The Ethicist and the Fireman

The Ethicist is on a medical kick this week, and I somewhat take exception to the way in which he handled the second question in the column. You can go ahead and read it, or I can paraphrase: the author was a fireman responding to an accident scene. He apparently knew the victim, and was aware that she had Hep C. When two cops approached to assist, the fireman, rightly concerned about potential for disease transmission, offered the two gloves, but they declined. The fireman was writing to ask if he should have disclosed her status, potentially compromising her privacy, but protecting the policemen. Given that this incident is now in the past, the fireman asks, should he tell the cops so that they can be tested?

Cohen says that yes, the fireman should approach the cops, and gently berates the fireman for not insisting that the cops wear gloves at the scene. As it turns out, the fireman ended up talking to the victim, who decided to go talk to the cops herself.

I know that some emergency services personnel and doctors read this site on occasion (God only knows why), and I hope that they are shuddering at the thought of responders refusing gloves at an accident scene.

But I’m not sure I like the way that Cohen formulated his response. For starters, he said that the fireman did the wrong thing by not disclosing her infection status, although he follows up to say that the cops were idiots (Cohen says “knuckleheads”) for refusing to wear gloves. The fireman, Cohen says, should have made certain that the cops were wearing gloves, at any cost.

And here’s where I disagree. Not with insisting that gloves be worn at an accident scene, but with Cohen urging the fireman to violate confidentiality. The fireman should have insisted that the cops wear gloves…because it is standard protocol at an accident scene, for exactly this reason. Who knows what the infection status of a victim is? I’m not who was in charge of that accident scene, but they should have been ensuring that the responding personnel followed basic safety procedures. There was no need to disclose the victim’s status—the fireman should have gently, but firmly, insisted that the police officers wear gloves or stand aside. It’s just that simple.

Ironically, by getting his name printed in the New York Times, the fireman probably has disclosed his friend’s disease status anyway.

Something about this letter feels…artificial and odd to me. I cannot believe that a volunteer fireman would knowingly put policemen responding to an accident at risk. I also have a hard time believing that trained police officers would not put on gloves when they respond to an accident. Is the letter fake, or are first responders in Michigan…er…knuckleheads?

Please, kids. It’s all well and good to protect people when you know that there is a risk, but what about when you don’t know? Are these cops charging around, willy nilly, eschewing the latex? Because that, my friends, is a terrifying thought. If you work as a first responder, I think you have a responsibility to look after the victim, but also to keep an eye on the safety of everyone at the scene. Allowing someone to handle a bleeding accident victim barehanded is no way to play, and I think that Cohen should have stressed that. Now, two men get to wait for up to six months to find out whether or not they have been infected with Hep C, and a woman has to disclose her disease status to people it wouldn’t have concerned normally, all because one man failed to enforce a basic protocol known to anyone with half a brain. And that just sucks for everyone, now doesn’t it?

Any of my medical/emergency services readers want to weigh in on this one?

[Hep C]