An unprotected exposure report form (Appendix J) should be completed for any care provider who believes he or she may have had an unprotected exposure to an infectious disease in the course of attending, assisting or transporting a person to a hospital or clinic as part of his/her professional duties.
Note: UMass Lowell EMS requires the use of universal precautions when treating all patients or if necessary the utilization of infection control kits.
If you believe you may have had an unprotected exposure to an infectious disease (as described in regulations 105 CMR 172.001), you must provide the information on this form to the facility which treated the patient. If you are a member of the ambulance crew, you must complete the form at the same time you bring the patient to the hospital. Other individuals may be included on the form the ambulance crew presents to the hospital or shall file their own form within 24 hours of the unprotected exposure.
Procedure for Unprotected Exposure
- Notify the transporting ambulance service of the incident. They will, in turn, complete the Massachusetts Department of Public Health Unprotected Exposure Form.
- The EMTs who transport the patient are responsible for the completion and submission of the unprotected exposure report form for the ambulance crew. This form shall be submitted to the hospital on arrival.
- Within 24 hours, the faculty advisor must be notified of the unprotected exposure in writing. Medical follow-up will be provided by the university at the university’s expense to UMass Lowell EMS members involved in an unprotected exposure incident.
- Copies of all unprotected exposure forms will be kept in the employee file for the duration of employment plus 30 years.