntman]

Seems like a key point is that the situation is "outside the hospital", NOT while at work. In such situations, medical professionals are not legally bound to do a single damn thing, contrary to the (legal) requirement to help someone while on duty. Personally, I would not help them, as (has been mentioned here already) I have way more moral/ethical/whatever responsibilty to my family/friends to avoid the slightest risk of hurt (i.e infection) than I do to someone I do not know, regardless of their dire situation. In my experience, most docs/nurses/etc would agree with this train of thought.

For interviews however, all they really want to see is your critical thought processes that lead you to your conclusion. So I'd say as long as you explain your reasoning out loud to the interviewer clearly and intelligently, either answer is cool.

Something else though, is make sure to make a decision...it is alright to discuss both options, but don't be a fence-sitter - pick a definite course of action! Or else the interviewer will think "damn if he can't even give me a straight answer now, then what the hell is this guy gonna do when he's in a real situaltion like this!?"

 

[JustR]

Something else though, is make sure to make a decision...it is alright to discuss both options, but don't be a fence-sitter - pick a definite course of action! Or else the interviewer will think "damn if he can't even give me a straight answer now, then what the hell is this guy gonna do when he's in a real situaltion like this!?"

I agree..
Interestingly… there is not a right or wrong answer.
Stick to the option and present the critical thinking.

 

[willow18]

I don't think anyone with EMS experience would touch that person, or honestly say they would. Doctors seem much more cavalier about these things for some reason, so maybe some physicians would see that as a "wrong" answer.
Or not.

Right on. I'm an EMT and the first thing they teach you and keep repeating and repeating, Scene saftey and BSI (body substance isolation). If you fail to mention those two things during any of the practical exams it's an automatic fail!

My response would be: I'd call 911 and try to acquire gloves etc. If he/she challenges me on the answer, i'll just say that's how I was trained. I don't think adcom's are looking for heroic people. Maybe they're just looking for common sense. Are they looking for "selfless" people, perhaps. But in this case Selfless = Foolish.

 

[Orth2006]

I was asked this question at my last interview, and it left me like a deer in the headlights:

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

I still don't know what the proper answer is, any suggestions?

This question is somewhat ambigous. First what is the HIV patient doing outside the hospital. Doesnt he/she have any sense to go into the hospital and ask for help? If he/she made it thus far they might as well push to go in.
Secondly since its just outside the hospital there will be other people around and most likely someone will alert the Emergency department before you have time to think about a glove.
Thirdly responding to the more ethical side of the question, consider a person drowning in quick sand that asks for your help since you are on dry land. It would be foolish to jump into the quick sand in an attempt to help the person because both of you would probably sink and drown. This is a similar situation. You will be much more helpfull to a patient when you maintain your own safety.

 

[Bluntman]

Right on. I'm an EMT and the first thing they teach you and keep repeating and repeating, Scene saftey and BSI (body substance isolation). If you fail to mention those two things during any of the practical exams it's an automatic fail!

LOL...seriously, by the end of that course it's soo ingrained that I felt that I was gonna accidently say "BSI/Scene Safety" before I started a conversation with my friends!

 

[DropkickMurphy]

Personally I don't have a problem with taking care of HIV+ patients, and I didn't have a problem (until I became a father) with putting myself at risk to take care of a patient such as this, but if I don't have the proper PPE to do what I need to do, then I'm risking bring home whatever that patient has to my fiancee and daughter and that is an unacceptable risk. We make judgment calls of this nature all the time in medicine- to withhold necessary treatment due to varying degrees of certain or uncertain danger or unacceptable costs:benefits rations- but for some reason HIV+ provokes a particularly fervent response among many people, maybe because it affects young persons, those who have "their whole lives ahead of them", maybe because we can identify with the patient, or maybe out of some gut reaction to attempt to hide our own fears of the disease by treating those with it differently. Let me sum it all up by saying this: this is why I always carry a pair of latex gloves on me. But if I forgot them, then that patient is going to bleed until I have the way to protect myself. All altruism aside, you have to survive and remain healthy to take care of all the other patients who need your services.

 

[DrBowtie]

I think the key is that even if you don't treat, that you don't leave the patient as that is neglect and abandonement which could open up a lawsuit.

 

[bubbleyum]

i also interpreted this "outside the hospital" as on the street right outside the hospital.
in that case, i would say, call for back-up while i run in and get gloves.
if not right outside the hospital, call for back-up while i go get something that i can use as gloves.

although i do know that hiv is not transferrable through common human contact, i guess anything could happen during the course of treatment where you could be at risk. like if the patient was violent and somehow you get injured while trying to take care of him etc. better to be careful so your mind can be focused on doing a thorough job.

 

[Bluntman]

I think the key is that even if you don't treat, that you don't leave the patient as that is neglect and abandonement which could open up a lawsuit.

It's perfectly legal for a doc on his day off to not do anything and never approach the situation. He could just drive right on by waving out the window. Once you stop and start to do something though, then you are required to stay on scene and help to the best of your professional ability until relieved by equally (or better) qualified medical personnel. If you don't, that is abandonment.

 

[WholeLottaGame7]

It's perfectly legal for a doc on his day off to not do anything and never approach the situation. He could just drive right on by waving out the window. Once you stop and start to do something though, then you are required to stay on scene and help to the best of your professional ability until relieved by equally (or better) qualified medical personnel. If you don't, that is abandonment.

Correct. While driving by and waving without even calling 911 probably makes you a bad person, but you're not legally obligated to do anything. If you were to start to help him as a health care provider then leave, that would constitute abandonment.

 

[AxlxA]

Volunteering at the ER, i always carried a pocket full of gloves. I even put gloves in my car in case i ever need them. I think if you're a physician, u would probably hvae gloves in your briefcase/bag/purse just for any emergencies. Personal Protective equipment is crucial in providing safe health care for all.

How do you know if the patient has HIV? If i saw someone bleeding, I would probably just jump in, provide some bandage to keep it under pressure. Probably take off my layers of clothes and use it to press against his wounds. Though these are not certified PPE, i think it will atleast help. Always DIAL 911!!!! Stay calm and control the crowd.

 

[Bluntman]

How do you know if the patient has HIV? If i saw someone bleeding, I would probably just jump in.

That is a good point, and reminds me of a funny time when a surgeon told me that he doesn't like to know his patients' insurance status until after he performs the operation.

 

[AxlxA]

That is a good point, and reminds me of a funny time when a surgeon told me that he doesn't like to know his patients' insurance status until after he performs the operation.

LOL good point.

 

[JustR]

Volunteering at the ER, i always carried a pocket full of gloves. I even put gloves in my car in case i ever need them. I think if you're a physician, u would probably hvae gloves in your briefcase/bag/purse just for any emergencies. Personal Protective equipment is crucial in providing safe health care for all.

How do you know if the patient has HIV? If i saw someone bleeding, I would probably just jump in, provide some bandage to keep it under pressure. Probably take off my layers of clothes and use it to press against his wounds. Though these are not certified PPE, i think it will atleast help. Always DIAL 911!!!! Stay calm and control the crowd.

Great!! true!! realistic!!! and Funny comment!!!

 

[willow18]

LOL...seriously, by the end of that course it's soo ingrained that I felt that I was gonna accidently say "BSI/Scene Safety" before I started a conversation with my friends!

Yep, and we even had a whole debate whether we should say "BSI/Scene Safety" or "Scene Safety/BSI"

 

[Suppuration]

If he were to be saved, he'd die later on anyway

That's a sure winner during a med school interview. Works well in scenarios with CF patients, too. Jesus Christ...

 

[Jon Davis]

That's a sure winner during a med school interview. Works well in scenarios with CF patients, too. Jesus Christ...

That type of reasoning used all the time. Its called triage. If you wanna be a doc, you have to be prepared to make life and death decisions. Practicing medicine isnt all roses.

That quote was totally taken out of context. Read the entire post. Name one person who has recovered from full blown AIDS. Either he dies from the wounds or dies later on due to AIDS. Even if he did receive a huge amount of blood transfusion, he would die soon due to a now a greatly diminished immune system.

How can you extend life threatening blood loss of an AIDS patient to cystic fibrosis?

 

[45408]

as an EMT,

your safety > your partner's safety > the patient

 

[DropkickMurphy]

Actually it should be more like
your safety > your partners safety > the safety of others on scene > the patient

 

[WhatUpDoc!]

Call me idealistic, altruistic, or just plain dumb, but I think that it is quite a tragedy to leave a bleeding human being to die regardless of their prognosis. A lot of the replies to this post either sidestep the question, or bring up irrelevant information in an attempt to make the question more "answer friendly." Whether the man has AIDS or a freakin head cold, the fact of the matter remains that he needs life sustaining attention. That doesn't mean going to grab a pair of gloves or calling 911 while you sit back at a distance in fear of your own mortality. This individual could have only a couple of seconds left and applying direct pressure could provide the means to save his life. I'm not in disagreeance with the EMT logic of putting the safety of yourself first, but (as the famous cliche goes) desparate times call for desparate measures. For those of you who are so concerned about contracting a life-threatening virus that you neglect your responsibilities as a health care provider, maybe you should pick a profession that limits your exposure to such dangers. Try medical transcriptionist. I'm sorry, it just pisses me off that the majority of responses to this topic involve letting the man bleed to death or doing something to totally avoid the situation. And to respond to the whole "tirage" methodology, a man dying on the streets is not competing for resources with any one else at that specific moment in time. Therefore, the tirage argument is invalid. Ok, I'm done raving, and I realize their is no clear-cut right or wrong answer to the question. But I guarantee you that if I was on adcom, I would seriously lose respect for any interviewee that answered this question like some some of the replies on this thread.

 

[Jon Davis]

And to respond to the whole "tirage" methodology, a man dying on the streets is not competing for resources with any one else at that specific moment in time. Therefore, the tirage argument is invalid.

Again, out of context. The triage example was just to show that some decisions in medicine are made based upon the seriousness of injuries. Sometimes a patient just can't be saved while another can.

I wouldn't be so cold hearted and just let him die (which I did say but shouldn't have used those exact words) and watch from a distance. Obviously, calling for backup would be the thing to do. It seems like you expanded into a general case in which a person would be hurt. That would call for a different response, no doubt.

Ask yourself, how many doctors would do the altruistic thing and blindly jump in with no method of protection? I would bet dollars to donuts, most would just call for extra help.

One point though, these are just interview questions. We are just naive pre-meds when it comes to these decisions. After completing my training and stuff, I might look back and think wtf was I saying? My point is, you will have a much better picture on what to do in a scenerio like this. I agree with the thesis that this is just to see how you think in a certain situation.

 

[gujuDoc]

Call 911 at least!

I was going to say. Couldn't we respond by saying I'd call 911, and then take it from there in trying to determine what to do depending on the extent of the bleeding and where the bleeding is coming from (i.e. was it something like a gash in the arm?? vs. someone who was shot in the gut.)

So if it is something like a gash in the arm, you'd find some sort of something which you could use to wrap their arm in.

 

[gujuDoc]

Ok so here's the thing. I reread the situation presented in the original post and there are a few things to take into account:

This situation is kind of vague for the following reasons...

1. Do we define outside of the hospital as being right outside of the hospital literally??? Or does it mean somewhere far away from the hospital??

2. If they guy is profusely bleeding to death and some random person you've never seen the patient history of, then how do you know they are even HIV/AIDS positive??? I'm sure AIDS or HIV is not the first thing that is going to pop out of their mouth, for you to know that they are of such status.

3. Do we know if it is something like a bullet through the gut or a gash on the arm that caused the bleeding???

Also, someone mentioned that we see him when we are driving. If we encountered him, that would probably be different then seeing him through a car window. So this all leaves some major questions, because if we are in the car we will probably have more materials to help them (i.e. first aid kit which will have gloves for our own safety).

I think, the person that said it is a way to see how you react under pressure was probably on target. I'd probably call 9-11 and have them apply pressure if possible, where the bleeding is occuring. I doubt if it were someone random, though, that we'd even know the status of the patient as an HIV patient.

 

[DrBowtie]

It's perfectly legal for a doc on his day off to not do anything and never approach the situation. He could just drive right on by waving out the window. Once you stop and start to do something though, then you are required to stay on scene and help to the best of your professional ability until relieved by equally (or better) qualified medical personnel. If you don't, that is abandonment.

Within the context of the question the doc had approached the pt with HIV/AIDS.

 

[teedub]

Treat him. Then think about taking post exposure prophylaxis. Here's a dirty little secret that the public health community doesn't want the public to know (for good reason). The risk of contracting HIV from a one time exposure to a known HIV+ person is actually pretty low (low enough that it may actually be more risky to take the PEP).

But that kind of sidesteps the intent of the question with technical details. Ask a different question: patients life or yours? What's the ethical thing to do? Let the patient die.

There, now we can all ace that one. Too bad they don't ask you these questions at 2:30 in the am. Answers flow a lot easier then.

i'll agree with that. thanks for the input...

 

[teedub]

as an EMT,

your safety > your partner's safety > the patient

i agree with that too. in fact, i think you can get in trouble for NOT treating the situation that way.

 

[Psycho Doctor]

I was asked this question at my last interview, and it left me like a deer in the headlights:

Outside the hospital, you encounter an HIV-positive patient who is bleeding profusely and needs immediate treatment. You don't have any gloves. What do you do?

I still don't know what the proper answer is, any suggestions?

How do you know he's HIV???

 

[Psycho Doctor]

I thought when he said "outside the hospital" he meant like somewhere out of close range to the hospital. If i'm right outside the hospital, I'll probably show more caution, since his/her death is a little more preventable.

i thought he was right outside also

 

[Psycho Doctor]

Interesting question (yet somehow stupid at the same time). Assuming you have no open wounds on your hands the chances of contracting HIV are virtually nil. Autopsies were done without gloves until the 1970's, and unless the patient has Lassa you're in pretty good shape. If possible, call 911. Then I'd take my shirt off, place over the wound and apply pressure (gloves or no gloves). If it soaks through, there's always my pants. Hell, use your shoe to apply pressure, even if you have to put your hand in it. Belt = tourniquet. Just pray you're not doing this while on retreat in a nudist colony.

I suppose the interviewer can just keep throwing up hypothetical roadblocks that make it more and more dangerous for you to treat this guy, thus turning this from a problem-solving question to an ethical dilemma. In which case the answer is: "Bearing in mind the relatively low risk of transmission, if I can find a way to help this person without endangering myself too much then I will do it, but if push comes to shove I'm going to have to opt for my own self-preservation." Personally I'd be a LOT more concerned about his HepC status.

This harkens back to the old "would you perform surgery on someone with HIV" question. The answer was: "Assuming universal precautions are in place, absolutely."

why are you more concerned of his HCV status???