First Aid and CPR Ethics For Hepatitis B Carrier
December 13, 2015 6:00 AM   Subscribe

Should a low risk Hepatitis B carrier (or anyone with a bloodborne infection) pursue first aid/CPR/AED training?

For personal knowledge and betterment, I'd like to enroll in a First Aid/CPR/AED class. However, I'm a chronic asymptomatic Hepatitis B carrier (infected at birth prior to standard vaccination of newborns; my tests as an adult show a persisting Hep B surface antigen but have always had an undetectable viral count).

I'm wondering about the ethics of administering first aid and in particular, mouth-to-mouth CPR as someone who carries a virus transmissible by bodily fluid, even if the risk for saliva transmission is low. Most of what I've seen online talks about the ethics from the standpoint of risks of transfer from the potential victim, and not the other way around. Other articles talk about ethics as a consideration for health care workers. I'm not a health care worker; I just think this would be good to know as a citizen. However, I worry about the issue of consent, where an incapacitated person might not be able to consent to first aid or CPR treatment from me knowing of my status.

Should I pursue this kind of skill if I can't ethically use it? If the only concern re: risk is via bodily fluid exposure, I could forego CPR entirely and take first aid only, which would still be useful even if just for myself. I've thought about asking this of training organizers, but I'd like to do this anonymously first. Thoughts from laypeople, actual first responders, and health care workers are appreciated.
posted by anonymous to Health & Fitness (13 answers total)
I believe the focus with CPR is now chest compressions, and mouth-to-mouth is no longer recommended for adults. Compressions only has been found to be as effective as compressions + mouth-to+mouth, (at least when the average person is performing it), and more effective than nothing at all.
posted by ghost phoneme at 6:27 AM on December 13, 2015 [8 favorites]

Well, here's a thought from a lay person:

If I'm in a situation where I need CPR, the fact that one day I might get hepatitis as a result of that CPR is not likely to be chief among my concerns.

I mean, maybe if there are other people on the scene who *can* do CPR, you might want to defer to them in an emergency involving an adult (since kids have been vaccinated, most likely) who needs mouth-to-mouth (which is mostly deprecated these days for adults), but I don't think that's a reason not to learn the skills.

The calculus might be different for assisting with not-necessarily-life-threatening bleeding injuries at any point where you are also injured.
posted by jacquilynne at 6:28 AM on December 13, 2015 [2 favorites]

From what I understand, current CPR protocol is chest compressions only. You might want to call up the Red Cross and ask them directly- over the phone is pretty anonymous. (Plus, the First Aid/AED portions would be helpful anyway.)
posted by PorcineWithMe at 6:28 AM on December 13, 2015 [2 favorites]

For the last several years, CPR teaching actually forgoes the assisted breathing in favor of chest compression only in order to encourage more bystanders to jump in and help. I think you should get trained. Having the knowledge doesn't compel you to use it, and can make you more capable to either step in yourself or direct others if someone is having a medical crisis. The Red Cross also offers a course called Preventing Disease Transmission. It's pretty straightforward, common knowledge type stuff, but it may help make you feel more prepared.
posted by phunniemee at 6:29 AM on December 13, 2015 [1 favorite]

Yes, you should absolutely go for it!

Hepatitis B is transmitted during birth, by sexual contact, and exposure to the blood of an infected person. The CDC specifically states that although the virus can be found in saliva, it's not thought to be transmitted by activities such as kissing (quick reference here).

There are also small single-use barrier devices for rescue breathing, easily carried on your keychain or in a purse, which can help to further reduce risk.

That aside, as others have said - for lay responders, it's completely acceptable to do chest compressions only. Blood still contains a fair amount of oxygen even when you stop breathing for a short while. Compressions circulate that blood to continue delivering oxygen to your tissue. Even without delivering rescue breaths, compressions and AED use are lifesaving skills and absolutely worth learning.
posted by staraling at 6:48 AM on December 13, 2015 [8 favorites]

I did basic CPR training last week (the AHA course), and it still included breaths and compressions. It's emphasized that the most important part is calling emergency services and providing compressions (see Hands-only CPR), but assisted breathing hasn't been eliminated.

I'd say go for it. You could carry your own pocket mask if you like.
posted by zamboni at 6:50 AM on December 13, 2015

I'd rather be alive with hepatitis than dead, so if you happen to find me in a collapsed state one day, please do CPR away. You could also carry a pocket mask or face shield (the latter comes in a sachet and will fit in a wallet etc) or do compressions only.
posted by intensitymultiply at 7:53 AM on December 13, 2015 [6 favorites]

If I'm in a situation where I need CPR, the fact that one day I might get hepatitis as a result of that CPR is not likely to be chief among my concerns.

I'd rather be alive with hepatitis than dead, so if you happen to find me in a collapsed state one day, please do CPR away.

My concern with this from an ethical standpoint is that often bystanders fail to correctly assess if someone should receive CPR or not. It's a false dichotomy to say that the choice is between living with Hepatitis B and dying -- there's a spectrum of outcomes where sometimes OP's intervention could result in harm, sometimes in benefit. That's true for everyone who administers bystander CPR, regardless of their health status, but HBV can be devastating to someone who is immunosuppressed and you're unlikely to know that in advance. That's on top of the more 'standard' potential harms of rib fractures and resuscitating someone whose wish is to not receive resuscitation.

That said, as has been well covered above, there's no risk of transmission if you follow the current guidelines and perform chest compressions only. I would also suggest obtaining training in locating and using AEDs, as their success rate is significantly higher than CPR.
posted by telegraph at 8:04 AM on December 13, 2015 [1 favorite]

I carry a keychain-sized CPR/First Aid kit that contains non-latex gloves and a universal mask. Most first responders follow universal precautions now to prevent contact with blood-borne illnesses. It's trivially easy to comply and people who see my kit always say, "Wow, what a great idea!" Nobody thinks it's weird. I carry one in my purse, and one in my car's glove box. (In fact I slid a couple bandaids and alcohol wipes in the purse one and I am THE MOST POPULAR MOM AT THE PLAYGROUND because I can always clean up a scrape and have a bandaid immediately to hand.)

Personally given the choice between dying of a heart attack and risking Hep B infection from my rescuer, I'D TAKE THE HEP B IN A HEARTBEAT. You know, the ones you're thudding into my chest while CPRing me.

I got trained myself after my toddler collapsed and stopped breathing and was revived by CPR-trained park employees, who had him breathing again before the ambulance even got there. The magnitude of my gratitude to those trained bystanders who saved my child is impossible to overstate. Get the training. Call ahead to the Red Cross and explain your situation if you are super-concerned; in my experience they're very helpful and knowledgeable about universal precautions and can take care in training. But get the training and be the bystander who can save someone's toddler's life.
posted by Eyebrows McGee at 9:06 AM on December 13, 2015 [7 favorites]

The one day first aid course I just did included things like
- making the situation safe as the highest priority
- making sure to get help from passers by and not deal with a situation on your own if you can avoid it (and if you did that, there would be another person at hand able to give rescue breaths).
- under what circumstances you should DEFINITELY call an ambulance right away, and when you should be just advising someone to visit the urgent care centre or similar
- what to do about broken bones
- putting unconscious but breathing people into the recovery position
- how to deal with burns, how to identify burns that should go straight to hospital
- how to deal with shock caused by loss of blood or serious dehydration
- what to do about foreign objects in the eye
- how to deal with choking
- what info to get from the casualty in order to give to paramedics: e.g. allergies, medication, etc .

We were specifically advised that first aid kits should contain gloves. We were also told that while it's still recommended to give rescue breaths during CPR, it's quite possible that we might feel that would be unpleasant or unsafe (eg. if the other person has blood/froth/mucus around their mouth, or just is a total stranger), and that it is completely acceptable to just give CPR in that case.

Pretty much everything we did, I could have done by instructing another less well trained person in how to do it on scene, without even needing to touch the casualty myself. In many cases you could deal with the situation by talking the casualty themselves through what to do (e.g. sit on floor, elevate legs; or rinse burn under tap; or apply frozen peas wrapped in a jumper; or wait calmly for ambulance).

In conclusion, go on the first aid course!
posted by emilyw at 10:05 AM on December 13, 2015

"Should I pursue this kind of skill if I can't ethically use it?"

Yes, absolutely. In addition to what everyone else has said, you can use your knowledge to direct someone who hasn't had this training.
posted by Brittanie at 10:59 AM on December 13, 2015 [2 favorites]

I would say absolutely go for it!

First Aid and CPR teaches the important skill of learning to think about what you would have to do before you have to do it. You will learn about staying calm, actions you can take without ever even touching someone, and emergency preparedness. You may want to discreetly speak with your CPR instructor and inform them of your status before using mannequins if they are teaching 'mouth to mouth' so you can either opt out of that, or allow them to be extra diligent with cleaning procedures if you make mouth to mouth contact with the mannequin.

Like EVERYONE you should have a first aid in your vehicle which would include gloves (which protect you from the patient and the patient from you!) and a CPR mask of some kind. If you are extra concerned, keep a 'keychain' CPR mask in your purse, but 'compressions only' CPR is now totally acceptable for the bystander, and best of all, it HELPS!. Just doing chest compressions is not a situation where you body fluids are at all likely to come in contact with the patients.

If you are injured yourself (say in a car accident), having First Aid knowledge will help you help yourself, as well as direct others who may be less calm/prepared. It will also help you protect other people from your blood, by being able to better help yourself.

I wish everyone would take CPR/First Aid....the people you are most likely to help/save are the people closest to you!
posted by Northbysomewhatcrazy at 2:49 PM on December 13, 2015

You should absolutely pursue this. Your Hep B is irrelevant to almost everything you'll learn, and as other have pointed out at the moment the general practice for non-professional CPR is focused on chest compressions. Carrying a mask as Eyebrows suggests is also a great and easy thing to do.
posted by Wretch729 at 5:46 PM on December 13, 2015

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