Putting their lives on the line: Meningitis in first responders

I came down hard — justifiably, I think — on health care workers a few days ago in discussing the extraordinary toll of hospital-acquired infections on vulnerable patients. So for equal time, here’s the story of some health care workers who take risks on their patients’ behalf instead of subjecting them to risk.

In its weekly bulletin today, the CDC describes the case of two first responders who contracted meningitis while checking on a 36-year-old man who had not been seen outside his house for several days. One was a police officer, the first one to enter the bedroom where the man was lying unconscious in a mess of feces and vomit; the second was a respiratory therapist who helped suction out the man’s airway and intubate him when he arrived at the emergency department.

Two days after the man was found and transported to an ER, the 30-year-old officer had a sore throat and felt nauseated. He went to his primary-care physician four days after that. While he was in the doctor’s office, he got a call from another member of his department: The hospital had diagnosed the patient with meningococcal meningitis, and the health department was tracing all his contacts.

Meningococcal meningitis — caused by Neisseria meningitidis — is so serious and so infectious that it is a nationally notifiable disease: The discovery of any case requires an immediate phone call to the local health department. That’s because it is also a deadly disease: At least 1 in 10 who contract it die, and survivors can be left brain-damaged or deaf and are at risk of losing limbs because of disrupted circulation and tissue death. Immediate antibiotic treatment is crucial.

The police officer went from the doctor’s office to an ER — not the one where they had brought the patient — and was admitted immediately and put into isolation. One day later, a 47-year-old man was brought by ambulance to yet another local hospital, and also put into isolation on potent antibiotics. He was the respiratory therapist who had helped care for the patient 7 days earlier.

The police officer was in the hospital for 5 days; the respiratory therapist, for 11. Both went home. The original patient who unknowingly infected them was not so fortunate: He was hospitalized for 20 days and then sent to a rehab institution.

The cases occurred in California, and the state department of public health there investigated. It determined that another 21 first-responders and ER workers — four cops, three firefighters, 2 paramedics and 14 personnel in the ER — had probably been exposed, and 16 of them took antibiotics prophylactically to prevent them developing the disease.

The CDC report, based on the CDPH investigation, scolds the first responders for not using breathing protection — which they should have been doing going in the door, because the patient fell ill last December in the midst of the H1N1 flu pandemic. (It also scolds the first and third hospitals for being slow in reporting the disease and offering prophylactic treatment to their employees). But it simultaneously notes how rare it is for workers to catch meningitis from those they are caring for.

I wonder, though, if we don’t underestimate the infectious-disease risks that first responders take on our behalf. While I was researching SUPERBUG, I kept hearing stories of EMTs and paramedics who believed they had been infected with MRSA while transporting patients, often from nursing homes. (See this 2007 Dallas Morning News story, of the death of a Texas firefighter, for one example.) Firefighters have blogged about it, a study last summer found MRSA on surfaces throughout firehouses, and there’s now an online training course teaching EMTs what to watch for.

A few years ago, I spent a year embedded in ERs around the US, eight overnight shifts per month, to get some sense of what patient overcrowding and staff stress were doing to emergency medicine. Every night, I heard EMTs complaining about sore arms and wrenched backs from manhandling patients on and off gurneys and up and down stairs, and I could see for myself the bruises, gashes and bite wounds they incurred wrestling combative and disoriented patients off the street and into their trucks. I wonder now if I shouldn’t have been more concerned for the threats to them that I couldn’t see — and that they didn’t either.

Update: A day after I posted this, the website Firehouse.com published news of a new study that found MRSA on 4 percent of firehouse surfaces in Snohomish County, Washington, and Mike Coston of Avian Flu Diary covered what looks like another portion of the same study: MRSA colonization among first responders.

Image courtesy Flickr user IWishMyNameWasMarsha under CC


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