EMT's checking BS

[truetiger]

I just can't wrap my mind around how a$$ backward California is. What's the harm in BLS having a glucometer? If a diabetic can check their own sugar, why can't the first responders?

 

[wanderingmedic]

I just can't wrap my mind around how a$$ backward California is. What's the harm in BLS having a glucometer? If a diabetic can check their own sugar, why can't the first responders?

Yes. It is BS if a first responder cannot check a BS.

 

[technocardy]

If it is an all-ALS system, I don't see a need for a glucometer for BLS. If it is a tiered system, then BLS could use it to help triage and/or treat patients.

But why?... Why restrict EMT-Bs because "it is an all-ALS system"?

 

[medicsb]

I just can't wrap my mind around how a$$ backward California is. What's the harm in BLS having a glucometer? If a diabetic can check their own sugar, why can't the first responders?

You should be able to do something with the information gathered. Many diabetics adjust their insulin according to their blood glucose level and many log measurements to be evaluated by their physician.

If BLS can't react in some way to the information, then it is useless. If it is an all-ALS system (as is most of CA to my knowledge), then the information gathered is of little use. Save the money and put it towards something else (and let the medics check the BGL).

 

[truetiger]

Every system should be an ALS system. I don't understand why they send an engine and a squad on a sick case? Just send one ALS ambulance. I've never understood CA's system with fire and private ambulances responding. I'm a big fan of the 3rd service (ambulance district) model.

 

[truetiger]

You should be able to do something with the information gathered. Many diabetics adjust their insulin according to their blood glucose level and many log measurements to be evaluated by their physician.

If BLS can't react in some way to the information, then it is useless. If it is an all-ALS system (as is most of CA to my knowledge), then the information gathered is of little use. Save the money and put it towards something else (and let the medics check the BGL).

Oral glucose? Food? I worked a hypoglycemic patient that was treated by simply having him eat. BGL was 20. He was alert and oriented, able to swallow. BLS could do the same.

 

[DesertMedic66]

Oral glucose? Food? I worked a hypoglycemic patient that was treated by simply having him eat. BGL was 20. He was alert and oriented, able to swallow. BLS could do the same.

We can assist patients with their own tests (at least my county).

If the patient isn't able to check his/her own sugar then we can't do anything to treat it since our only treatment option is oral glucose for alert and orientated patients.

 

[Bullets]

Oh look, a california thread.....

Every system should be an ALS system. I don't understand why they send an engine and a squad on a sick case? Just send one ALS ambulance. I've never understood CA's system with fire and private ambulances responding. I'm a big fan of the 3rd service (ambulance district) model.

Problem is, numbers dont support your model


BLS cant do BGL in NJ, but we "assist" family with glucometers all the time

 

[truetiger]

Say what you want but it works well for us here in MO. You can make a good living as a transport only medic. This allows employers to attract and keep good employees. We're not a stepping stone for the fire jobs.

 

[medicsb]

Oral glucose? Food? I worked a hypoglycemic patient that was treated by simply having him eat. BGL was 20. He was alert and oriented, able to swallow. BLS could do the same.

Change in mental status in a diabetic patient (especially one on insulin or a sulfonylurea) should be considered hypoglycemia until proven otherwise. If you're BLS and ALS is already on the way, then treat empirically for hypoglycemia. You do NOT need a glucometer to do this.

In a tiered system, a BGL could indicate an ALS request (if not already sent) OR indicate ALS cancellation in some cases. If ALS is on its way regardless, the glucometer is a waste of time and money.

 

[truetiger]

So why not prove otherwise earlier? What if it's a suspected stroke patient with slurred speech? Wouldn't it be beneficial for the EMT first responders to rule out hypoglycemia quicker and get a stroke protocol started quicker? Or if it is hypoglycemia, correct it so the patient can be reassessed sooner?

 

[technocardy]

So why not prove otherwise earlier? What if it's a suspected stroke patient with slurred speech? Wouldn't it be beneficial for the EMT first responders to rule out hypoglycemia quicker and get a stroke protocol started quicker? Or if it is hypoglycemia, correct it so the patient can be reassessed sooner?

Exactly! Since when is having more information a bad thing?

 

[medicsb]

So why not prove otherwise earlier? What if it's a suspected stroke patient with slurred speech? Wouldn't it be beneficial for the EMT first responders to rule out hypoglycemia quicker and get a stroke protocol started quicker? Or if it is hypoglycemia, correct it so the patient can be reassessed sooner?

If EMTs can call a stroke alert and transport without ALS, then sure, use a glucometer. But being able to do that wouldn't be characteristic of an "all ALS" system.

 

[truetiger]

No, but if the fire dept arrives on scene before us, has a positive stroke scale, time of onset, and normal blood glucose level then I can go ahead and arrange air transport while en route.

 

[medicsb]

Exactly! Since when is having more information a bad thing?

Actually, having "more" information can be a bad thing especially when it is useless and doesn't change what you're going to do (wasted time and money), or when it changes what you're going to do, but what you do is harmful (wasted time, money, and patient morbidity or mortality). There is a term frequently heard among surgeons (particularly those that practice trauma): "victim of medical imaging technology" (aka "VOMIT), which is applied to patient who undergo exhaustive work-ups (up to and including invasive surgical procedures) because some imaging (i.e. information) found something that looked potentially pathologic but wasn't, usually in the context of a questionable indication for imaging in the first place. This certainly does occur outside of imaging and can be applied to simple laboratory studies.

 

[truetiger]

That's a bit far fetched here, don't you think? Comparing complex medical imaging to a procedure people perform at home on a daily basis...

 

[technocardy]

Actually, having "more" information can be a bad thing especially when it is useless and doesn't change what you're going to do (wasted time and money), or when it changes what you're going to do, but what you do is harmful (wasted time, money, and patient morbidity or mortality).

It's not useless if you can save the paramedic minutes by telling them their unresponsive patient has a BGL of 1.2 mmol/L. Now the patient is getting the D50 quicker then if the paramedics have to do an assessment while BLS had been sitting there for 5 minutes and had only applied oxygen (which they'd do because they can't monitor SpO2...) (Yes, I know it's a very specific example and highly unlike in an all-ALS system)

There is a term frequently heard among surgeons (particularly those that practice trauma): "victim of medical imaging technology" (aka "VOMIT), which is applied to patient who undergo exhaustive work-ups (up to and including invasive surgical procedures) because some imaging (i.e. information) found something that looked potentially pathologic but wasn't, usually in the context of a questionable indication for imaging in the first place. This certainly does occur outside of imaging and can be applied to simple laboratory studies.

Except we're talking about a simple, incredibly low risk test that's done by people from all walks of life and all ages on a regular basis. I'm sure EMT-Bs can be taught to do it properly.

 

[medicsb]

Context, folks. My response was in regard to the inference that "more" information is never bad, which was not apparently specific to the use of a glucometer. Regardless, if the glucometer is not going to change what the EMT does, then they do not need it, and in those cases that extra information would be useless (thus, a bad thing, even if just teeny-tiny bad thing).

 

[medicsb]

It's not useless if you can save the paramedic minutes by telling them their unresponsive patient has a BGL of 1.2 mmol/L. Now the patient is getting the D50 quicker then if the paramedics have to do an assessment while BLS had been sitting there for 5 minutes and had only applied oxygen (which they'd do because they can't monitor SpO2...) (Yes, I know it's a very specific example and highly unlike in an all-ALS system)

It takes "minutes" for a medic to check a BGL? What sort of glucometer are they using? When I worked as a medic, knowing the BGL before hand would have saved 5-20 seconds at best, which is how long our glucometers could take to make a measurement. (The sad truth is that even if the EMTs gave me a BGL and they're not part of the same service as I, then I can't really trust that they're maintaining their glucometer, so I'm double checking anyways.) If an EMT tells me the unresponsive patient is a diabetic and then gives me vitals that tell me that the patient hemodynamically stable, then I go right for the IV and grab a glucose from the IV. While waiting the 5-20 seconds, I'm pulling the box of D50 from my bag.

Except we're talking about a simple, incredibly low risk test that's done by people from all walks of life and all ages on a regular basis. I'm sure EMT-Bs can be taught to do it properly.

This has nothing to do with whether or not they can do it, or its safety. It has everything to do with whether or not they can do anything with the information provided. If the answer is "no", then they do NOT need glucometers.

 

[Tigger]

Can't pretty much every EMT nationwide at least give oral glucose?