NYS EMT's To Be Able To Check Blood Sugar

[x635 4,066]

Finally! Such a simple procedure, and defintely a good addition to an EMT's toolbox.

Albany research leads to EMT testing changes statewide - New York  Email this article 

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Emergency medical technicians in New York state may now perform additional diagnostic tests, following a joint research effort between the Albany, N.Y., Fire Department and the Albany Medical Center. 

The two-year study, conducted by Dr. Bruce Ushkow, director of emergency medical services at Albany Med and medical director of the AFD, showed that basic EMTs are capable of safely and accurately performing blood glucose tests at the scene of an emergency. This test typically is performed only by paramedics who are trained to administer more advanced medical care, but who often arrive at the scene after basic EMTs. 

"Glucometry results are helpful in determining if a patient is suffering from a serious sugar-related medical condition," Ushkow said. "If the basic EMT is the first to arrive at a scene, allowing them to perform glucometry and act upon the results could improve accuracy of the diagnosis and expedite proper care." 

The New York state Department of Health has directed Ushkow to develop a program to train EMTs in glucometry.

Jul 20, 2005, 20:13

[Guest alsfirefighter]

Good addition as long as it doesn't get like how the nebulizer protocol made some things.

Nothing replaces good clinical assessment and judgement when it comes down to deciding hypoglycemia and good clinicians do so without the use of a glucometer.

I've seen too many EMT's misusing nebulized albuterol when not warranted. Giving it to pulmonary edema patients, hyperventilating patients and so on.

EMT's do not lose your ability to use your brain to figure diabetic emergencies out. Just because the glucometer may say one thing, it doesn't mean its correct, calibrated or the patient isn't functioning at the level the device is reading.

[x635 4,066]

Or as taught commonly "treat the patient, not the monitor"

[Guest NYTruckie]

Or as taught commonly "treat the patient, not the monitor"

Why back when we were told all the "toy's" (at that time LP10's) Only will give you number, and only a number. I agree with ALS and the X. Start treating the patient, have an idea what is going on and use the "toys" to try and confirm what you are thinking.

[Guest WolfEMT]

Or as taught commonly "treat the patient, not the monitor"

Why back when we were told all the "toy's" (at that time LP10's) Only will give you number, and only a number. I agree with ALS and the X. Start treating the patient, have an idea what is going on and use the "toys" to try and confirm what you are thinking.

That's pretty much what my department should do. We just got a Pulse Ox for the purpose of using it for fire fighter rehab. The problem is that they didn't realize that CO has twice the affinity for hemoglobin than O2 does, so a fire fighter who could have near death CO poisoning would actually read 100 on the Pulse Ox. I agree with X and Truckie: treat the patient, not the number or monitor.

As far as testing blood glucose levels, EMTs really don't have too much of a reason to do so. If you have a patient who has a blood glucose level of 50 and is conscious, it's not too much of a problem because you can always give them some insta-glucose and await ALS interface or take them straight to the ER. But what happens if your patient is unresponsive? Surely, you're not going to administer insta-glucose since it will block the patient's airway; in the end, you're still going to have to wait for ALS to arrive on scene, so allowing EMTs to do a Dex stick doesn't really serve too much of a practical purpose.

[Medibart 55]

I think they should do it the old fashioned way before they had labs and glucometers -- taste the urine!

[WAS967 97]

Bottoms up!

But my sentiments are the same. Treat the patient. If I come into a scene and people are playing with a glucometer yet the patient is sitting there U/U with no oxygen and no vitals taken, I shall have to destroy said glucometer.

[ems-buff 81]

does anyone know when this well be applyed to NYSEMT-B

[Guest]

I think they should do it the old fashioned way before they had labs and glucometers -- taste the urine!

I glad I'm not the only one still doing that.

[Guest]

does anyone know when this well be applyed to NYSEMT-B

No

[Guest]

I agree strongly to treating the patient and not the "toy's". But I would like to say that it is about time NYS stepped up to the playing feild. On a basic level Blood Gluc's aren't really that nescessary. However it is a step in the right direction. Who knows maybe within the next 10 years we'll see basics doing combi-tubes, IV's and possible some front line non cardiac meds! One can only hope that the level of the bar will constantly raised.

[Skooter92 7]

I strongly feel......actually, I HATE pulse oximetry on BLS rigs, I always thought that EKG screens/strips on BLS AEDs should go the way of the dodo (and they did, thank you!)......I don't see any positive aspect to having glucometers either.

My rant.

My issues.

[BuffMedic236 0]

Excellent!

[Guest alsfirefighter]

I agree, I love when I ask for a set of vitals and I see the pulse ox coming out to get a pulse rate...how about quality? Then the automatic BP cuff...umm no. Then to top it off, those with AED's that can monitor and they hand me a strip and tell me what it is. Where exactly is EKG monitoring in the BLS protocol? Or how about the fact that the device isn't suppose to be attached unless your patient is unresponsive.

[ems-buff 81]

it sounds like to me that you guys don't want us to check blood sugar. why not though. i mean won't the CIC'S teach us how to use these machines the right way. I mean some EMT's really, really try hard to do the best we can . i honestly feel real bad that some of you guys don't think we could not do a good job with the glucometer i mean if it can help use with any diabetic problems then i say go for it. it's all about PT. care right

[Guest NYTruckie]

it sounds like to me that you guys don't want us to check blood sugar. why not though. i mean won't the CIC'S teach us how to use these machines the right way. I mean some EMT's really, really try hard to do the best we can . i honestly feel real bad that some of you guys don't think we could not do a good job with the glucometer i mean if it can help use with any diabetic problems then i say go for it. it's all about PT. care right

I think what the paramedics (myself included) are saying is that the EMT's should know that is a low blood sugar problem without having to check the blood sugar. Which is worse for a patient low BS or High BS? What will happen to a person (that can protect there own airway) if you gve instant glucose if the BS was normal or High, are you causing damage?

So when are the EMT going to check BS in Diabetic's only? Can some EMT's list some other calls they might what to check a patients BS?

[ems-buff 81]

i can only think of altered mental staus poss. drunks PT. who are unresponsive PT. who vomit

sorry those are the only one's i can think of at the moment. i'm sure there's more can you guys give me some more EX. please

[Guest skubasam]

Or as taught commonly "treat the patient, not the monitor"

Why back when we were told all the "toy's" (at that time LP10's) Only will give you number, and only a number. I agree with ALS and the X. Start treating the patient, have an idea what is going on and use the "toys" to try and confirm what you are thinking.

That's pretty much what my department should do. We just got a Pulse Ox for the purpose of using it for fire fighter rehab. The problem is that they didn't realize that CO has twice the affinity for hemoglobin than O2 does, so a fire fighter who could have near death CO poisoning would actually read 100 on the Pulse Ox. I agree with X and Truckie: treat the patient, not the number or monitor.

As far as testing blood glucose levels, EMTs really don't have too much of a reason to do so. If you have a patient who has a blood glucose level of 50 and is conscious, it's not too much of a problem because you can always give them some insta-glucose and await ALS interface or take them straight to the ER. But what happens if your patient is unresponsive? Surely, you're not going to administer insta-glucose since it will block the patient's airway; in the end, you're still going to have to wait for ALS to arrive on scene, so allowing EMTs to do a Dex stick doesn't really serve too much of a practical purpose.

Hemoglobin has more like a 200x affinity for the CO molecule than for the oxygen molecule. Really screws up your reading.

[Pudge3311 5]

IMO, the EMT's coming out of a lot of these classes really isnt all that prepared for some of the things they are going to encounter. I see people having trouble taking simple vital signs and doing basics like applying oxygen and splinting and we want to give them more toys to play with. Sure Id like to see EMT's doing more, but maybe we should either make the class a little longer or do something, patient care should be getting better and it sure doesnt look like thats the case to me.

[ems-buff 81]

i think it's up to the EMT if he or she doesn't want to do thinks the right way than he or she shouldn't have nothing to do with PT. care WHaTS SO EVER

[WAS967 97]

Then to top it off, those with AED's that can monitor and they hand me a strip and tell me what it is.

I'll still never forget the time I had a PO come out of a house U/A @ a cardiac call and tell me that the patient is conscious, but he's in V-Fib. My only words were "no he's not". And after all that, the defib pads were on backwards (not a big deal bit still - if you're gonna try to interpret rhythms, please at least know how your gear works. KTHX.

Anyhoo. I'd be interested to hear from the MD who did the study and see what his feeling are and what benefits he sees in this. I wonder if I can find his email around anywhere.

[Guest alsfirefighter]

I know I'm not saying you shouldn't be able to use it or that an EMT-B won't be able to properly. What I'm alluding too, is other protocols and treatment abilities that aren't being utilize properly or correctly.

Case in point. The other evening I had a call for a possible diabetic in a car w/ PD on location. Patient was oriented, however was lethargic in answering questions. Pt. stated she did suffer from diabetes, checked blood sugar, came back as 84. That's in the normal range right? Still gave dextrose based on her slowness in responding, she was 20 mins north of her place of residence coming from work in the city, pale skin etc.

[Skooter92 7]

ALS, you did your job according to good patient care, not cookbook medicine, which is what we're all supposed to do. I've been criticized by ED nurses for giving dextrose to patients who were technically CA+Ox3, but had slow responses, altered sensorium or flat affect with known diabetic histories. Guess what? IT WORKED. Sorry, folks, but according to Da Rulz, I is a bad boy.

BLS providers do not need diagnostic tools other than a BP cuff, stethoscope, penlight, and watch, as well as a BRAIN (not a criticism, just in the list of tools-nothing implied). Their skillset should emphasize immediate assessment and reaction, rather than ANY sort of deliberation or contemplative diagnosis. NOT NEEDED. NOT APPROPRIATE. Period.

To muddle the waters with devices whose readings can be easily misinterpreted, misused or too heavily relied-upon, does the patient no good.

There.

I said my piece.

Take the pulse ox's OFF your BLS rigs, folks.

Take them out of your jump bags, and tie a watch with a second hand to the strap.

Give your patients oxygen according to their presentation, not their "number".

Grrrrrrr.

[Guest alsfirefighter]

What glucometers are really useful for are in cases where a persons therapuetic index of their insulin is at its peak and is utlizing mass amounts of dextrose in their system. By using the glucometer to get post D50 administration in timed intervals you can see if they are using the dextrose up at a fast rate so you can again administer more until you make the balance.

Unfortunately, oral glucose is not as effective or as fast acting as IV admin'd D50 so you'd have to get something from the area to give them in addition and it won't give you as high a spike in blood glucose levels as D50 will. For severe hypoglycemia the oral glucose will get them to slowly climb but may not be enough to get them into a normal range. At that point you go for getting them a safe level for proper body function being mentation at most being the brain needs 2 things to run...oxygen and glucose.

[GAW6 66]

I agree that some of the new EMTs coming out are not the greatest, but I think a lot of the problem is that the new crop of EMTs have become "medic dependent". They are not like the "old-timers" who had to run calls on their own and therefore were made to THINK! The new EMTs rely on the medics for everything.

[Guest EMSwhitecloud]

Being diabetic myself, i would like to say a couple of things. One, a meter is to a diabetic as a pacemaker is to a cardiac patient. Its not a "toy" and Im sorry but if im showing symptoms of low blood sugar I want people to go by the machine. I think EMT's should be able to do this because (1) I was doing it as a 7y.o....not hard and (2) why delay care of a diabetic with low blood sugar to wait for a medic or possibly put the patient at risk of a seizure??? Just a couple of thoughts

[ems-buff 81]

Being diabetic myself, i would like to say a couple of things. One, a meter is to a diabetic as a pacemaker is to a cardiac patient. Its not a "toy" and Im sorry but if im showing symptoms of low blood sugar I want people to go by the machine. I think EMT's should be able to do this because (1) I was doing it as a 7y.o....not hard and (2) why delay care of a diabetic with low blood sugar to wait for a medic or possibly put the patient at risk of a seizure???  Just a couple of thoughts

Thank you =D> =D> =D> =D> =D> =D> =D> =D> =D>

it's all about PT. Care

[Guest alsfirefighter]

EMSwhitecloud you bring up a valid and important point. And I know I've said this to you before but I give you credit for the strength you've had for the majority of your life dealing with diabetes.

The point is this...this shouldn't be happening: 2) why delay care of a diabetic with low blood sugar to wait for a medic or possibly put the patient at risk of a seizure??? Just a couple of thoughts If anyone is waiting for a medic to treat hypoglycemia they are in direct risk for negligence and failure to treat. Oral glucose has never killed anyone, even if you are not sure they may be having a stroke, that small increase in glucose isn't going to effect anything.

And I'm sure being we've worked together that you know if I didn't have a glucometer, I wouldn't need one to treat you. My point is noone should. It gives you an idea of a starting point and is more valuable as a pertinent negative then anything else.

[WAS967 97]

Oral glucose has never killed anyone, even if you are not sure they may be having a stroke, that small increase in glucose isn't going to effect anything.

Killed? Probably not. But have you ever seen someone slopping a tube of glutose down someone's gullet when they are Unconc/Unresp?

"Have the medic hurry up, the patient is gurgling now!"

<SIGH>

[Guest NYTruckie]

Killed? Probably not. But have you ever seen someone slopping a tube of glutose down someone's gullet when they are Unconc/Unresp?  

  "Have the medic hurry up, the patient is gurgling now!"

   <SIGH>

Last week at a Nursing Home, First by the RN, then by the Patients Doctor who was on the floor.