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Accident and Injury Report Form



MEDICAL STUDENT PROTOCOL
Needlestick / Puncture Wound / Splash / or Bodily Fluid* Exposure (BBFE)

In the event that a MEDICAL STUDENT is exposed to blood or bodily fluid:

STEP 1: WASH
the area with soap and water. For mucous membrane exposure (eyes, nose, mouth), flush with water.

STEP 2: REPORT
to Nurse Manager during the day (D)/Nurse Administrator during the Evening/Holidays/ Weekend (E/H/W) on the unit where the exposure occurred to complete the Accident/Injury Report and to initiate the source patient testing** (For assistance reaching the Nurse Manager/Nurse Administrator at Mount Sinai Hospital main campus, dial "0").

STEP 3: VISIT
one of the following locations for immediate care and obtain Discharge/Visit Summary Report:

- ISMMS Students at MSH: Monday- Friday, 9am - 4pm: Jack Martin Fund Clinic (JMFC), 17 East 102 St., 3rd floor, (212) 824-7395 or x57395; All other times: go directly to the Emergency Department (ED)
- Visiting Students at MSH: Go directly to the local Emergency Department (ED).
- All Students at sites other than MSH: See below list *** "Where students should go in the event of injury or exposure"


STEP 4: CONTACT
Student Health Center (SHC) to schedule a follow-up appointment. Bring a copy of your Discharge/Visit Summary Report to SHC: Student Health Center: 17 East 102 St., 4th floor, Room D4-246, (212) 241-6023 or studenthealth@mssm.edu.



*** WHERE STUDENTS SHOULD GO IN THE EVENT OF INJURY OR EXPOSURE
If you are a medical student rotating at one of the following clinical sites, please report to the corresponding location below:


Bronx-Lebanon D: Employee Health Services (718)579-2643 165 Grand Concourse, Bronx, NY 10452 Monday – Friday 8am – 4:30pm

E/H/W: Go to ED 1650 Grand Concourse, 1st floor


Bronx VA D: Occupational Health Services (718) 584-9000, then dial x5175 130 W Kingsbridge Rd, Bronx, NY 10468, 6th floor, Area 6C Monday-Friday 8am-4pm

E/H/W: Go to ED (718) 584-9000, then dial x5255 130 W Kingsbridge Rd, Bronx, NY 10468


Brooklyn Hospital D: Go to Employee Health Services (718) 250-8774 121 Dekalb Avenue, Brooklyn, NY 11201, 2nd floor Monday and Friday 8am-4pm Tuesday, Wednesday and Thursday 9-5pm

E/H/W: Go to ED (718) 250-8075 121 Dekalb Avenue, Brooklyn, NY 11201, Ground level


Elmhurst Hospital D: Go to Occupational Health Services (718) 334-3030 79-01 Broadway, Elmhurst, NY 11373, Room A1-27 Monday-Thursday 7am-4pm; Friday 6am-4pm

E/H/W: Go to ED – ground level (718) 334-305479-01 Broadway, Elmhurst, NY 11373


Mount Sinai Beth Israel D: Go to Employee Health Services (212) 420-2885 317 East 17 Street, New York, NY 10003, 2nd floor M-F 8am-4:30pm

E/H/W: Go to ED (212) 420-2840 First Avenue at 16th Street, New York, NY 10003, Ground Level


Mount Sinai Hospital D: Go to Jack Martin Fund Clinic (JMFC) (212) 824-7395 17 East 102nd Street, New York, NY 10029, 3rd floor Monday- Friday, 9am - 4pm

E/H/W: Go to ED (212) 241-6639 101St and Madison Ave, New York, NY 10029


Mount Sinai Queens D/E/H/W: Go to ED (718) 267-4285 25-10 30th Ave, Long Island City, NY 11102, Ground Level


Mount Sinai St. Luke’s D/E/H/W: Go to ED (212) 523-3335 111 Amsterdam Ave, New York, NY 10025, Ground level


Mount Sinai West D/E/H/W: Go to ED (212) 523-6800 1000 Tenth Avenue, New York, NY 10019, Ground floor




      ** Source Patient Testing will be coordinated by Nurse Manager/Nurse Administrator, Provider, and Student Health.

Source patient testing includes:


• Hepatitis B surface antigen (HBsAg) • Hepatitis C antibody (anti-HCV or HCV Ab)

• HIV rapid antibody (HIV Ab) test - HIV verbal consent with chart documentation. - Anonymous HIV test for source patient unable to consent.

• If known HCV positive, then HCV RNA Quant • If known HIV positive, then HIV Viral Load