EMT-B finger sticks?

[Guest CrotonFalls33]

For my on campus ambulance corp, I had to take a CPR recert course and the training officer told us that EMT-Bs are in the process of becoming authorized to do finger sticks, I assume for basic blood test draws. Any of you guys hear anything about this? because for me it was completley out of the blue

[mlfcemt093 0]

For my on campus ambulance corp, I had to take a CPR recert course and the training officer told us that EMT-Bs are in the process of becoming authorized to do finger sticks, I assume for basic blood test draws.  Any of you guys hear anything about this? because for me it was completley out of the blue

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My ambulance corps Monroe Vac in orange county has been authorized by the hudson valley to do a pilot program for blood glucose testing so yes it's on the way we have been doin the program for about 2 months

[Guest]

Blood glucose measurement, not the drawing of blood (they are VERY different, and are out of the scope of practice for a EMT-B ), has been reviewed by the state and deemed a skill capable of being carried about by the EMT-B. The state is, last I was told, handling blood glucose levels the same as albuterol and epi-pen administration. Individual agencies will become certified after they have submitted a training program curriculum to the state for approval.

Edited October 13, 2006 by 66Alpha1

[bartman884 0]

Blood glucose measurement, not the drawing of blood (they are VERY different, and are out of the scope of practice for a EMT-B ), has been reviewed by the state and deemed a skill capable of being carried about by the EMT-B. The state is, last I was told, handling blood glucose levels the same as albuterol and epi-pen administration. Individual agencies will become certified after they have submitted a training program curriculum to the state for approval.

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That is correct. The Albany Fire Department participated in a pilot program a few years ago for BLS Glucometers. After review the state Ok'ed it and left it up to regions to set up their own protocols. My BLS volly corps up in Albany has already begun carrying albuterol and is in the last stages of the process for obtaining glucometers. This is a great program because 1) The glucometers are free, almost any company will donate them to an EMS agency knowing they will have to buy all the calibration and test strips and 2) This is a great addition for patient care. This agency, a college based ambulance service, does not get automatic ALS and often has substantial response times so the ability to do finger sticks on known diabetics and drunks (not that we ever get those) is very useful.

The one pain in the a** is like epi/albuterol everyone in the agency must be in-serviced before you can carry the glucometers and a sharps policy must be established.

[Guest CrotonFalls33]

yea thanks for clearing that up guys, i figured that it was glucose testing, but didnt want to make any quick assumptions. Its sounds like a great addition for the EMT toolbox. We haven't started a pilot program for training at my ambulance corps here in Westchester for this yet, but im sure were not too far from it. Anybody else locally in the process or are authorized yet?

[WAS967 97]

Some tips for those of you using glucometers to test blood sugar readings on your patients:

1) Clean the pinch site thoroughly with the prescribed solution (usually alcohol swabs). This is to ensure that there is no dirt, or other material that will contaminate the sample. This is very important in cases where a diabetic may have been trying to take sugar/glutose/etc in an effort to reverse a low sugar level. Residual sugar on the skin can cause a false high reading.

2) Make sure the solution that you used to clean the site is COMPLETELY DRY. If you don't let the alcohol/water/etc dry before taking the sample, it can cause the blood to be thinned out causing a false LOW. I suggest using a clean 2x2 to blot the site dry before pinching.

3) If you use the type of glucometer that draws the blood into the test strip or has a drop of blood that sits on top of a sensor, MAKE SURE YOU GAIN A COMPLETE SAMPLE. Make sure the test strip is full of blood, and make sure the sensor is covered with blood and not just half so. If the sensor on the glucometer does not have a complete sample, it can lead to a false reading as well (I've seen this happen numerous times with the Bayer Asencia Elite Glucomters.

4) Treat the patient and not your monitor. If you draw a sample and it reads 200, yet the patient is altered yet able to swallow, give the glucose anyway. First person to tell me they withheld glucose becuase the glucometer told them to, gets it bounced off thier helmet.

Edited October 25, 2006 by WAS967

[INIT915 1,119]

Not having read the BLS protocols on this, what is the rational behind knowing the BGL?

Any new treatments for BLS to administer, or still limited to the oral glucose?

[WAS967 97]

Still limited to gluTose.

[Guest]

more accurate field diagnosis and ED reporting? Not really sure, other than i remember the state saying finger sticks were a skill that the EMT-B was capable of carrying out.

[Guest]

Slowly but surely we note the progression of responibilities withing the scope of basic practice. But here's the question. EMT-B's now can give Epi Pens, ALbuterol treatments, pilot programme's afoot for Accu Check's in the field by BLS. I smell the extinction of EMT-B's in 10 years and the Phasing in of EMT-I's as the basic level.

That's not a bad thing though.

[ny10570 745]

There is an effort by some right now to increase the abilities of CFR to the level of EMT-B and make EMT-B the level of EMT-CC(I). This would go a long way towards freeing up ALS from alot of calls and allow alot more people to recieve effective pre-hopsital care. But I think this is technically called a pipe-dream.

[roeems87 0]

There are some MAJOR differences between CC and I levels... careful not to bunch the two together...

[Guest]

CC's and I's can only operate when a paramedic is enroute or o/s to the scene....they were developed as an intermediary to branch BLS and an extended ALS response (like in rural areas of upstate NY where you have minimal ALS resources covering a large area). Nothing is going to "free up" a medic, because they still are the highest level of pre-hospital care.

Edited November 14, 2006 by 66Alpha1

[roeems87 0]

ALS protocols vary by region. It may be the case in lower parts of NY that CCs cannot operate without a medic enroute or present, that is not true in many other upstate areas. And CC's do in fact "free up" medics because medics are not necessary to supervise CCs in many regions in upstate NY. There are NO ALS skills/medications taught and tested of paramedics that are not taught and tested of Critical Care techs as well. By region, it varies which they are allowed to perform (with standing orders, medical control orders, or not at all).

The major difference between CC and Medic is the design of the curriculum and training--NOT the skills. CC and Medic ALS treatment of a patient will not vary at all. The difference exists in the focus being technician vs. clinician (though both must make field diagnoses and treatment decisions based upon them). Training for CC requires extensive rotations throughout the hospital and ambulance systems, supervised by nurses and doctors--very similar to paramedic programs, with some differences. Medic (from my understanding) typically involves strictly doctors and additional time.

If anyone has questions about differences in Medics, CCs, and/or Is or is interested in how this type of system works in places like Central NY EMS or other regions in "upstate" feel free to PM me. If you want some examples of protocols, i'd be more than happy to provide those as well.

Unfortunately in westchester and NYC (the only two regions in NYS currently not recognizing CC protocols) don't utilize this level at all, though it's purpose in the area would obviously be grossly different than the one it serves up here in the middle of the state.

[Guest]

should have clarified - i only assumed we were discussing Westchester/Hudson Valley