Does your BLS protocal incl. glucose monitor finger-stick?

[WuLabsWuTecH]

We have oral glucose and a glucometer.

Just like any piece of equipment it has to be calibrated to make sure it's accurate and yes, it makes a difference.

Why are we giving oral glucose to someone with a blood sugar of 400?

 

[rhan101277]

They are on the trucks, but here in Mississippi EMT-Basic's can't use them. If you happen to work in Alabama you can :wacko:

Otherwise you rely on signs and symptoms, history, ALOC etc. when giving oral glucose.

 

[Captain 24]

West Virginia

According to the Protocols that we follow it states that the blood sugar reading must be below 80 in order to give oral glucose. it does not matter weither if they are awake enough or not. If they cant swallow you just put it between the cheek and gum.

 

[Katie Elaine]

In the state of Connecticut, as basic level providers we are allowed to use a glucometer. Personally, I use it if the patient is showing AMS, ALOC, abnormal behavior, has a Hx, is showing standard S&S, or the call type asks for it (ie a fall). But there are other people on my department who tend to use it every call that there may be the slightest chance the patient is hypo- or hyperglycemic.

And we only administer oral glucose if the patient is alert and oriented, and can swallow. If the patient can't swallow I don't put ANYTHING into their mouth.

I actually went to an EMS conferance a few months ago, and many people were taken aback that CT EMT-Bs are allowed to do a finger stick, because it is "invasive."

 

[boingo]

R/O hypoglycemia is important for pts suspected of CVA. If you have the option of transporting to a stroke center v.s. the local hospital, obtaining a blood glucose would be beneficial.

 

[WuLabsWuTecH]

In the state of Connecticut, as basic level providers we are allowed to use a glucometer. Personally, I use it if the patient is showing AMS, ALOC, abnormal behavior, has a Hx, is showing standard S&S, or the call type asks for it (ie a fall). But there are other people on my department who tend to use it every call that there may be the slightest chance the patient is hypo- or hyperglycemic.

And we only administer oral glucose if the patient is alert and oriented, and can swallow. If the patient can't swallow I don't put ANYTHING into their mouth.

I actually went to an EMS conferance a few months ago, and many people were taken aback that CT EMT-Bs are allowed to do a finger stick, because it is "invasive."

Katie, imagine the looks I get when I tell doctors at the medical school attached to my undergrad institution that in Ohio we can intubate (Oral tracheal only, no nasal for us) and start CPAP!

What further confuses them is that I have no idea how to start a line or how to draw blood, something that EMT-B's can do in Missouri when under direct medical control (such as in the hospital they work at).

can CT basics give epi pens then or sub-Q epi or is that too considered invasive?

 

[VentMedic]

Katie, imagine the looks I get when I tell doctors at the medical school attached to my undergrad institution that in Ohio we can intubate (Oral tracheal only, no nasal for us) and start CPAP!

I can only imagine what they think.

What further confuses them is that I have no idea how to start a line or how to draw blood, something that EMT-B's can do in Missouri when under direct medical control (such as in the hospital they work at).

The EMT-Bs at the hospital are probably not working under their EMT-B cert. That would be way too limiting. Hospitals will usually only look at the EMT(P) certs as a proof that you have had some medical training. The hospital will then have a job description for the ER Tech which will meet the guidelines in their state for nonlicensed personnel and satisfy the requirements for the accrediting agencies geared toward hospitals and NOT prehospital.

 

[PapaBear434]

We can give glucose checks at our discretion, but we need to get a Doc's signature after the fact and be able to justify it. Not that it matters though, as the Doc's usually take it, sign it without looking or asking why or what they are signing (goes for ALS too), and the signature is little more than a circular scribble that I could easily copy with very little effort.

Anyone with AMS gets a glucose check off the bat, so long as they're aren't any other obvious signs like a head wound or something.

 

[Jac [ITA]]

Over here we don't use, as BLS, it but we have in the ambulance....

 

[DHarris52]

New Jersey

We carry oral glucose but are not permitted to take BGL. Go figure. Usually a family member is present and I give it the old "I'm not allowed to do it, but if you want to take his blood sugar while I run out to the rig to grab something, I can't stop you". Works every time.

 

[VentMedic]

New Jersey

We carry oral glucose but are not permitted to take BGL. Go figure. Usually a family member is present and I give it the old "I'm not allowed to do it, but if you want to take his blood sugar while I run out to the rig to grab something, I can't stop you". Works every time.

Why are you running out to the rig? Leaving the patient?

If the patient has his/her own machine a family member will probably be more than happy to do a stick if they haven't already.

 

[JPINFV]

Why are you running out to the rig? Leaving the patient?

If the patient has his/her own machine a family member will probably be more than happy to do a stick if they haven't already.

This. Same thing with nursing/assisted living staff at facilities.

 

[DHarris52]

If the patient has his/her own machine a family member will probably be more than happy to do a stick if they haven't already.

That'd be great...IF it wasn't illegal for us to ask them to do that.

 

[LucidResq]

Colorado - Yes.

EMT-Bs can use a glucometer, but "additional local training is recommended" and "medical directors shall ensure that indivduals performing these skills and acts obtain appropriate additional training." BGL via glucometer was taught in my EMT-B program.

In CO, we also have EMT-B with IV authorization. EMT-B IVs are allowed to use glucometers and administer D50 in addition to other skills, drugs and fluids. Almost every working EMT-B has their IV auth., and it is required by every ambulance service and hospital I've checked out.

 

[VentMedic]

That'd be great...IF it wasn't illegal for us to ask them to do that.

But you don't leave the patient once you've suggested this and made it clear that you are not allowed to do the procedure.

Is it also illegal for you to ask the patient if they have an asthma inhaler that you can assist with? ASA? Nitro? Epi-pen?

Sometimes commonsense has to prevail.

 

[JPINFV]

That'd be great...IF it wasn't illegal for us to ask them to do that.

Who said that it was illegal?

"BGL at patient contact time ____ per family/staff (as appropriate)."

 

[DHarris52]

But you don't leave the patient once you've suggested this and made it clear that you are not allowed to do the procedure.

Huh?

Is it also illegal for you to ask the patient if they have an asthma inhaler that you can assist with? ASA? Nitro? Epi-pen?

Nope, it's not.

Sometimes commonsense has to prevail.

There's this little thing called "scope of practice".

 

[VentMedic]

There's this little thing called "scope of practice".

It is not you doing the d-stick. It is the family and they are NOT under YOUR scope of practice.

You have the opportunity to get a number and the family may already suspect the problem. Are you actually going to turn down that piece of information and attempt to treat blindly by your limited EMT-B scope of practice?

And yes, you will still have to do an assessment even with the number.

 

[Shishkabob]

It's not illegal.

It may be against your agencies policies / protocols, but it's nowhere near illegal.

 

[CAOX3]

Why wouldnt a medical director allow an EMT use of a BGL monitor?