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established guidelines and procedures, not on the pres-ence of HCV infection alone.10

1. Harpaz R, Von Seiddlein L, Averhoff FM, et al. Transmission of hepatitis B virus to multiplepatients from a surgeon without evidence of inadequate infection control. N Engl J Med.1996;334:549-554.

2. Esteban JI, Gomez J, Martell M, et al. Transmission of hepatitis C by a cardiac surgeon. NEngl J Med. 1996;334:555-559.

3. Centers for Disease Control and Prevention. Immunization of health-care workers: recom-mendations of the Advisory Committee on Immunization Practices (ACIP) and the HospitalInfection Control Practices Advisory Committee (HICPAC). MMWR Morb Mortal Wkly Rep.1997;46(RR-18):1-42.

4. Centers for Disease Control. Recommendations for preventing transmission of humanimmunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive proce-dures. MMWR Morb Mortal Wkly Rep. 1991;40: No. RR-8.

5. Department of Labor, Occupational Safety and Health Administration, 29 CFR Part 1910.1030:Occupational Exposure to Bloodborne Pathogens; Final Rule. Federal Register. Dec 6, 1991.

6. Centers for Disease Control and Prevention. Recommendations for follow-up of health-careworkers after occupational exposure to hepatitis C virus. MMWR Morb Mortal Wkly Rep.1997;46:603-606.

7. Centers for Disease Control and Prevention. Public Health Service Guidelines for the man-agement of health-care worker exposures to HIV and recommendations for postexposure pro-phylaxis. MMWR Morb Mortal Wkly Rep. 1998;47(RR-7):1-33.

8. Janssen RS, St. Louis ME, Satten GA, et al. HIV infection among patients in US acute carehospitals. Strategies for the counseling and testing of hospital patients. N Engl J Med.1992;327:445-452.

9. Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexuallytransmitted diseases. MMWR Morb Mortal Wkly Rep. 1998;47(RR-1):1-116.

10. Society for Healthcare Epidemiology of America. Management of healthcare workersinfected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other blood-borne pathogens. Infect Cont Hosp Epidemiol. 1997;18:349-363.

This policy statement was prepared by the Public HealthCommittee. It was revised and approved by the ACEP Board ofDirectors October 2000. It replaces the policy statement titled“HIV and Bloodborne Infections in Emergency Medicine” orig-inally approved by the ACEP Board of Directors September1996.

Boarding of Admitted and Intensive CarePatients in the Emergency Department

[American College of Emergency Physicians. Boarding of ad-mitted and intensive care patients in the emergency depart-ment. Ann Emerg Med. October 2001;38:484-485.]

Optimal utilization of the emergency department (ED)includes the timely evaluation, management, and stabi-lization of all patients presenting to it. The ED should notbe utilized as an extension of the intensive care and otherinpatient units for admitted patients, as this practiceadversely affects quality of care and access to care. Emer-gency physicians, hospital administrators, EMS direc-tors, and community leaders should work together toresolve this problem. In order for the ED to continue to

• HCWs who are HIV positive should not be:–Precluded from performing any medical servicesbased on HIV status alone;

–Required to inform patients of their HIV statusunless the patient is put at risk by exposure to theHCW’s blood or body fluid;

–Required to obtain informed consent before thedelivery of emergency services.

• Unless a practitioner is implicated in provider-to-patient HIV transmission, HIV infection per se does notconstitute a basis for barring an HCW from any patient-care activities, including invasive procedures.10

• Decisions to restrict the practice of HIV-positiveHCWs should be individualized and based on uniformand objective performance standards for competence,ability to perform routine duties, and compliance withestablished guidelines and procedures, not on the pres-ence of an HIV infection of the HCW.10

H E P A T I T I S B R E C O M M E N D A T I O N S

• All emergency HCWs with any potential for bloodexposure should receive HBV vaccine unless medicallycontraindicated and should be tested for immunity aftervaccination.3

• The Centers for Disease Control and Prevention rec-ommendations regarding clinical activity for HCWs whoare HBsAg and/or HbeAg positive should be followed.4

HbeAg positive HCWs should double-glove routinelyand should not perform those activities that have beenidentified epidemiologically as associated with a risk forprovider-to-patient HBV transmission despite the use ofappropriate infection control procedures.10

• Hepatitis B testing and postexposure prophylaxisshould be discussed with victims of sexual assault at suchtime as the treating physician believes that such discus-sion would be clinically appropriate.9

H E P A T I T I S C R E C O M M E N D A T I O N S

• Mandatory HCV testing should not be a condition ofemployment for HCWs.

• Unless a practitioner is implicated in provider-to-patient HCV transmission, HCV infection per se does notconstitute a basis for barring a HCW from any patient-care activities, including invasive procedures.10

• Decisions to restrict the practice of HCV-infectedHCWs should be individualized and based on uniformand objective performance standards for competence,ability to perform routine duties, and compliance with

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provide quality patient care and access to that care, theAmerican College of Emergency Physicians (ACEP)believes that:

• Hospitals have the responsibility to provide qualitypatient care and optimize patient safety by ensuring theprompt transfer of patients admitted to inpatient units assoon as the treating emergency physician makes such adecision. The hospital regulatory and accrediting bodiesshould mandate this prompt transfer as one of their stan-dards.

• Emergency physicians should work with their ad-ministrators, nursing director, and EMS medical directorto develop a workable plan to achieve the prompt transferof admitted patients to inpatient units.

• Hospitals should have staffing plans in place thatcan mobilize sufficient health care and support person-nel to meet any increased patient needs at any time of theyear. The hospital regulatory and accrediting bodiesshould mandate this standby plan as one of their stan-dards.

• Hospitals should develop appropriate mechanismsto facilitate availability of inpatient beds that could in-clude accessing other monitored beds, use of dischargewaiting areas, and prompt discharge to skilled nursingfacilities as appropriate. The hospital regulatory andaccrediting bodies should mandate bed availability plan-ning as one of their standards.

• Emergency physicians should work with their hospi-tal to monitor and improve the use of limited inpatientresources.

• Staffing ratios applicable to other specialized areas/units of the hospital should apply equally to the ED toassure that patients receive a consistent standard of carewithin the organization.

• Hospitals and emergency physicians should worktogether to ensure the prompt availability of inpatient ser-vices so as to not jeopardize the community’s EDs, EMSservices, and their community’s health care safety net.

• Mutual aid and transfer agreements should be inplace to assist any hospital that is unable to meet theemergency and intensive care needs of their community.

• Hospital diversion should be instituted only wheninternal resources have been exhausted and other com-munity facilities have resources available to meet theneeds of patients presenting to their facilities. EMS sys-tems should develop mechanisms to address patientdiversion by health care facilities utilizing the ACEP pol-icy on Ambulance Diversion.

This policy statement was approved by the ACEP Board ofDirectors October 2000.

Collective Bargaining

[American College of Emergency Physicians. Collectivebargaining. Ann Emerg Med. October 2001;38:485.]

The American College of Emergency Physicians (ACEP)believes that medical professionals who choose to use col-lective bargaining should never use collective action thatcould delay or deny patients access to timely, qualityemergency care.

This policy statement was approved by the ACEP Board ofDirectors October 2000. It replaces Council Resolution 36with the same name approved October 2000.

Disaster Data Collection

[American College of Emergency Physicians. Disaster datacollection. Ann Emerg Med. October 2001;38:485.]

The American College of Emergency Physicians (ACEP)believes that research in disaster epidemiology is criticalfor future disaster preparedness. Accurate data collectionin a disaster can be difficult without government mandateand assistance. Although the public health system gathersmass epidemiologic data, public health departments playlittle role in disaster data collection. Therefore, ACEPsupports the following:

• Public health systems and agencies should be incor-porated into disaster planning and response.

• All injuries and illnesses related to officially declareddisasters and terrorist events should be reported to publichealth agencies.

• All disaster-related injuries and illnesses should beincorporated into a disaster collection database to en-hance local disaster response.

This policy statement was prepared by the Disaster Medi-cine Section and the Emergency Medical Services Committee.It was approved by the ACEP Board of Directors October2000.

Emergency Medicine Workforce

[American College of Emergency Physicians. Emergency medi-cine workforce. Ann Emerg Med. October 2001;38:485-486.]

The American College of Emergency Physicians believesthat there is currently a significant shortage of physiciansappropriately trained and certified in emergency medicine.