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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



From one extreme to another

Police to get help fighting hepatitis C

By Jean MacDougall-Tattan
Staff Writer

HAVERHILL -- When police and firefighters respond to an accident, officials
said, they face the risk of being infected with hepatitis C, exposed
through the blood and bodily fluids of victims.

For two years the Fire Department has been working to protect its
firefighters from exposure, and now, Police Chief Alan DeNaro has asked the
Fire Department to help his officers lower their risk. The Fire Department
will also show police how to report exposures and track who was exposed, so
that if an officer develops symptoms down the road, he or she can prove the
illness is job-related.

This is the first time the Police and Fire departments in Haverhill have
relied upon each other for training.

"Their experience is far beyond what we have, and if we can use their
skills, we will," said DeNaro.


"We have to start tracking things. Hepatitis C in body fluids is a major
concern," said DeNaro, who said there have been no recent exposures that
initiated the collaboration between departments. "This is just something we
decided to accomplish and we're going to use the Fire Department's help,"
said DeNaro.

Fear of hepatitis C was stirred up in fire departments across the country
two years ago when the Philadelphia Fire Department did voluntary testing
and found that 300 firefighters came up positive -- that's 10 percent of
the department complement.

Some had infected their spouses because they didn't know they had it --
people can have hepatitis C for up to 10 years with no symptoms.

According to the Centers for Disease Control, symptoms include jaundice,
fatigue, dark urine, abdominal pain, loss of appetite and nausea. If
undetected for a long time, patients develop chronic liver disease and
eventually need a liver transplant. But if it is detected early, the drugs
Interferon and Ribavirin can be used for treatment, and the combination can
rid people of the virus around 50 percent to 80 percent of the time.

News of what happened in Philadelphia caused Haverhill Fire Chief John E.
Hamel Jr. to appoint firefighter Paul Weinburgh as the department's first
infectious disease control officer. Hamel appointed him almost immediately
after he became chief. Weinburgh was a paramedic with American Medical
Response ambulance service in Haverhill before he started working for the

Hamel said public safety personnel are lobbying for a bill, much like the
Heart Bill, that would allow firefighters to retire because of infectious

Last year there were 28 cases of hepatitis C reported in Haverhill, but
Community Health Nurse Debra L. McLaughlin, who tracks infectious diseases
in Haverhill, says there are others who have not yet been diagnosed because
they have no symptoms.

According to the Centers for Disease Control, over 3.9 million Americans
are known to be infected with the disease and over 25,000 new cases are
reported every year.


McLaughlin said the number of hepatitis C cases across the country spiked
over the last two years because so many people tried to give blood after
the Sept. 11 terrorist attacks, and hepatitis C is one of the things the
blood supply is screened for.

Neither Weinburgh nor Hamel would talk about whether any Haverhill
firefighters have hepatitis C or if there have been any exposures.

"Confidentiality is a big piece of this job. We wouldn't release that
information anyway -- we wouldn't want anyone to be afraid to call the Fire
Department out of fear that they may get something from ambulance workers,"
said Weinburgh, who admits that even he may not know if a firefighter is

"I'd like all firefighters to be tested annually, but some are hesitant to
have testing done through the department out of fear of discrimination if
they test positive. Some have it done anonymously through their own private
doctors," said Weinburgh.

Marianne Bitner, director of clinical services for Trinity Emergency and
Healthcare Transport, the city's ambulance service, said she is never told
if an employee tests positive because all testing is done through a private
consultant and all the information is strictly confidential.

Though universal precautions -- protocol used with all patients to ensure
the safety of health-care workers -- should, in theory, protect
firefighters and ambulance workers from all diseases, Weinburgh said
protecting workers from hepatitis C requires more. Hepatitis C can live in
even dry blood for up to two weeks, so people who touch it can be infected
if they have even a minor cut or open wound, said Weinburgh.

"If a firefighter has the body fluids of an infected person on his gear and
his gear is not disinfected, the virus will live on that gear. If he puts
the gear back on and has an open cut or wound, he could get the virus,"
said Hamel.

Universal precaution is the use of rubber gloves on hands, goggles to
protect eye membranes and masks if patients are coughing, spitting or
sneezing. The next step is protective clothing, like disposable
plastic-lined gowns to protect clothing.

To ensure the gear can not infect a firefighter down the road, firefighters
need to have their gear disinfected, and that costs anywhere from $75 to
$125 depending on the level of contamination, said Hamel, who said that
when the gear is sent out, it is sometimes gone for a week.

"What happens is you have firefighters weighing the necessity of cleaning
the gear versus being without their gear for a whole week," said Hamel, who
said his department has extractors -- the equipment to disinfect gear --
but they do not have the $10,000 or so it would take to renovate the fire
station to put it in.

Though Weinburgh works to protect firefighters from infectious diseases, he
refuses to voluntarily increase his own level of exposure -- he will not
work on the Fire Department ambulance anymore. "I have a family -- I have
young children," said Weinburgh.

To protect firefighters, Weinburgh needs hospitals to share information
they discover about the patients they transport.

Paramedics and emergency medical technicians always ask people if they have
anything they should know about, but because people might not know they
have hepatitis C, asking that question does not always help.

Other infectious diseases are also a concern, so Weinburgh wants the
hospital to tell them if a patient has hepatitis A, B, C, D or E, or other
infectious diseases like HIV/AIDS, meningitis and tuberculosis. A new type
of TB discovered over the last two years is resistant to antibiotic treatment.

"Right now AIDS and HIV are the least of our concerns," said Weinburgh.

Bitner said universal precautions should be used by all health-care workers
at all times.

"A newborn or an elderly person in a nursing home have just as high a
potential to give you something as the drug addict in the alley," said Bitner.

Firefighters already have universal precautions gear, and the Police
Department should have 110 complete sets of gear, including protective
suits, within the next two weeks, said DeNaro, who said his department
purchased them with a state SATURN (Statewide Anti-Terrorism United
Response Network) grant.


Bitner said all Trinity employees are given physicals and tested for
tuberculosis, take the series of hepatitis B vaccines and check every piece
of equipment for universal precautions.

If body fluids get on Trinity workers, that patient is asked to be tested
so proper tracking can be done on the employees.

"If the patient is positive, the employee is offered testing and medical
treatment. If the patient refuses to be tested, the employee is given all
the information and the opportunity to go through protocols and have
follow-up treatment at Trinity's expense," said Bitner.

"It is important to report any exposure, no matter how minor it seems. Fill
out the packet and get checked. That way the employee is reassured and if
there is a problem there is a record of when and where there was an
exposure," Bitner said. "I tell employees to go the extra mile because of
the concern that they might come down with something six years from now."

Weinburgh said some people get insulted when paramedics and EMTs come at
them with the rubber gloves and masks.

"They ask us if we're afraid they have something," said Weinburgh, who said
a firefighter could be the one with something and not know it, so the
gloves and masks protect the patient as well as the firefighter.

The good news is that education about risks has made health-care workers
more aware, and the young EMTs and paramedics she hires have lots of
questions. "That's good, because just five years ago, people didn't even
want to put on gloves," said Bitner.

Weinburgh is also working to protect the public from hepatitis C, and
trying to get biohazard stickers put on vehicles involved in accidents that
have blood in them, especially if the blood is from an infected person.

He said that would warn tow-truck drivers, as well as people working in
junkyards retrieving parts.

"People could cut themselves on a piece of glass with blood on it and get
infected and not know it for years," said Weinburgh.

"Years ago if there was an accident we'd hose the blood off the area and be
done with it. Today we have to disinfect the area, generally with bleach,
and then hose it down," said Weinburgh, who said that if they don't, a
child could fall off a bicycle and scrape himself on pavement where there
has been infected blood and become ill.

Weinburgh said he would also like to teach local businesses about how they
should clean areas where people have been injured and lost blood or other
body fluids.

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