# Blood Glucose Checks



## ajax (Apr 26, 2010)

Here in MA, protocol says: "Use of electronic glucose measuring devices by EMT Basic and Intermediate personnel is considered to be an Optional Skill when the EMT B or I is working under the supervision of a Paramedic in the P-B or P-I staffing configuration. EMT Basic personnel may also be trained in the use of a glucometer at the solo Basic level as a service option."

Can Basics in your state check glucose levels?


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## JPINFV (Apr 26, 2010)

In California, with the right "Optional Skills Package" they can.


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## Pneumothorax (Apr 26, 2010)

its part of our regions protocols..


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## TransportJockey (Apr 26, 2010)

Any basic in NM can do it. And I believe any basic in CO can do it


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## 8jimi8 (Apr 26, 2010)

tx yes.


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## Incyder38 (Apr 26, 2010)

JPINFV said:


> In California, with the right "Optional Skills Package" they can.



Just curious what county you work in?


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## Shishkabob (Apr 26, 2010)

As 8jimi said, yes, EMTs can check BGL in the state of Texas, and it's expected that a new basic be able to (In my area)


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## JPINFV (Apr 26, 2010)

Incyder38 said:


> Just curious what county you work in?



I worked in Orange County from 2005-2007, however Orange County did not have that package when I worked there. It does look like they're adding it with the new EMT accreditation program though.

Edit to include:

http://www.emsa.ca.gov/laws/files/reg2.pdf

Page 16, starting with line 9 if you're curious as to where I know about the "optional skills package."


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## Incyder38 (Apr 26, 2010)

JPINFV said:


> I worked in Orange County from 2005-2007, however Orange County did not have that package when I worked there. It does look like they're adding it with the new EMT accreditation program though.
> 
> Edit to include:
> 
> ...



Affirm dude, thanks!


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## nomofica (Apr 26, 2010)

Up in Canada, it's in the scope of practice for EMRs (equivalent to EMT-B) to check BGL. Most EMS companies that hire EMRs will allow them to operate in their full scope.


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## MrBrown (Apr 26, 2010)

Our Ambulance Technician (somewhere between EMT B and EMT I) can check a BGL and give IM Glucagon.

Even our trainee Technicians working as an Ambulance Assistant can check a BGL.


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## Tincanfireman (Apr 26, 2010)

Depends on your MCO and the service.  In some services down here in the South, Basics can't do any "invasive skill", including BGL's.  If you work for a service whose MCO is a little more liberal, BGL's are permitted.  IMHO, there's no reason under the heavens why a Basic can't do a BGL when a patient's 7 year old granddaughter can...


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## emt_irl (Apr 27, 2010)

nationally emt's in ireland can check bgl


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## MRE (Apr 27, 2010)

My service does BGL checks at the basic level without any oversight.  So there is at least one rural town service doing it in MA.


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## MrBrown (Apr 27, 2010)

So why the problem with EMTs checking a BGL?


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## abuan (Apr 27, 2010)

basics in hawaii can when working under a paramedic similar to your set up. but if on a BLS rig, then no.


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## medicdan (Apr 27, 2010)

MrBrown said:


> So why the problem with EMTs checking a BGL?


The criticisms in the US tend to be that it's an invasive skill (poking the finger), and requires some semblance of aseptic technique, it will cloud the decision making of the EMT, or delay on-scene assessment unnecessarily. 
Perhaps the most important criticism is that ultimately, EMTs have few resources to correct BGL findings. Many, if not all BLS trucks carry oral glucose, but if a patient is hyperglycemic or unable to maintain their own airway, there is nothing the crew can do.


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## xgpt (Apr 27, 2010)

I'm just a student doing ride-alongs and I've taken it on 3 different patients...

gloves, open bandaid/2x2/alcohol set aside, swab finger, gauze away alcohol (messes with the reading), poke with a safety needle, bleed, test, bandaid, dispose of all wrappings in a glove.

How hard is that? 

I live in Virginia.

Also...we CAN do something if they are hyperglycemic and mostly functional, if we get a stupid diabetic with a high glucose, we can ask med control if we should ask the diabetic to self-administer insulin.

If they are hypo, we give them some glucose.

Why is p r i ck censored on this forum? That's a little overzealous no?


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## JPINFV (Apr 27, 2010)

xgpt said:


> Why is p r i ck censored on this forum? That's a little overzealous no?



It's one of those two way words. It's ok to ____ your finger... just don't finger your _____.

/channeling George Carlin.


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## xgpt (Apr 27, 2010)

JPINFV said:


> It's one of those two way words. It's ok to ____ your finger... just don't finger your _____.
> 
> /channeling George Carlin.



I guess...

I just think :censored::censored::censored::censored::censored: is used on this forum more often when needles are involved...


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## JPINFV (Apr 27, 2010)

If anyone isn't getting the Carlin reference, do yourself a favor and google "7 dirty words." Beforwarned, foul language used...


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## xgpt (Apr 27, 2010)

Yeah...I do...

Wiki lists them...

:censored::censored::censored::censored::censored: isn't one of them


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## JPINFV (Apr 27, 2010)

It's a part of his skit where he talks about the 2 way words. Like balls. It's ok to say, "Roberto Clametti has 2 balls on him.", but you can't say "I think he hurt his balls on that play."


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## mcdonl (Apr 27, 2010)

*Maine*

In Maine, the basic can use the glucometer but must call for ALS... common practice is to cancel ALS if the reading is normal or slightly off and oral glucose brings a hypoglycemic patient back to normal readings and signs/symptoms return to normal.

The only times I have had the chance to do it is on clinical ride times, where I had a medic with my anyway


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## xgpt (Apr 27, 2010)

mcdonl said:


> In Maine, the basic can use the glucometer but must call for ALS... common practice is to cancel ALS if the reading is normal or slightly off and oral glucose brings a hypoglycemic patient back to normal readings and signs/symptoms return to normal.
> 
> The only times I have had the chance to do it is on clinical ride times, where I had a medic with my anyway



That seems backwards...shouldn't you check the reading _before_ calling ALS?


What's the normal response time in your area for ALS backup? Is it really long or something?


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## mcdonl (Apr 27, 2010)

xgpt said:


> That seems backwards...shouldn't you check the reading _before_ calling ALS?



That was what I said...  but... no such luck.




xgpt said:


> What's the normal response time in your area for ALS backup? Is it really long or something?



XG... in my small town (4000 people....) we have one or two medic's that work perdiem one or two days a week, the rest of the time they are full time in the cities we are about 30 minutes from. 

Our average response time looks like this:

Call comes in = t
Ambulance Leaves = t+8-10 minutes
On Scene = t+12-15 minutes

So, like I said.. if one of our ALS providers are in town, and respond we generally just have a basic as a driver but if they are not around we have to call for mutual aid from the neighboring town to our East, and they are roughly 10 minutes away on a good day, with perfect conditions and they also are limited so if we can minimize the amount of time they spend in our town just because we want to rule out a blood sugar problem we do.

I hope that all made sense.


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## alphatrauma (Apr 27, 2010)

xgpt said:


> What's the normal response time in your area for ALS backup? Is it really long or something?



In my area (as if you were actually talking to me)... zero. There are no BLS units. Medic/Basic on all calls, unless the planets align and you have Medic/Medic.

And to the original question, Yes. Basics can perform BGL checks


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## CAOX3 (Apr 27, 2010)

I hold certifications in two states, we can check BGL in both, one we can use oral glucose and glucagon the other just oral glucose.


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## xgpt (Apr 27, 2010)

mcdonl said:


> That was what I said...  but... no such luck.
> 
> 
> 
> ...



It takes you 10 minutes to get out the door? Wow...we've aim for <1min. before we're rolling.


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## JPINFV (Apr 27, 2010)

Given the size, it's possible that it's a volunteer service that doesn't have a station crew. Call comes in, pagers go off, providers respond to the station, and then respond in the ambulance to the call. However, yea... in general I can't see a reason for a 5-10 minute delay between alert and response response (maybe if someone was taking a shower or taking a poop when the response came in...).


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## lightsandsirens5 (Apr 27, 2010)

WA Basics can. And they give oral glucose.



xgpt said:


> I guess...
> 
> I just think :censored::censored::censored::censored::censored: is used on this forum more often when needles are involved...


 
Is it bad to say poke? We didn't know if we should call IV practicals in ILS calss a poke party or a stick party. We ended up with stick since drugs are less offensive.


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## Madmedic780 (Apr 30, 2010)

*Oregon*

Getting a BGL is well within Basic Protocols same with admin Oral Glucose.


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## CA_EMT (Apr 30, 2010)

JPINFV said:


> I worked in Orange County from 2005-2007, however Orange County did not have that package when I worked there. It does look like they're adding it with the new EMT accreditation program though.
> 
> Edit to include:
> 
> ...



Those are the old regs. When the new ones take effect on July 1 you will have to be an AEMT (previously CA EMT-II) to do blood glucose determination.

An EMT-B (previously called an EMT-I (1) by CA) can still give oral glucose though. The Scope of Practice has not changed. They just took away a lot of the "optional skills" and moved them to the AEMT Scope of Practice


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## JPINFV (Apr 30, 2010)

Since the EMT2010 project hasn't gone into effect yet, how could these be "old?" Sure, it'll be gone in a few short months, but it ain't dead yet. What'll be interesting to see, though, is if any counties will use the grandfather clause to keep EMT-IIs around and if anyone else will start to use AEMTs (very doubtful) as a replacement for EMTs.


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## Akulahawk (Apr 30, 2010)

JP's correct. Basics here can check BGL if the local EMS agency has approved it and the Basic is accredited to do that skill. Interventions, however, are generally limited to oral glucose. As an example: Santa Clara County is a little different... I looked around and haven't seen the optional scope of practice for EMT's. The last time I looked at it, they called it Advanced EMT or EMT Enhanced or something like that, and the max scope was basically EMT-2 without IV's or IV meds. That was about 10 years ago...


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## mycrofft (Apr 30, 2010)

*A prime example of California's limitless ability to complicate stuff.*

Too many consarned flavors of *emergency   medical   technician*.
They teach 85 y/o semi-senescent spinster ladies to do fingersticks, fer gosh sakes!


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## EMTtoBE (May 11, 2010)

In Las Vegas we can't but they taught us how in class..lol


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## medicRob (May 11, 2010)

In TN, our EMT-IVs can check blood glucose levels, administer oral glucose and D5w, and D50. There is a push right now in our state to move from the EMT-IV level to what is known as "EMT-Advanced" which adds the ability to initiate 12 leads (but not read them, yes I know how redundant this sounds), and to administer narcan. They are doing GAP analysis right now with regard to the DOT National Standard vs EMT-IV.


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## VirginiaEMT (May 30, 2010)

ajax said:


> Here in MA, protocol says: "Use of electronic glucose measuring devices by EMT Basic and Intermediate personnel is considered to be an Optional Skill when the EMT B or I is working under the supervision of a Paramedic in the P-B or P-I staffing configuration. EMT Basic personnel may also be trained in the use of a glucometer at the solo Basic level as a service option."
> 
> Can Basics in your state check glucose levels?



Yes, heck, it is one of the simple things to do. We are required to get a signtature from the ER doctor when we arrive there, bu that is a local thing.


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## jjesusfreak01 (May 30, 2010)

I believe in NC EMTs can check glucose, give oral glucose, and we can give narcan.


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## Fox (May 30, 2010)

medicRob said:


> In TN, our EMT-IVs can check blood glucose levels, administer oral glucose and D5w, and D50. There is a push right now in our state to move from the EMT-IV level to what is known as "EMT-Advanced" which adds the ability to initiate 12 leads (but not read them, yes I know how redundant this sounds), and to administer narcan. They are doing GAP analysis right now with regard to the DOT National Standard vs EMT-IV.



I think it's because TN made their own level of EMT, then only requires a basic certification to become licensed. Which is odd, because I believe we can do everything a EMT-I/85 can do - minus the optional intubation some states do. Because we have IV therapy and the combitube out here. Seems other basics on here can't do most of these things?

That's why I wince when classmates struggle with the basic test. If they knocked us up to the I/85 I think less would be licensed.


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## Fox800 (Jun 4, 2010)

EMTs in Texas can use glucometers. Our first responders LOVE to do it, even when it's painfully obvious that there's no need. You got rear-ended and your ankle hurts, and you have no history/meds/allergies? Better check a blood glucose!

For billing, blood glucose measurement automatically qualifies as an ALS transport. Congratulations! Now their transport bill is $1000+ instead of $600.

I always facepalm when this happens, I often tell them to stop when they're getting ready to do one.


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## MonkeySquasher (Jun 6, 2010)

Fox800 said:


> For billing, blood glucose measurement automatically qualifies as an ALS transport. Congratulations! Now their transport bill is $1000+ instead of $600.



Yeah, my company is like that too.  If you're an I/B rig, before letting the Basic handle it, an "ALS" or "ILS Assessment" must be done, which always includes a BGL, so they can bill for it.


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## MoonachieFirstAid&Rescue (Jun 7, 2010)

Negative for NJ


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## MidwestFF (Jun 7, 2010)

Negative for Indiana as well.


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## jjesusfreak01 (Jun 7, 2010)

In NC, use of glucometers and oral glucose is a pure basic skill, though all of the services in my area run all ALS units.


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## TransportJockey (Jun 7, 2010)

For teh states that aren't allowed to do a CBG, do you carry oral glucose and is that within your scope?


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## ajax (Jun 7, 2010)

In MA we do carry oral glucose. It's in the protocol for unknown AMS in a conscious pt.


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## EMS*Princess (Jun 18, 2010)

Its a requirment here in Ohio- I have to test myself often so I'm relatively adept at it


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## UsualSuspect147 (Jun 30, 2010)

LA - heck yeah we can and I do often.


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## UsualSuspect147 (Jun 30, 2010)

Fox800 said:


> EMTs in Texas can use glucometers. Our first responders LOVE to do it, even when it's painfully obvious that there's no need. You got rear-ended and your ankle hurts, and you have no history/meds/allergies? Better check a blood glucose!
> 
> For billing, blood glucose measurement automatically qualifies as an ALS transport. Congratulations! Now their transport bill is $1000+ instead of $600.
> 
> I always facepalm when this happens, I often tell them to stop when they're getting ready to do one.



Wow that's idiotic. There is no reason to check it in that instance.


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## mar7967 (Jun 30, 2010)

New York leaves it up to the individual regions to determine I believe. My region allows EMT-B's to check BGL if their agency is approved to do so, and if they have gone through training on how to do it. Even if you can't check BGL, you are still allowed to give oral glucose in a diabetic emergency (better to give glucose to a hypoglycemic pt than to withhold from a hypoglycemic pt)


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## PotashRLS (Jun 30, 2010)

Wisconsin EMT-Basics check Blood Glucose and can administer Oral Glucose and Glucagon IM.


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## huey28 (Jul 2, 2010)

here in MA there are many fire dept that check the BS level.. and when im on the intercept truck and the FD doesnt get a BS for an unresponsive i get quite peeved


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## CA_EMT (Jul 9, 2010)

jtpaintball70 said:


> For teh states that aren't allowed to do a CBG, do you carry oral glucose and is that within your scope?



In CA we carry oral glucose and it is within our scope.


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## MrBrown (Jul 9, 2010)

What the deuce, how can they allow you to dish out glucose but not do a BGL? Gah!

Our Ambulance Technicians can check a BGL as well as give IM Glucagon and PO Glucose (10% Glucose drawn out a 500ml bag we'd normally give IV)

So legit question, how do those of you can give glucose but not do a BGL differentiate between hypoglycaemia and say, a stroke or an altered patient where glucose will be harmful?


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## mar7967 (Jul 9, 2010)

MrBrown said:


> What the deuce, how can they allow you to dish out glucose but not do a BGL? Gah!
> 
> Our Ambulance Technicians can check a BGL as well as give IM Glucagon and PO Glucose (10% Glucose drawn out a 500ml bag we'd normally give IV)
> 
> So legit question, how do those of you can give glucose but not do a BGL differentiate between hypoglycaemia and say, a stroke or an altered patient where glucose will be harmful?



If the pt has a history of diabetes, and it presents as a diabetic emergency, our protocols say to give glucose. You can do a stroke test to see if they are possibly having a stroke...but the theory I guess is that it is less dangerous to give glucose to a hyperglycemic person than to withhold from a hypo.


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## JPINFV (Jul 9, 2010)

mar7967 said:


> You can do a stroke test to see if they are possibly having a stroke...



There's a reason why Los Angeles Prehospital Stroke Scale requires a blood glucose level.


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## mar7967 (Jul 9, 2010)

JPINFV said:


> There's a reason why Los Angeles Prehospital Stroke Scale requires a blood glucose level.



I was not aware of the LA stroke scale. I was only taught the Cincinnati Stroke Scale. 

My agency is able to check BGL, but not all in my area can. I don't really know what they do, but that is what our protocols state.


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## JPINFV (Jul 9, 2010)

You are aware that hypoglycemic patients can present as positive on the Cincinnati Stroke Scale?


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## mar7967 (Jul 9, 2010)

JPINFV said:


> You are aware that hypoglycemic patients can present as positive on the Cincinnati Stroke Scale?



Yes, I was just saying the Cincinnati scale does not require a BG. 

My protocols for diabetic emergencies state:
"Assess BG if available.
...
Treatment should *not* withheld from patients with a stroke-like presentation, as this is likely due to hypoglycemia."

Edit: Keep in mind we are talking about giving oral glucose only anyway. ALS would be able to do a BGL check even if BLS can't and go from there. BLS is not going to be giving a D50 drip or anything.


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## JPINFV (Jul 9, 2010)

Except you said earlier...



mar7967 said:


> If the pt has a history of diabetes, and it presents as a diabetic emergency, our protocols say to give glucose.* You can do a stroke test to see if they are possibly having a stroke...*



Emphasis added

So, what's the purpose of doing a stroke test if there is a high likelihood that a positive test is because the patient has hypoglycemia?


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## mar7967 (Jul 9, 2010)

JPINFV said:


> Except you said earlier...
> 
> 
> 
> ...



I guess you are right. I am not really sure, and like I have said, we can do BGL checks so I would be doing it anyway, and basing my decision to give oral glucose on the BGL.


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## Too Old To Work (Aug 27, 2010)

Fox800 said:


> EMTs in Texas can use glucometers. Our first responders LOVE to do it, even when it's painfully obvious that there's no need. You got rear-ended and your ankle hurts, and you have no history/meds/allergies? Better check a blood glucose!
> 
> For billing, blood glucose measurement automatically qualifies as an ALS transport. Congratulations! Now their transport bill is $1000+ instead of $600.
> 
> I always facepalm when this happens, I often tell them to stop when they're getting ready to do one.



I see this way too often. Our EMTs are only supposed to use them to differentiate between CVA and Hypoglycemia when a patient has stroke like symptoms. Unfortunately, this has spread to just about every medical patient. Just the other night I arrived to find the BLS guys doing a BG on a patient with a complaint of dyspnea and chest heaviness. They hadn't put O2 on him yet, but they were convinced it was hypoglycemia. Of course it wasn't and the patient did everything but hang a sign that said "I have Angina" around his neck. 

I'm constantly telling the BLS guys to put the glucometer away. The next step is bringing a mallet to work and smashing the things when they are used inappropriately. Our QA people don't seem to care about that. 

And no Fox800, I don't work in Texas. I work about 2K miles away, but I guess the problems are the same. 

If the only tool you have is a hammer, everything starts to look like a nail. If the only tool you have is a glucometer, everyone starts to look like a hypoglycemic.


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## EmtTravis (Aug 27, 2010)

In IL we can also check bgl and also give glucose if needed.


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## CAOX3 (Aug 29, 2010)

Too Old To Work said:


> If the only tool you have is a hammer, everything starts to look like a nail. If the only tool you have is a glucometer, everyone starts to look like a hypoglycemic.



This is priceless....unfortunatley its true.


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## CAOX3 (Aug 29, 2010)

CAOX3 said:


> This is priceless....*unfortunatley* its true.



Here let me fix this for myself unfortunately.


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## JPINFV (Aug 29, 2010)

I believe the word you're looking for is "unfortunat*el*y

Darn it.. should have quoted you...


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## medicRob (Aug 29, 2010)

CAOX3 said:


> This is priceless....unfortunatley its true.



Let me fix this for you.

This is priceless. Unfortunately, it's true.


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