NYS EMT's To Be Able To Check Blood Sugar

[Guest alsfirefighter]

Your right, it is opinion on my part, and comes from observation and one that is shared by many of my colleagues, including several on here as stated. Thats great that there are EMT's with higher medical training. When I'm on the BLS engine I'm an EMT that's a paramedic. Your assessment skills are strengthed I'm willing to bet by your background.

I never said I've never seen a medic walk a MI patient, all I said was I've seen emt's do it and not have everything proper done, but they are being monitored. Protocol violation. I can tell you that I do not walk them, and everyone that knows me can attest to this, and very rarely will you ever find one of my co-workers do this. So if your seeing it in your area, its a QA/QI issue for that medics agency as well. I'm well aware of the action of D50 and glucagon. If you do not have impaired liver function and are not getting blasted with it on a regular basis your liver will cope. I'm not a massachist, if the level isn't that low I will utilize oral glucose and fruit juice, but if its low, your getting a line and D50, can't get a line, then your getting IM glucagon.

[WAS967 97]

Even tho emotion can be hard to detect in ASCII, I can tell from Roberta's post that the topic is getting heated. No real reason to be as we look to get both sides of any topic here and a good debate can be a learning tool for us all.

Simple fact is that EMTs with advanced assessment skills are in the vast minority in EMS today. I interact with, lets see, 14 different ambulance corps, on a regular basis. Including Roberta, I can count about 4 nurses that I know of that regularly ride calls for said corps, 3 doctors (2 rarely, 1 frequently tho he's now in Iraq), a handful of medics (maybe a dozen at most), and about the same number of EMT-Is. Do I wish more people had better assessment skills? Damn skippy.

I've seen some damn fine students come out of Charlie's class thanks to the skills you and Brett and Charlie have imparted on them. I've seen some good students come out of Marty's class in Valhalla too. But I'm not going to beat a dead horse by saying that class can only teach a person so much. Practice makes perfect. People just don't get the practice they need.

You can only get so much experience running calls with an agency that does less than 1000 calls a year. I see a huge difference between the skills of the EMTs in a busy system like Peekskill or Mohegan and those of say the EMTs in Pound Ridge or Verplank. Some I would trust to be able to integrate a Glucometer into their treatment regimen, and others I would not.

As for Medics walking people down stairs in MI: It's not the topic at hand. We could start a whole seperate thread about lazy medics. My only hope if that they are in the minority, but some people would debate that as well.

[Guest]

Thanks for the Teaching boost Chris. However I was not getting heated at all about the topic. I am sorry If it came off that way. Its all about whats best for the Pt. I think EMTs should learn alot more about Diabetic emergencys and you know my feelings on Insulin pump training so no need to get into that. All I was trying to say is that I dont think it would hurt to do glucosans at the EMT-B level. I agree that we still have to treat the Pt. and not the machine.

[Guest EMSwhitecloud]

I agree with Roberta on EMT's needing to know more about diabetics...In EMT class we were taught signs and symptoms and how to treat if they were a known diabetic and were alert. If it werent for Roberta none of us in the class would have known about insulin pumps. I think shes right, there should be a protocol on "pumps". I also agree with the fact that you can keep your IM's, ive told this to a lot of friends who are medics. When my blood sugar gets low, I get very tired and very emotional, the last thing i want is an IM if i am able to swallow juice or oral glucose.

Ive said this once before but it is coming very close to diabetics having a pump that automatically reads your BS and gives you insulin...now if i have a low BS it will shut off...But when i am given D50 its going to turn on and compensate for that high now..which will be defeating the purpose....shoulnt all EMS providers know how to deal with this medical device that is very common in todays age?

If the answer is yes....then why cant EMT's check BS which is a lot less complicated??? I was doing it at the age of 6.......

I understand treat the patient not the machine...but give them some oral glucose ( if able) test their blood while they are getting that then continue by treating them accordingly..... simple as that.

Edited September 22, 2005 by EMSwhitecloud

[Guest]

My thoughts exactly Erica. I dont think the question is can an EMT B do a glucoscan, Like you said we have been doing them since we were very young kids. I think the Issue that ALSMedic was bringing up had more to do with what the EMT-B would do with the info they get from the machine. Like holding glucose because the number was good. You know as well as I do that if you have a 400 BS that drops fast to a 200 BS you will have the same symptoms as hypoglycemia..

Say that happenes, an EMT B takes your BS it reads 200.. you are having hypoglycemic symptoms. what does the EMT-B do..Hmmm Most of them I think would recheck the BS.. recheck 189.. Hmmmm cant be low blood sugar. what would most EMT-Bs do ..I think they would monitor and hold the glucose. Then in about 10 minutes or so Bam BS of 24 unresponsive..

I would hope that wouldnt happen but I think that is the concern . we have a pulse ox on the ambulance.. I know I have given a Pt. with a 98 pulse ox O2 as per protocal ..But I guess there are EMTs that dont.. Anyway back to training ..Properly trained I think it could be a good thing.

[WAS967 97]

My favorite is when people use the pulse ox to give me a number for pulse during vitals. And I'm sure there are still people that don't comprehend the concept of false high reading with CO exposure. But all we can do is correct them and move on, hoping they learn and don't do it again.

Speaking of Oximetry: Check this out. I've seen it advertised in server trade rags recently. Looks like a promising item. THIS is something I could see anyone using at say fire rehab scenes: http://www.masimo.com/rad-57/

[DaveTFD 0]

good topic, i have been searching for this ever since i heard about the glucometers on BLS rigs. i think it is a great idea to have them on board. lemme say that agian...its a great idea to have them on board, but not to have them relied on to do your assesment. where i am, the bls provider will get there b4 als, do their assesment and make transport decisions. any good emt-b can tell what a diabetic emergency, and furtermore with experiance has a good knowledge of hypoglycemia. i think the glucometer is a good idea because before the medic gets on board you can save time by getting a glucose reading for them. its all about helping the pt after all, and saving time is always a good thing.

if any1 knows when this is supposed to be passed in albany, lemme know.

[Guest]

I volunteered with EMS in Westchester for a while. I recently starting attending college in North Carolina, so I got my NC EMT-B certification through reciprocity (which was really quick and easy, by the way) and I've been working for a couple of weeks with my college's EMS service.

In North Carolina, EMT-B's are actually allowed to do a bunch of stuff that we can't in NY. (So, I’ve had to play some serious catch-up.) Basics carry epi-pens and can administer them to anyone showing signs of serious analphylaxis; we also have albuterol with we can administer to anyone with an Rx for a bronchodliator and signs of asthma. (In NY, we need to use the patient’s meds, if they have them, or take an additional training course.) Here, EMT-B’s can use a combitube. BLS buses or flycars can carry nitro and asprin, but the patient needs to have an rx for nitro and we need med con for both.

But, more relevantly, we are allowed to use glucometers and do so on a regular basis. Working on a college campus, we get a lot of AMS calls. Most of the time, they are secondary to EtOH, but pulse ox and glucometry, coupled with thorough patient assessment, are essential tools for us.

One of the biggest concerns that people seem to have is that basics will throw clinical assessment out the window because of their new "toys." I know I haven't been here long, but, thus far, I have never seen patient assessment compromised by these tools. I have seen these tools improve the quality of care than we can provide. In my humble opinion, glucometry is great. I'm glad we can use it and I’m looking forward to when basics in NY can too.

[DaveTFD 0]

good post benny

[ems-buff 81]

Bumb!!!!!!!!!!!!!!

Does anyone know of progress of this new procedure for us EMT-B's

[Guest]

afaik the state is working with someone to create a CME type course to bring the EMT-Bs up to speed, once that happens i suppose they will alter the BLS protocol. But, from what ive been told its extremly hard to change health laws and such in NYS....like it takes an enourmous ammount of lobbying. Someone showed me a 1998 or 1999 dated memo in which the state stated it hoped to have EMT-Bs intubating by 200/2001. As you see...that hasnt, and is unlikely to happen any time soon because of the difficulty in getting such laws amended. So, its going to be slow going.

Edited February 19, 2006 by 66Alpha1

[firemoose827 324]

Hey, this is great news. I am so happy we can now check the BS level on patients and save that much more valuable time for the medics to treat the patient. I am Pro patient assesment and using all of you senses to acurately asses the patient, and treating the patient, not the equipment. I have seen it too many times where we go into a house with someone gasping for air and clutching their chests, and the only thing the crew chief does is grab that Pulse Oximeter! What about O2, vitals, lung sounds, Hx, and THAN use of the diagnostic tools to support whatever thesis all of you competent EMTS have hopefully been able to have come up with already with just good patient assesment. Man, the art of patient assesment has been forgotten, Huh ALSfirefighter and all you others out there who support it?

Oh well, I guess I have been out of EMS for too long and am glad to have recently rejoined the ranks by Recerting my Basic EMT again. I was an EMT for three years and a EMT-CC for three, but let it drop. I just got it back again and run with Cobleskill Rescue Squad and fire department.

Everyone have a great day, and stay safe.

Jonesy.

[Remember585 815]

Hey, this is great news.  I am so happy we can now check the BS level on patients and save that much more valuable time for the medics to treat the patient.

Careful with that comment. If we could check the "BS" level of every patient and treat what we find, then quite a few of our "BS" calls wouldn't require transport.

In all honesty, being able to check the blood sugar levels of patients is a great idea, HOWEVER I think it is vital for those of us on the BLS level to not be "lured" into using machines for everything. More and more people are buying the Monitors with the pulse oxymeters and NIBP units in them. And, sadly, so many EMTs rely on these things rather then their own skills to assess patients.

I think if we start checking sugar levels with machines / devices, we'll lose another skill that many EMTs are already lacking - ASSESSMENT!

[Guest]

i would say any AMS or general illness. Any trauma or head injury, i wouldnt check blood sugar because checking for trauma and injury and protecting against hypoperfusion is far more important than giving someone a stick in the finger and traying to administer glucose on a patient that is backboarded and collared.

[ny10570 745]

NYS allwos EMT's to check blood sugar. Its up to the local REMAC's to develop the training and protocall

[firemoose827 324]

Careful with that comment.  If we could check the "BS" level of every patient and treat what we find, then quite a few of our "BS" calls wouldn't require transport.

In all honesty, being able to check the blood sugar levels of patients is a great idea, HOWEVER I think it is vital for those of us on the BLS level to not be "lured" into using machines for everything.  More and more people are buying the Monitors with the pulse oxymeters and NIBP units in them.  And, sadly, so many EMTs rely on these things rather then their own skills to assess patients.

I think if we start checking sugar levels with machines / devices, we'll lose another skill that many EMTs are already lacking - ASSESSMENT!

←

Hey 585, I just wanted to ask if you read my whole post, and how I am pro-assesment? I agree with you about the machinery usage, and how many EMT's are relying on them ONLY, I do a complete assesment on my patients and I also get them off scene as quick As I can whereas most of my squad will set up a portable ER and be on scene for 20-30 minutes!! I was just trying to say how nice it was to let us at the BLS level check the BS level so that when ALS arrived they did not have to spend the first few minutes checking it, they can use our readings and treat accordingly with ALS intervention. I do agree with you though, too many EMT's are becoming too comfortable with their machines and diagnostics. I am old school though, I rely on my senses and my gut impression, I am either saying "OH s***", and going, or just saying "Another free ride to the ER!"

Have a good one.

[Guest]

Giving EMT's more responsibility is a noble thing, and the progressive thing to do. But without some serious training, both theoretical and practical, the attention once placed on exact patient assessment goes out the window.

I believe it was ALS Firefighter whom first mentioned about the Albuterol protocol. After the implementation of that protocol (and I;m only using my old VAC as example) we recieved a rather brief inservice/CME and were now certified to carry Epi/Albuterol/Pulse Ox's. Problem was that all the EMT's were afraid to touch the meds, but sure as hell had a ball with the pulse ox's. For patients trully in need of albuterol/EPI, the EMT's simply waited for the Medic to show up and care for the patient. The answer I got from every one of those EMT's "I'm not taking that chance." or "I really don't know how to use it."

There lacks serious training on this part in the classrooms. A few hours of covering the subject isn't enough. A 2 hour in house CME is not enough. Confidence and knowledge cannot be instilled that way and to expect consistant results is a farce. They need to be taught simply not how to operate the equipment or dispence the med. But GREAT emphasis needs to be placed on the CORRECT application of such device/med during the course of a thourough physical examination.

I don't wanna divide the line between paid and vollie but I think I already have. We owe it to the vollies to make sure that they are 100% sure of the new protocols instilled upon EMT-B's and that in a moments notice they can jump in and do the job w/o a medic. Even some of us paid people could use a run through the ropes every now and then.

Treat the patient, not the monitor. GOOD.

A good/detailed physical exam saves your a** every time.

Machines fail, your brain shouldn't.

I'm all for the advancement of EMT's. I'm more in favor of the state getting off it's lazy a** and bringing the classes up to par. I'm also for the region stepping it up with a bit more stringency when it come's to these new protocol's e.g. Epi/Albuterol. Don't simply send out protocol sheets and someone to do a one nighter of training. These are meds, higher standards need to be in place when it comes to that.

[Guest]

I agree with Roberta on EMT's needing to know more about diabetics...In EMT class we were taught signs and symptoms and how to treat if they were a known diabetic and were alert.  If it werent for Roberta none of us in the class would have known about insulin pumps.  I think shes right, there should be a protocol on "pumps". I also agree with the fact that you can keep your IM's, ive told this to a lot of friends who are medics. When my blood sugar gets low, I get very tired and very emotional, the last thing i want is an IM if i am able to swallow juice or oral glucose. 

  Ive said this once before but it is coming very close to diabetics having a pump that automatically reads your BS and gives you insulin...now if i have a low BS it will shut off...But when i am given D50 its going to turn on and compensate for that high now..which will be defeating the purpose....shoulnt all EMS providers know how to deal with this medical device that is very common in todays age? 

  If the answer is yes....then why cant EMT's check BS which is a lot less complicated??? I was doing it at the age of 6.......

I understand treat the patient not the machine...but give them some oral glucose ( if able) test their blood while they are getting that then continue by treating them accordingly..... simple as that.

←

white cloud, there are EMT's out there that still find it hard to use a BP cuff that has the bulb and dial in one, and even haven't worked an AED since EMT class. Wanna take that chance without sending them through a detailed class about what they are about to endeavour on?

[Guest cya69]

Excellent!

←

Excellent??????? Unfortunately too many EMT's already forget to perform the basic procedures when assesing a patient. Basic vitals and a good history are far more important to me than a blood sugar number which I would not trust anyway - who knows when the glucometer was calibrated? and what are they going to do with information once they have it? whos' to say the blood sugar levels are the problem at hand? let's get the BLS skills where they should be before giving the EMT's another "toy" as it has been referred to. By the way, where will they keep the glucometer? in their clip boards which seem to be the most important piece of equipment for most VAC's? good BLS before ALS, any good EMS provider knows this to be the case and if you don't - shred your card.