# Obtaining BGL



## Thriceknight (Jan 14, 2012)

Is obtaining a PT's Blood Glucose Level as an EMT-B in ANYONE'S scope of practice?? ? ? ? ? ? ?:blink:


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## STXmedic (Jan 14, 2012)

I've never seen it not in a basic's scope, but that's down here in Tx.


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## Chris07 (Jan 14, 2012)

Some counties in California allow it via expanded scopes (not many however). I _heard_ that Orange County allows EMTs to check BGL, but I do not know if that is true (I would be quite surprised if they did).


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## JPINFV (Jan 14, 2012)

I believe EMTs in OC are now (well, as of the January 1, 2011) allowed to assist paramedics with obtaining a BGL, not simply do it on their own. 

To the OP, if you're at a health care facility like a nursing home, you can always ask if they can get an updated BGL "for the hospital."


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## DesertMedic66 (Jan 14, 2012)

My county will now(sometime in march) allow EMTs to get a BGL when asked to by a AEMT or medic.


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## medicdan (Jan 14, 2012)

Massachusetts EMTs can, and often DO perform BGL while working BLS and ALS. It's a service option-- requiring a simple signature from one's medical director, a limited lab license, and training for the entire staff.


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## Martyn (Jan 14, 2012)

In Florida we can do BGL


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## Shishkabob (Jan 14, 2012)

Yes, along with syringe drawn episode, duonebs and king tubes. 


Yay Texas, boo crappy states that suck at EMS.


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## rescue1 (Jan 14, 2012)

In Maryland it's an optional by county protocol which we use.


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## fast65 (Jan 14, 2012)

It's in the EMT-B scope of practice here.


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## STXmedic (Jan 14, 2012)

Linuss said:


> Yes, along with syringe drawn episode, duonebs and king tubes.
> 
> 
> Yay Texas, boo crappy states that suck at EMS.



I even know of a few Basics that can perform IVs, IOs, needle decompression, and D50 and Narcan admin in addition to what you stated h34r: Gotta love Texas


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## tylerp1 (Jan 14, 2012)

http://www.idph.state.ia.us/ems/common/pdf/scope_of_practice.pdf

It's allowed here in Iowa, but I heard they were possibly taking it out? Not quite sure, but I did it in the ER..best case scenario? a Basic telling me my unconscious pt's glucose is 28 when I arrive on scene..

..keep dreaming, right? haha jk


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## EMSLaw (Jan 14, 2012)

PoeticInjustice said:


> I even know of a few Basics that can perform IVs, IOs, needle decompression, and D50 and Narcan admin in addition to what you stated h34r: Gotta love Texas



Don't they call those people EMT-Intermediates? 

BGL is outside of the EMT-B scope of practice in NJ at the moment.  The theory is apparently that it wouldn't effect treatment decisions.


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## STXmedic (Jan 14, 2012)

EMSLaw said:


> Don't they call those people EMT-Intermediates?



Might as well, but they still keep their pretty little EMT-B patch


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## Ramis46 (Jan 14, 2012)

Yeah here in Iowa we can, But by 2016.. (14 or 16) we are rescoping the scope of practice, since there are up to like 12 different active lvls in iowa. I really can't understand why they wouldn't let EMT-B to obtain BGL, its a helpful tool, and its not all that invasive.


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## Sourmash (Jan 14, 2012)

In my scope here in Oregon. Had to demonstrate the ability to do so in order to get my reciprocity. Check em daily.


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## Medic Tim (Jan 14, 2012)

in Maine a basic can do it if they have taken the extra training module. In New Brunswick the lowest Provider on any truck is the equivalent to an Intermediate so everyone can do bgl.


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## DownSouthMedic (Jan 14, 2012)

Martyn said:


> In Florida we can do BGL



Yep, do it everyday...although we don't really have much as far as treatment outside of oral glucose or a upgrade to ALS for those extreme cases.


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## Tigger (Jan 14, 2012)

As mentioned it's allowed in Massachusetts, though I had never heard of those additional training requirements. It's a standing order for basics in Colorado, which is where I was first certified.


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## Tigger (Jan 14, 2012)

PoeticInjustice said:


> I even know of a few Basics that can perform IVs, IOs, needle decompression, and D50 and Narcan admin in addition to what you stated h34r: Gotta love Texas



An extra 21 hour class in Colorado and pending medical director approval Basics can start IVs, give fluids, D50, narcan (IV and IN), and first line cardiac drugs under a medic's direction during an arrest. IOs are allowed under a waiver in some areas.


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## EMS123 (Jan 14, 2012)

It is within an EMT-B's scope of practice in NY, with Medical Director approval and training.


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## BloggerMedic51 (Jan 14, 2012)

I've never understood why obtaining a BLG isn't a BLS skill in some places (there area also some states where SpO2 is ALS only). While I get that some things need to be advanced skills, obtaining a BGL and pulse ox aren't among them in my opinion. Lay people can be taught in about a minute how to give a glucagon shot, why not an EMT? Some of the rules we have in EMS are just plain silly.


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## EMT-Tony (Jan 14, 2012)

My service allows it due to a variance course, because because BLS at my service can administrate oral glucose (of course) and Glucagon


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## CBentz12 (Jan 14, 2012)

I dont see why not because its not hard to do it.


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## NYMedic828 (Jan 14, 2012)

EMS123 said:


> It is within an EMT-B's scope of practice in NY, with Medical Director approval and training.



This.

NY State has put it into the scope of practice for EMTs, but it is only useable if the agency medical director approves of it and the agency provides formal training to their providers.

In New York City, they have not yet adopted glucometry for BLS. I wish they would, because all too often I get called as a backup for an "AMS" only to show up and rule out CVA because the BLS crew thought they may be a diabetic. This could hinder the transport of a critical CVA by 10-20 minutes.


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## 18G (Jan 15, 2012)

Glucometer use is not allowed by Basic's in Pennsylvania.


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## EMS123 (Jan 15, 2012)

For all the states that dont allow basics to do BGL is just one more reason for a basic to work hard and move up the EMS ladder towards Paramedic.


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## NYMedic828 (Jan 15, 2012)

EMS123 said:


> For all the states that dont allow basics to do BGL is just one more reason for a basic to work hard and move up the EMS ladder towards Paramedic.



Honestly, I always found it absolutely insulting to EMTs that they are not permitted to perform a skill that is expected of a 90 year old woman to do on her on 3 times a day.

A monkey humping a football could work a glucometer, and there really is no safety issue with the lancets, it is impossible to stick a patient and yourself with a one time use disposable lancet, and if someone were to stick themself by mistake, its a clean needle.

Like i said above, I have had many a stroke patient in my short time as a medic that could have had 20 minutes shaved off their transport time had the BLS crew had use of a glucometer.


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## Dwindlin (Jan 15, 2012)

Indiana no.  Ohio yes.


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## Fish (Jan 16, 2012)

Thriceknight said:


> Is obtaining a PT's Blood Glucose Level as an EMT-B in ANYONE'S scope of practice?? ? ? ? ? ? ?:blink:



Common Basics scope across Texas:

o2
AED
Asprin
Albuterol
Syringe drawn EPI injected IM/SQ or EPI(If they have that instead)
Oral Glucose
Check BGL
King Airway
Nitro

All these can be given by basics, and are usually standing orders


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## rmabrey (Jan 16, 2012)

BloggerMedic51 said:


> I've never understood why obtaining a BLG isn't a BLS skill in some places (there area also some states where SpO2 is ALS only). While I get that some things need to be advanced skills, obtaining a BGL and pulse ox aren't among them in my opinion. Lay people can be taught in about a minute how to give a glucagon shot, why not an EMT? Some of the rules we have in EMS are just plain silly.



Can't do BGL or SPo2 here. Apparently I'm smart enough to tell the difference between pink and blue, but not read a number. 

Sent from my Desire HD using Tapatalk


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## R99 (Jan 16, 2012)

Here's what our emergency medical technician can do

Oxygen
OPA, NPA, LMA, PEEP
CAT
12 lead ECG
Aspirin
GTN
Oral glucose
Glucagon
Salbutamol
Ipatropium
Entonox
Methoxyflurane (where used)
Paracetamol
Ondansetron
Loratadine
Adrenaline


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## NYMedic828 (Jan 16, 2012)

R99 said:


> Here's what our emergency medical technician can do
> 
> Oxygen
> OPA, NPA, LMA, PEEP
> ...



Where is this? That is an absolutely unreal scope for an EMT compared to the rest of the US.

They can do a 12 lead, but no 3 lead? I imagine it is 100% machine interpreted then.


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## NomadicMedic (Jan 16, 2012)

NYMedic828 said:


> Where is this? That is an absolutely unreal scope for an EMT compared to the rest of the US.
> 
> They can do a 12 lead, but no 3 lead? I imagine it is 100% machine interpreted then.



New Zealand. Nothing like this exists for basics in the US.


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## the_negro_puppy (Jan 16, 2012)

NYMedic828 said:


> Where is this? That is an absolutely unreal scope for an EMT compared to the rest of the US.
> 
> They can do a 12 lead, but no 3 lead? I imagine it is 100% machine interpreted then.



In countries like Aus and NZ we don't really have a  EMT-Basic level.


Our  standard paramedic level is a mix between your EMT-I and Paramedic, with our Intensive Care Paramedics have a broader range of skills inclduing intubation, cardioversion, TCP, ketamine, amiodarone, magnesium, sodium bic etc. 

The standard paramedic level here by the end of the year should be:

OPA/NPA/LMA
IVs
Glucagon/10% Glucose/Glucose Gel
Sodium Chloride 0.9%
Morphine
Methoxyflurane
Tylenol
Adrenaline (epi)
Midazolam (versed)
Ceftraixone (anti-biotic for meningicoccal disease)
Ventolin/Atrpvent
Metoclopromide/Ondansetron
Vitamin B12 for Cyanide poisoning
Magnesium Sulfate for envenomation only
Aspirin/Nitro
12 lead ECG / Defib
EtC02
Needle chest decompression on consult


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## Fish (Jan 16, 2012)

NYMedic828 said:


> Where is this? That is an absolutely unreal scope for an EMT compared to the rest of the US.
> 
> They can do a 12 lead, but no 3 lead? I imagine it is 100% machine interpreted then.



I am sure it is just them assisting the Medic with a 12-Lead, or putting it on for them and then letting them interpret


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## Fish (Jan 16, 2012)

n7lxi said:


> New Zealand. Nothing like this exists for basics in the US.



Oh, oops. I mispoke


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## EMTGoose (Jan 16, 2012)

Thriceknight said:


> Is obtaining a PT's Blood Glucose Level as an EMT-B in ANYONE'S scope of practice?? ? ? ? ? ? ?:blink:


it is within the EMT-B's scope of practice here in the great state of Oregon


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## truetiger (Jan 17, 2012)

EMT-B's can check BGL's here in Missouri


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## HMartinho (Jan 17, 2012)

In Portugal, EMT-B's and certified first responders can check BGL's.


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## frdude1000 (Jan 17, 2012)

In Maryland, EMT-B's cannot check a BGL.


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## HMartinho (Jan 18, 2012)

Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:

Anyway, how can you detect hypoglycemia without getting the BGL?

Sorry to say but this is ridiculous...h34r:


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## adamjh3 (Jan 18, 2012)

HMartinho said:


> Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:
> 
> Anyway, how can you detect hypoglycemia without getting the BGL?
> 
> Sorry to say but this is ridiculous...h34r:



Its considered an invasive procedure and is thus prohibited in many areas. 

It doesn't make sense but that's how it is. 

Sent from my DROID X2 using Tapatalk


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## jjesusfreak01 (Jan 18, 2012)

adamjh3 said:


> Its considered an invasive procedure and is thus prohibited in many areas.
> 
> It doesn't make sense but that's how it is.
> 
> Sent from my DROID X2 using Tapatalk



We stuck each other in my high school science class to do blood typing...


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## adamjh3 (Jan 18, 2012)

jjesusfreak01 said:


> We stuck each other in my high school science class to do blood typing...



As did I. I've also stuck my mom when she was AMS due to being hypoglycemic. 

Sent from my DROID X2 using Tapatalk


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## Lurch (Jan 24, 2012)

As noted above, in PA we may not check BGL.  Our EMT instructer unloaded on another student when during practice sessions he would ask a diabetic patient if he would check BGL.  The instructor said administering glucose to someone hypoglycemic may save them, and giving it to someone with a BGL of 200 won't make any real difference. 

Our protocols state to give all suspected diabetic episodes glucose if they can protect their own airway thus no need to check BGL per our protocol.


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## JPINFV (Jan 24, 2012)

Lurch said:


> As noted above, in PA we may not check BGL.  Our EMT instructer unloaded on another student when during practice sessions he would ask a diabetic patient if he would check BGL.  The instructor said administering glucose to someone hypoglycemic may save them, and giving it to someone with a BGL of 200 won't make any real difference.
> 
> Our protocols state to give all suspected diabetic episodes glucose if they can protect their own airway thus no need to check BGL per our protocol.




...because ruling out a differential diagnosis for such things like CVA isn't important. After all, the altered patient with a history of diabetes MUST, MUST MUST, be hypoglycemic, right?


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## Lurch (Jan 24, 2012)

I didn't write the state protocol, just presenting it for a point of reference.  

A suspected stroke would obviously be treated differently than a diabetic episode.  That said, what harm could come of giving a conscious stroke patient that can protect his airway glucose?  I am not trying to be difficult, but am curious as I am not yet an EMT but a student taking the state exam this weekend realizing that I still have a lot to learn.


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## JPINFV (Jan 24, 2012)

Lurch said:


> That said, what harm could come of giving a conscious stroke patient that can protect his airway glucose?  I am not trying to be difficult, but am curious as I am not yet an EMT but a student taking the state exam this weekend realizing that I still have a lot to learn.




First things first, if you haven't taken the exam yet, be a little careful learning from forum topics like this. For multiple reasons, most importantly being the difference between the difference on a cognitive level between real life and the exam, a lot of topics could be considered "wrong" by a testing standard, but "right" from an appropriate level of care standard. EMT-B exams assume you can't think. A lot of what goes on in the clinical threads is, arguably, well beyond the minimum standard for EMS providers, but especially so at the EMT level because it requires that the provider thinks instead of mindlessly saying, "but it doesn't hurt, so..." (and... yes... it isn't your fault). 

Ok, that out of the way, yes giving oral glucose to a patient with an unknown BGL is appropriate and essentially harmless in the grand scheme of things if the patient is ultimately not hypoglycemic. However, if you can determine the blood glucose level, then why administer something that you now know is ultimately not indicated? The protocols that say to administer oral glucose to all altered patients is based off of being ignorant of the BGL. I say, why be ignorant of the BGL if you don't have to be?


Next, does your state/area have dedicated neuro centers like trauma centers or cath labs? Hypoglycemia can present with stroke like symptoms to the point that it's a rule out category on at least one stroke scale (the Los Angeles Prehospital Stroke Screen). As such, and assuming no other indication for paramedics, being able to rule out hypoglycemia vs stroke allows me to make the argument that having paramedics ultimately provides little additional benefit (again, assuming no other indication or need for paramedics) and allows you to bypass the closest hospital in favor for a specialty center if your system recognizes them.


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## technocardy (Jan 26, 2012)

HMartinho said:


> *Someone can explain me why some EMT-B's can not verify the BGL?* They are afraid that the patient bleed to death? :unsure:
> 
> Anyway, how can you detect hypoglycemia without getting the BGL?
> 
> Sorry to say but this is ridiculous...h34r:



I guess the rational in not allowing EMT-B's to check a BGL is that regardless of the result, it wont effect the treatment they can provide. Hyper/hypo it wont make a difference. I don't know if EMT-B's can give oral glucose to a pt or not, but in the prehospital setting if you give some oral glucose to a pt who is hyperglycemic it wont make too much of a difference, however if they are hypo and you give the pt glucose then it will help improve the pt's condition. So either way you don't need to know? I dunno.. I don't necessarily agree with it, but that's what I came up with.

I'm just assuming that's the rational because EMRs in Alberta can take a BGL.


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## Flightorbust (Jan 26, 2012)

Tigger said:


> An extra 21 hour class in Colorado and pending medical director approval Basics can start IVs, give fluids, D50, narcan (IV and IN), and first line cardiac drugs under a medic's direction during an arrest. IOs are allowed under a waiver in some areas.



the class tigger is talking about is the IV class. Its my understanding that they have changed it to where a basic w/o IV can now get a BGL as well as it has become a NREMT skill. Once a Basic has their IV they can give IVs, D50 and narcan. The more ALS stuff a basic can do under direction of a Medic because of Rule 20 (I think its 20).


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## DrParasite (Jan 26, 2012)

HMartinho said:


> Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:
> 
> Anyway, how can you detect hypoglycemia without getting the BGL?
> 
> Sorry to say but this is ridiculous...h34r:


I believe there are two reasons for this.  The first is that checking a BGL is considered invasive (as you are puncturing intact skin), and EMTs are not permitted to do invasive procedures.

the other reason is assuming you find the person to be unconscious or not alert and possibly hypoglycemic, and you check the BGL and find it low, what can you do?  you can't administer any IV sugar.  if the person is alert, and a diabetic, they should be able to check their own BGL.

at least that was what I was told when I asked.  I think if a 12 year old can check his family's BGL, than an EMT should be trained in how to do it as well.  but that's just my 2 cents.


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## Underoath87 (Jan 28, 2012)

I'm supposed to take a BGL on every pt I bring to the ER (working IFT in Florida).


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## HMartinho (Jan 28, 2012)

DrParasite said:


> I believe there are two reasons for this.  The first is that checking a BGL is considered invasive (as you are puncturing intact skin), and EMTs are not permitted to do invasive procedures.
> 
> the other reason is assuming you find the person to be unconscious or not alert and possibly hypoglycemic, and you check the BGL and find it low, what can you do?  you can't administer any IV sugar.  if the person is alert, and a diabetic, they should be able to check their own BGL.
> 
> at least that was what I was told when I asked.  I think if a 12 year old can check his family's BGL, than an EMT should be trained in how to do it as well.  but that's just my 2 cents.



Sure, we can not give IV glucose and unfortunately in Portugal we do not use glucose gel. However, as say our protocols, and as I learned in the various courses that I attended, we can give a pope of sugar (sorry but do not know the English term). We put 16 to 24 mg of sugar in a cup, 3 ml of water, and make a thick and concentrated pope of sugar, which is placed inside the cheeks, or under the tongue, which will be absorbed into the bloodstream.


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## bushinspector (Jan 28, 2012)

Interesting thread. In Oklahoma you are allowed to check. In addition to this I been thinking about getting our medical director to be able to transport Pt with a class 5 drug.


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## ethomas4 (Jan 30, 2012)

I dont like to be rude online, but CA has got to change their protocols. For some reason in this state when you become an EMT you actually become a certified RETARD. The state needs to demand more out of their EMTs, if that requires more training, class, practice, weeding people out etc so be it, that is actually a GOOD thing!!


The only place where I have been able to check a blood sugar in CA was when I was working in an elementary school and the principal asked me check it on a 2nd grader twice a day. Ironic.

EMT B in CA is a joke. I have had the pleasure of working as EMT I and P in other countries and since we love to boast about how awesome we are here I love to educate people on how dumb we really are in EMS. I worked 8 months in MExico.  Most Mexican EMS personnel put usa EMT Bs and Is to shame...unfortunately they lack money.


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## JPINFV (Jan 30, 2012)

California doesn't have a statewide protocol.


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## Akulahawk (Jan 30, 2012)

JPINFV said:


> California doesn't have a statewide protocol.


They have something more like a state-wide menu of skills that the Local EMS agencies can pick from... and those agencies get to set the protocols for their system. I don't think I've heard of the State EMS Authority rejecting a LEMSA EMT-1 Protocol, as long as it's within the typical EMT-1 scope or a specific trial study.

Actually, it's the same way with Paramedics too...


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## JPINFV (Jan 30, 2012)

"Statewide menu of skills"? I like the way that sounds.


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## SeanEddy (Jan 30, 2012)

The service I work for allows EMT-Basics to check a BG. They can also administer oral glucose to correct the problem, assuming no contraindications for PO medications exists. 

Having worked in California for most of my career, I can feel your pain.


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## SeanEddy (Jan 30, 2012)

JPINFV said:


> California doesn't have a statewide protocol.



Your right, they don't have a "statewide protocol" per-se, but they DO have a minimum and maximum scope of practice. The county medical directors essentially have a list of skills and medications to choose from. Anything outside of that can't be added without doing an approved study to prove the benefit and necessity. 

The county I worked in fought tirelessly for years to get stuff added. It's a horrible system with way too much red-tape and politics to get through.


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## Monkadelic (Mar 8, 2012)

It's out of scope of practice here in NE MS- a lot of things are :sad: Also MS decided to nerf AEMT because the board believed it takes away from the paramedic- ie. everyone will hire AEMTs instead so they can pay them less... etc.  You gotta go to TN for an advanced certification- that is the closest place I seen to us.  I can't understand why they don't go to a national scope of practice since you have to know everything for registry anyways, but can only do half the things you are taught varied by the area you are in... I just don't get that train of thought by the higher ups.  Can anyone enlighten me more on that? Power struggles vs control nuts? etc?


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## Handsome Robb (Mar 8, 2012)

Monkadelic said:


> It's out of scope of practice here in NE MS- a lot of things are :sad: Also MS decided to nerf AEMT because the board believed it takes away from the paramedic- ie. everyone will hire AEMTs instead so they can pay them less... etc.  You gotta go to TN for an advanced certification- that is the closest place I seen to us.  I can't understand why they don't go to a national scope of practice since you have to know everything for registry anyways, but can only do half the things you are taught varied by the area you are in... I just don't get that train of thought by the higher ups.  Can anyone enlighten me more on that? Power struggles vs control nuts? etc?



Catering to the lowest common denominator. 

Why do you think many places in CA still make medics call for orders all the time?

Also having state/county departments governing EMS generates income for that state or county.


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## Monkadelic (Mar 8, 2012)

NVRob said:


> Catering to the lowest common denominator.
> 
> Why do you think many places in CA still make medics call for orders all the time?
> 
> Also having state/county departments governing EMS generates income for that state or county.



yeah that sounds about right to me.... but it's still ridiculous imo.  a person schooled and trained in interventions and emergencies is considered lower in standards than the person that has not been trained to do the simple things themselves to prevent a call to EMS.  Seems like a catch-22 in all reality- ie... you HAVE to know this; but you CANT do it! lol April fools! here's your certificate! via con dios!


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## BearChicago (Mar 16, 2012)

We use them in IL. Very handy. I'll do it as indicated, and on every almost every run going to the ED as well, because 99% of the time the hospital will ask for one.


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## Christopher (Mar 18, 2012)

I can't understand how POC blood glucose measurement is not the Standard of Care. It's at the medical responder level in NC.

If I were an enterprising lawyer I'd sue


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## Anjel (Mar 18, 2012)

Just thought I would throw Michigan into the places EMTs can do BGLs.

We have three glucometers in our truck at the moment.


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## emt_irl (Mar 18, 2012)

in ireland emt's can do bgl but we can use oral glucose and glucogon i.m to do something about a low bgl reading


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## oshawamedic (Mar 23, 2012)

in ontario we do


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## bstogner (Mar 30, 2012)

Our medical control allows it.  They actually advise us to do it on any pt we deem necessary.


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## jjesusfreak01 (Mar 31, 2012)

emt_irl said:


> in ireland emt's can do bgl but we can use oral glucose and glucogon i.m to do something about a low bgl reading



And while at first glance, it would appear reckless to allow EMTs to do Glucagon injections, hypoglycemia (usually) doesn't fix itself and can progress to badness quickly, while BGLs and IM injections are actually quite easy to do.


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## Medico (Apr 1, 2012)

In a VA EMT-B can check BGL as well as administer SL nitro for chest pain, obtain 12-lead, put pt on cpap, place king or LMA, and administer duo nebs.


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## Talonrazor (Apr 2, 2012)

Here at my agency, BGLs are part of our vitals and are taken on every patient by my EMT-Bs and EMRs.


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## NomadicMedic (Apr 2, 2012)

Talonrazor said:


> Here at my agency, BGLs are part of our vitals and are taken on every patient by my EMT-Bs and EMRs.



Every patient? Seems kind of pointless to me. I only take them when indicated.


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## Talonrazor (Apr 2, 2012)

n7lxi said:


> Every patient? Seems kind of pointless to me. I only take them when indicated.



Has to do with our population. We are a public inebriation enforcement agency. Our units pick-up any public inebriate or intoxication due to drugs and transfer them to our detention facility, where they stay for 12 hours. Due to this, we deal with a huge amount of "street folks". And almost all of them have diabetic issues due to lifestyle. Every patient we deal with is "AMS". So we have to rule out AMS due to other issues than ETOH. BGLs, narcotics, HEENT etc.

Every time the FD pulls up to perform ALS transfer to a hospital, they ask for BGLs.


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## emt_irl (Apr 2, 2012)

jjesusfreak01 said:


> And while at first glance, it would appear reckless to allow EMTs to do Glucagon injections, hypoglycemia (usually) doesn't fix itself and can progress to badness quickly, while BGLs and IM injections are actually quite easy to do.


well we wouldnt treat and discharge. they'd get it while waiting for als or on the way to the ed thankfully. i dont think id like to rely soley on the process of  glycogeniosis if i were a diabetic.

we'd usually check bgl in all unresonpsive patients, all patients who werent gcs15 and post seziure patients.


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## NomadicMedic (Apr 2, 2012)

Talonrazor said:


> Has to do with our population. We are a public inebriation enforcement agency. Our units pick-up any public inebriate or intoxication due to drugs and transfer them to our detention facility, where they stay for 12 hours. Due to this, we deal with a huge amount of "street folks". And almost all of them have diabetic issues due to lifestyle. Every patient we deal with is "AMS". So we have to rule out AMS due to other issues than ETOH. BGLs, narcotics, HEENT etc.
> 
> Every time the FD pulls up to perform ALS transfer to a hospital, they ask for BGLs.



Well, that certainly makes good sense. I was under the impression you were just finger sticking everybody.


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## EMSANTHEM (Apr 2, 2012)

*In CT it's no big deal*

glucometer readings are done by emt-b's here all the time on BLS and ALS calls you don't have to have a medic present or sign anything if you have a emt card you do it just of course have all your region classes completed


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## Altered Mental Status (Apr 9, 2012)

In Alabama it is. BGL is considered part of V/S.


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## Bullets (Apr 10, 2012)

there are 2 reasons we cant check BGL in NJ, and they are totally different


1.) If the patient is unresponsive, then i can check their BGL and maybe rule out a CVA, but otherwise my treatment does not change. If the patient is responsive then they can check their own BGL and i can treat with oral glucose.

2.) If EMTs are allowed to check BGLs, we can effectivley rule in/out a CVA. Now i "need" medics for any altered or unresponsive patient. If i can check their BGL and they are hyPOglycemic, then i need ALS, if the are normal then i can rule in a stroke, and i technically dont need ALS, just a hospital. EMTs could effectively cut their ALS requests significantly

NJ is still largely served by volunteers, so even though a patient may be transported in a BLS truck, the ALS service is the only one who is billing, so they get the money. If BLS can check BGL and thus cut down on ALS requests, then ALS loses money, and the ALS projects simply wont allow that

ALS is far more organized then BLS in this state


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## subliminal1284 (Apr 10, 2012)

In Wisconsin checking BGL is part of our normal assessment we can also administer glucagon via IM injection as an EMT B


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## Vivian (Apr 14, 2012)

I am an EMT-B in Maryland, in the western half of the state I can get BGLs, in the eastern half I cannot. I don't know of any other policies that change depending on where you are in the state, but at least in Western Maryland I can do it and do it often.


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## EMSSam (Apr 21, 2012)

By obtaining a BGL, you simply mean to lance the finger and draw blood onto the strip in a BGL device, right?

I only ask this because that seems far to simple a skill not to be allowed to be done by EMTs. I'm a student and on my first on-road shift with the ambulance as part of my university course I was already doing BGLs.


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## DesertMedic66 (Apr 21, 2012)

Yeah that's what they mean. The general rule it seems is "don't give EMTs any kind of object that can poke the patient" :glare:


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## Anthony7994 (Apr 21, 2012)

I had no idea that obtaining a BGL was NOT allowed to be done by all basics? It's pretty simple and, as many stated, not invasive at all. Just another essential assessment tool.


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## DesertMedic66 (Apr 21, 2012)

Anthony7994 said:


> I had no idea that obtaining a BGL was NOT allowed to be done by all basics? It's pretty simple and, as many stated, not invasive at all. Just another essential assessment tool.



It is allowed to be done by basics in different areas. My protocols changed this month now allowing basics to get BGLs.


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## 94H (Apr 21, 2012)

firefite said:


> Yeah that's what they mean. The general rule it seems is "don't give EMTs any kind of object that can poke the patient" :glare:



Except Epi-Pens!


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## DesertMedic66 (Apr 21, 2012)

94H said:


> Except Epi-Pens!



But EMTs (at least in my area) we can only assist the patient.


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## jjesusfreak01 (Apr 22, 2012)

My patient on a BLS IFT transport went hypoglycemic enroute the other day. I noticed the change in mental status, checked BGL (was 35), and had my paramedic partner pull the truck over so we could fix it. We ended up getting permission from the SNF to continue transport of our now stable patient, and all was well.

As an IFT agency, we transport maybe 20% diabetic patients, and it would be irresponsible for us NOT to have capability to check BGL.


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## preggoeggo (Apr 30, 2012)

In NC it's a basic skill. Although in my county, you have to pass expanded scope boards in order to obtain BGL. So...the state says I can, the county says I can't. (Less further testing) I guess they think we're going to poke our pt's in the eye? I can't figure it out.


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## pghboy2011 (May 4, 2012)

Thriceknight said:


> Is obtaining a PT's Blood Glucose Level as an EMT-B in ANYONE'S scope of practice?? ? ? ? ? ? ?:blink:



Yeah, that's one of those silly rules that seems to be pretty standard...I mean...if you cause someone harm by checking a BGL, you've royally screwed up, and don't deserve your cert...:rofl:


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## Christopher (May 4, 2012)

preggoeggo said:


> In NC it's a basic skill. Although in my county, you have to pass expanded scope boards in order to obtain BGL. So...the state says I can, the county says I can't. (Less further testing) I guess they think we're going to poke our pt's in the eye? I can't figure it out.



Actually, in NC it is a Medical Responder skill (Procedure 25 - Blood Glucose Analysis; MR thru EMT-P)...so are EpiPens.


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## pghboy2011 (May 4, 2012)

Christopher said:


> Actually, in NC it is a Medical Responder skill (Procedure 25 - Blood Glucose Analysis; MR thru EMT-P)...so are EpiPens.



I'm not from NC, what exactly is a Medical Responder? Is that similar to a First Responder that will go in, and just sustain until a transporting unit can arrive?


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## Christopher (May 4, 2012)

pghboy2011 said:


> I'm not from NC, what exactly is a Medical Responder? Is that similar to a First Responder that will go in, and just sustain until a transporting unit can arrive?



The nomenclature is likely interchangeable with "first responder," excepting the fact that it is a recognized certification. It is an 80 hour class covering the bare minimum to provide medical care in the State. CPR/AED, splinting, first aid, immobilization/extrication, BGL, EpiPens, decon; you get the idea.

At least in my area they're not really found anymore as most of the first responder agencies (read: fire departments) have gone EMT-B minimum. This is because our county's medical director placed the minimum at EMT-B. Further, these EMT-B's are practicing at the full NC scope (BIADs, nasal narcan, etc).


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## EpiEMS (May 5, 2012)

North Carolina sounds like a veritable EMS paradise!

I'd love to be able to take BGLs when I'm running without a medic. Technically, even with a medic, I'm not 'supposed to,' but they all expect it to get done, so who am I to say no (especially considering how easy it is to get)?


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## Sandog (May 5, 2012)

EpiEMS said:


> North Carolina sounds like a veritable EMS paradise!
> 
> I'd love to be able to take BGLs when I'm running without a medic. Technically, even with a medic, I'm not 'supposed to,' but they all expect it to get done, so who am I to say no (especially considering how easy it is to get)?



Working out of your scope is what says no? Eh?


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## heatherabel3 (May 29, 2012)

I know this is an old post but I am cracking up. I knew going into this that as an EMT-B I would be limited on what I could and could not do in the way of patient care but seriously..a BGL? I just, like seriously 5 minutes ago, checked my kids sugar, it was low, gave him 2 glucose tabs, rechecked in 10, was fine, gave him some protein and sent him on his way and I had all of 8 hours of "Diabetes education" at the hospital. 

And as far as giving glucose if their sugar is in the normal range isn't going to hurt anything. In the grand scheme of things your right but have you ever asked a Diabetic how they feel when their sugar goes up over 200 units in 10 minutes? Like crap, that's how. My son regularly gets off the bus with an awful stomach ache, headache, and begging for insulin because if the bus driver even thinks there is a chance he could be low she will give him a juice box. You are actually causing the patient more discomfort by giving the glucose if they don't need it than you would be by doing the 1/2 a second finger prick.


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## JPINFV (May 29, 2012)

heatherabel3 said:


> And as far as giving glucose if their sugar is in the normal range isn't going to hurt anything. In the grand scheme of things your right but have you ever asked a Diabetic how they feel when their sugar goes up over 200 units in 10 minutes? Like crap, that's how. My son regularly gets off the bus with an awful stomach ache, headache, and begging for insulin because if the bus driver even thinks there is a chance he could be low she will give him a juice box. You are actually causing the patient more discomfort by giving the glucose if they don't need it than you would be by doing the 1/2 a second finger prick.



In a situation where an EMT would give oral glucose to a known diabetic with an unknow BGL, "feeling like crap" is honestly going to be the least of the patient's symptoms.


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## Brandon O (May 30, 2012)

pghboy2011 said:


> Yeah, that's one of those silly rules that seems to be pretty standard...I mean...if you cause someone harm by checking a BGL, you've royally screwed up, and don't deserve your cert...:rofl:



Not sure if it counts, but I stuck myself with a lancet. Twice in one day.

Thought about having myself admitted for a CT. Or a psych workup...


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