# Glucometers for BLS



## Jon (Feb 13, 2005)

It is pretty obvious that BLS providers could easily be trained to properly use glucometers, so why don't we all have them?????


Jon


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## Chimpie (Feb 13, 2005)

I second that thought.  If you are able to treat you should be able to test.


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## Chimpie (Feb 13, 2005)

Oh, and congratulations for passing me in the number of total posts.   :angry:


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## MMiz (Feb 13, 2005)

Our BLS units no longer have glucometers because of cost.  While the devices are relatively cheap, the strips are expensive.

You also have to remember that ALS is already on scene or 2-3 minutes behind us at the most, and they carry the devices.

I think they're once again a great tool, and would like to see them back on the rig.


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## Jon (Feb 13, 2005)

> _Originally posted by Chimpie_@Feb 13 2005, 05:43 PM
> * Oh, and congratulations for passing me in the number of total posts.   :angry:   *


 I passed you in total number of posts sometime last week.

Oh, and posting a second time after your first like that is a great way to up your count :lol:    

Jon


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## rescuecpt (Feb 13, 2005)

I believe the theory around here is that the glucose test is an "invasive" procedure because you technically draw blood, and BLS does not perform invasive procedures.  On one hand, I don't agree with it, I don't see how it could hurt a patient so why not?  On the other hand, BLS protocols for glucose are based on suspicion of a diabetic emergency and the fact that more sugar won't hurt, while it may help, so why waste time testing, just give it.


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## PArescueEMT (Feb 13, 2005)

yet when we go to a "death Camp" for a diabetic, they tell us what the patient's last sugar was. So if they tell us, what would the harm be in checking with our meter, that we know is correctly callibrated, as opposed to telling the ED staff what the SNF gave us?


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## Jon (Feb 13, 2005)

> _Originally posted by PArescueEMT_@Feb 13 2005, 09:17 PM
> * yet when we go to a "death Camp" for a diabetic, they tell us what the patient's last sugar was. So if they tell us, what would the harm be in checking with our meter, that we know is correctly callibrated, as opposed to telling the ED staff what the SNF gave us? *


 I guess the idea is that we would stick the patient again, and thats mean (even though the ED is going to do it q 2 hours.







ALSO


I must apoligize. I was suffering from cranio-rectal inversion, and after PARESCUE discussed this with me as a topic idea, I jumped quicker and posted it, even though he came up with the idea.
Zak: I'm Sorry, please forgive me
Everyone Else: Sorry to involve you.

Jon


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## shorthairedpunk (Feb 13, 2005)

We have had BLS glucometer protocols in our system for 4 years or so, and its yet another monkey skill with the potential to save a life, once our B's get the glucagon, our diabetics will have a better shot at signing our refusals.


There have been absolutely no problems with B's using these toys. 

I really do think manufacturers need to be shot over the price of these strips, theres no reason for the strips to cost $1.75 a piece and up.


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## Summit (Feb 14, 2005)

All of our rigs have glucometers and it is a basic skill. Our basic IVs have standing D50 orders.


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## Jon (Feb 14, 2005)

> _Originally posted by Summit_@Feb 14 2005, 01:17 AM
> * All of our rigs have glucometers and it is a basic skill. Our basic IVs have standing D50 orders. *


 To only work in your system. where the protocols HAVE progresed since Johnny and Roy.


Jon


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## coloradoemt (Feb 14, 2005)

> _Originally posted by Summit_@Feb 14 2005, 12:17 AM
> * All of our rigs have glucometers and it is a basic skill. Our basic IVs have standing D50 orders. *


 The same with us...


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## Ray1129 (Mar 15, 2005)

> _Originally posted by MedicStudentJon_@Feb 13 2005, 05:31 PM
> * It is pretty obvious that BLS providers could easily be trained to properly use glucometers, so why don't we all have them????? *


  :blink:  Please tell me there are other places out there besides MD where you can use Glucometers.... *is hopeful* ....it comes in quite handy!  Just recently, actually, I had a patient tell me she took the wrong insulin medication, and when I checked her blood sugar I saw that it was 65.  After giving her glucose, calling for a paramedic, and getting her to the ambo(not in that particular order), I rechecked it and got a 45.  This made it really easy for the paramedic to decide what to do based on our 'discovery'.

-Ray


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## Phridae (Mar 15, 2005)

> _Originally posted by Summit_@Feb 14 2005, 01:17 AM
> * All of our rigs have glucometers and it is a basic skill. Our basic IVs have standing D50 orders. *


 Same here.

I don't understand why everyone else cant use a glumometer. A 6 y/o with diabetes can do it, why cant 25 y/o's with hours of training? I fail to see the logic in this.


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## TTLWHKR (Mar 15, 2005)

As a diabetic myself, I feel that pre-hospital treatment of diabetic related emergencies is often delayed b/c there is one piece of very important information missing. In 90% of the dispatched emergencies, the family or patient has not recently checked their blood glucose level; and are just requesting assistance based on the symptoms of either hypo or hyper glycemia. I personally, have never called an ambulance for an emergency related to this. I've found that many providers, however, may wait on the treatment b/c they do not know if the patients symptoms are concurrent with a high or low period, especially unconsciousness. Even someone that is completely out, you can rub a gel form of dextrose on the inside of the lips/gums. It's just too much of a risk to wait, if it's too high, well you don't have anyway to know that unless they can tell you. Many say that "glucose isn't enough" to treat them, I can attest that the little tube may taste like $hit, but it's a life saver. But the availability to test the level may result in better results in prehospital recovery w/out long term effect, vs. just putting them on oxygen and waiting for ALS. Plus, if you know the glucose level when you get to an ALS unit (remember not all areas of the US have a medic nearby) they can jump right in and administer lifesaving meds more quickly. Even an early intervention with glucose. But they would need to be more extensively trained, coming out of unconsciousness from hypoglycemia, as all ems personnel know, is similar to a seizure. Some do not recall the events, they are confused, scared and many are very combative. I've been known to put up a fight :blink:  and then not remember how I got a black eye (or someone else).


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## possum (Apr 10, 2005)

> _Originally posted by MedicStudentJon_@Feb 13 2005, 05:31 PM
> * It is pretty obvious that BLS providers could easily be trained to properly use glucometers, so why don't we all have them?????
> 
> 
> Jon *


 In the state of VA we can do one-touchs and a lot more if your omd will let you.

  possum  375


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## KEVD18 (Apr 14, 2005)

FROM THE COMPANIES POINT OF VIEW:
the devices are the ceap part. then you have to train everybody how to use em, conduct retraining according to protocols, buy the strips, replace the expired ones, buy new meters when the get dropped/lost/run over(its happened).  when the big picture is examined. its a really expensive skill to have. and what more, in my area, where no more than 15 away from a med facility. and if your pt is that bad, who cares if they say there on divert

FROM THE EMT'S POV:
a 6y/o can do this. why not me????? why gamble with a pt's safety and well being to protect your profit margin

FROM A DIABETICS POV:
WHAT?????? YOUR AN EMT AND YOU CANT DO THIS???? WTH???

btw: its an approved basic skill in ma but the services wont pay for the toys/upkeep/training


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## ffemt8978 (Apr 15, 2005)

That's a good explanation of the three different viewpoints involved.

The fourth side of this would be the state/medical director viewpoint.  "EMT-B's are going to poke a hole in the patient, which means it's an invasive procedure.  Do we want to allow this, or should we make it for the intermediate level (since they already poke holes in people)?"


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## KEVD18 (Apr 15, 2005)

see i counter that with the question: "how invasive is a bg stick" i mean we're not talking running a central line here, its a prick on the finger.


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## MMiz (Apr 16, 2005)

Just to add another perspective:

While the glucometers can often be gained for little or no money (really, I see them free after rebate all the time), the strips run about a dollar a strip.  Add the cost of maintenance, replacing lost strips / units, and multiply that by x many units, I can understand them getting expensive.

I still don't believe that's a reason that we shouldn't have them, but it's another perspective.


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## ffemt8978 (Apr 16, 2005)

> _Originally posted by KEVD18_@Apr 15 2005, 07:23 PM
> * see i counter that with the question: "how invasive is a bg stick" i mean we're not talking running a central line here, its a prick on the finger. *


 Have you read the 2nd Draft of the EMS Scope of Practice yet?

They consider it to be invasive, therefore, it will not be a Basic skill.  They also take away combitubes and I believe Epi-Pens away from the basic level.

I'm not saying I agree with this, 'cuz I don't.  As you pointed out, a 6y/o can do a BGM stick.  It makes no sense not to let a basic do them.


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## KEVD18 (Apr 16, 2005)

yeah... i get that its "classafied" as an invasive procedure. but in reality, not so much

you said "they" were taking combitubes and epipens away from basics. who's they?? a state ems board? the nremt?


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## ffemt8978 (Apr 16, 2005)

They as in those that wrote the Scope of Practice.


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## devist8me (Apr 17, 2005)

Our service just last year started allowing EMT's to use the glucometer.  Before that, I think our medical director was thinking along the lines of "its invasive so no" blah blah blah.  The education dept did big research on it and it was finally decided to allow it.  All the EMT's were trained and can now test.

Even though there are a few BLS trucks here, most have atleast one medic on board.  Its nice to have the EMT do the D-stick while I get the line (can't use the blood from the catheter due to the type glucometers we use).  Also, we don't go by the pt readings, even if they just checked it prior to us arriving.  Thinking here is we don't know how accurate their machine is and we test ours at the beginning of every shift.  So, every diabetic gets another stick.


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## KEVD18 (Apr 17, 2005)

"scope of practice" for where? it may be that i'm just unfamiliar with that term. are you speaking of just your service/area/state. or is this a nremt thing? or a dot thing? thanks in advance for clarifying


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## ffemt8978 (Apr 17, 2005)

It's the new proposed scope of practice authored/sponsored by the NHTSA (National Highway Traffic Safety Administration).  My guess is that the NREMT will follow the final Scope of Practice document and modify their standards accordingly.

This in not saying that every state will follow this scope, just like now, where not every state follows the NREMT scope.

It is a proposal to change the national standards of EMS care, with the ironic title of "Freedom Within Limits".  It seems to me that there are more limits than freedoms, and the care provided at the EMT-B level is going to suffer.


Oh yeah, this is my 
1000th
post.  Did I win something?


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## KEVD18 (Apr 17, 2005)

gotcha. thanks for the info. will be looking for the change


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## CodeSurfer (Apr 17, 2005)

> _Originally posted by ffemt8978_@Apr 17 2005, 05:29 PM
> * It's the new proposed scope of practice authored/sponsored by the NHTSA (National Highway Traffic Safety Administration).  My guess is that the NREMT will follow the final Scope of Practice document and modify their standards accordingly.
> 
> This in not saying that every state will follow this scope, just like now, where not every state follows the NREMT scope.
> ...


 Yeah, San Diego protocol allows for combitubes, but only one private company allows BLS to use them.  Protocol also includes activated charcoal for BLS, but none of the ambulances (BLS) here include it. Thats fine about the charcoal though... I've never been fond of black vomit anywhoo.


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## rescuecpt (Apr 17, 2005)

The guy I worked with last night refuses to use combi tubes because one of his pts had a severe allergic reaction to the latex in the cuffs.


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## CodeSurfer (Apr 17, 2005)

> _Originally posted by rescuecpt_@Apr 17 2005, 10:18 PM
> * The guy I worked with last night refuses to use combi tubes because one of his pts had a severe allergic reaction to the latex in the cuffs. *


 Everyone I've ever asked said they've never used it.  Mostly because San Diego has so many medics that people just end up being intubated.  One proctor in my class did say he heard of one being used when the medics couldnt see the chords of a self inflicted GSW to the face...    (he didnt make it even with the combitube... suprise)


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## DFDEMS (Apr 18, 2005)

I was under the impression that within Michigan it was approved but left up to the discretion of the regional medical director? Either way, I think they should be allowed to.


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## MMiz (Apr 18, 2005)

> _Originally posted by DFDEMS_@Apr 18 2005, 12:10 AM
> * I was under the impression that within Michigan it was approved but left up to the discretion of the regional medical director? Either way, I think they should be allowed to. *


 That's correct, it is up to the individual department / company.


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