# EMT's checking BS



## cspinebrah (Sep 24, 2013)

Heard a rumor going around that in Jan.2014 EMT-B's will be able to check pt's Blood Suger. Anyone heard of anything? What do you all think? ^_^


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## Mariemt (Sep 24, 2013)

Hmm, I've been checking blood sugar all this time!  So will I be able to like double check it??

Depends on your service, local protocols etc.


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## cspinebrah (Sep 24, 2013)

True, should have been more specific. This question goes out to all my LA County EMTs


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## Jim37F (Sep 24, 2013)

cspinebrah said:


> True, should have been more specific. This question goes out to all my LA County EMTs



I heard somewhere (don't remember exactly where, I know super helpful right?) that we're supposed to be getting Pulse Ox's, would be great if we could get those and Blood Sugar Readers


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## DesertMedic66 (Sep 24, 2013)

Could be like riverside county and only be able to check a BGL when a paramedic asks :blink:


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## technocardy (Sep 24, 2013)

EMT-B's in LA county can't check BGL or monitor SpO2? :blink:


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## TransportJockey (Sep 24, 2013)

I'm glad you clarified because our nm EMTs can do a hell of a lot, least of all CBG checks


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## Aprz (Sep 24, 2013)

I don't know about checking blood glucose level (BGL) for EMTs, but pulse oximetry (SpO2) will become part of the basic scope of practice for EMTs in California. Mycrofft posted it awhile ago.

http://www.emtlife.com/showthread.php?p=484324#post484324

*Edit:* The link in his post is broken. Something similar can be found at http://www.emsa.ca.gov/emsa_dispatch_june_2013#EMTandParamedicRegulationChanges


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## Mariemt (Sep 24, 2013)

technocardy said:


> EMT-B's in LA county can't check BGL or monitor SpO2? :blink:



Wow. So much for o2 titration


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## Jim37F (Sep 24, 2013)

Mariemt said:


> technocardy said:
> 
> 
> > EMT-B's in LA county can't check BGL or monitor SpO2? :blink:
> ...



Well in LA County a 911 medical call will almost always get fire department paramedic squad and an engine responding plus the BLS ambulance (unless the FD transports in their own ambulance and/or the medics ride on the engine then you may *just* get an engine and ambulance responding to everything)


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## technocardy (Sep 24, 2013)

Jim37F said:


> Well in LA County a 911 medical call will almost always get fire department paramedic squad and an engine responding plus the BLS ambulance (unless the FD transports in their own ambulance and/or the medics ride on the engine then you may *just* get an engine and ambulance responding to everything)



So because ALS is coming they deemed it unnecessary for EMT-B's to check a BGL, or monitor SpO2? I don't quite understand the logic there...


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## PaulEMT (Sep 25, 2013)

We check out a lot of BS that patients have. Too much.


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## Gastudent (Sep 25, 2013)

Jim37F said:


> Well in LA County a 911 medical call will almost always get fire department paramedic squad and an engine responding plus the BLS ambulance (unless the FD transports in their own ambulance and/or the medics ride on the engine then you may *just* get an engine and ambulance responding to everything)



Don't mean to get the thread off topic but I just have to ask, are you serious when you say a fire truck goes to nearly every medical call in LA County.

Lets say someone calls for vomiting, or something like that and they get not only and ambulance coming to there house but a fire truck.

Maybe it's because I have lived in the country all my life, and I now work in rural EMS, but I just find that hard to believe.


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## DesertMedic66 (Sep 25, 2013)

Gastudent said:


> Don't mean to get the thread off topic but I just have to ask, are you serious when you say a fire truck goes to nearly every medical call in LA County.
> 
> Lets say someone calls for vomiting, or something like that and they get not only and ambulance coming to there house but a fire truck.
> 
> Maybe it's because I have lived in the country all my life, and I now work in rural EMS, but I just find that hard to believe.



Pretty much all 911 calls in CA get a fire engine or truck and one ambulance. For some areas in LA I have seen a truck, a paramedic squad, and an ambulance all respond.


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## cspinebrah (Sep 25, 2013)

I work for a 911 company in la county and on a basic 911 call, ex: sob, C/p, vomiting, ALOC. We respond and you also get the squad which is the two medics and a truck/quint or engine.


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## Gastudent (Sep 25, 2013)

DesertEMT66 said:


> Pretty much all 911 calls in CA get a fire engine or truck and one ambulance. For some areas in LA I have seen a truck, a paramedic squad, and an ambulance all respond.



I see in Georgia not even in the big cities is there such a thing as a BLS truck. Basics don't work in 911 here. Nearly all the trucks in most of the cities that I know of have 1 paramedic and 1 EMT I or AEMT, and fire doesn't have much to do with ems in all but a few cities in the whole state. The way things are done in CA make it seem like a whole other country lol.


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## DesertMedic66 (Sep 25, 2013)

Gastudent said:


> I see in Georgia not even in the big cities is there such a thing as a BLS truck. Basics don't work in 911 here. Nearly all the trucks in most of the cities that I know of have 1 paramedic and 1 EMT I or AEMT, and fire doesn't have much to do with ems in all but a few cities in the whole state. The way things are done in CA make it seem like a whole other country lol.



For my area 911 ambulances are staffed P/B or P/P. The fire departments have at least 1 medic on the engine (sometimes as many as 4). Fire has to do EMS in order to keep making money.


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## Household6 (Sep 25, 2013)

How absolutely gosh darn ridiculous. Our EMRs do BGLs. Our medical director decided that it was stupid for EMRs not to be allowed meters, he changed our protocols. No one has died from complications of a finger lancet poke. At least that I know of --what's the reasoning? Anyone know?

6 year olds can be taught how to check blood sugar.


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## technocardy (Sep 25, 2013)

Household6 said:


> How absolutely gosh darn ridiculous. Our EMRs do BGLs. Our medical director decided that it was stupid for EMRs not to be allowed meters, he changed our protocols. No one has died from complications of a finger lancet poke. At least that I know of --what's the reasoning? Anyone know?
> 
> 6 year olds can be taught how to check blood sugar.



I've been wondering the same thing myself. Even if you have ALS right behind you, there's no harm in being first on scene and attaching an SpO2 monitor to Mrs. Johnson who's suffering from SOB, or to Mr. Smith who's a known diabetic and found unresponsive in his chair.


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## medicsb (Sep 25, 2013)

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.


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## truetiger (Sep 25, 2013)

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?


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## wanderingmedic (Sep 25, 2013)

truetiger said:


> 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.


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## technocardy (Sep 25, 2013)

medicsb said:


> 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"?


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## medicsb (Sep 25, 2013)

truetiger said:


> 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).


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## truetiger (Sep 25, 2013)

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.


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## truetiger (Sep 25, 2013)

medicsb said:


> 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.


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## DesertMedic66 (Sep 25, 2013)

truetiger said:


> 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.


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## Bullets (Sep 25, 2013)

Oh look, a california thread.....



truetiger said:


> 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


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## truetiger (Sep 25, 2013)

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.


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## medicsb (Sep 25, 2013)

truetiger said:


> 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.


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## truetiger (Sep 25, 2013)

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?


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## technocardy (Sep 25, 2013)

truetiger said:


> 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?


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## medicsb (Sep 25, 2013)

truetiger said:


> 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.


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## truetiger (Sep 25, 2013)

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.


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## medicsb (Sep 25, 2013)

technocardy said:


> 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.


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## truetiger (Sep 25, 2013)

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...


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## technocardy (Sep 25, 2013)

> 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.


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## medicsb (Sep 25, 2013)

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).


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## medicsb (Sep 25, 2013)

technocardy said:


> 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.


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## Tigger (Sep 25, 2013)

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


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## PotatoMedic (Sep 25, 2013)

medicsb said:


> 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 said:


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



Then I guess the answer is that EMT-B's should have a glucometer since they can do something about it.


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## NomadicMedic (Sep 25, 2013)

Well, if the patient is so obtunded that the only way to know about hypoglycemia is through a CBG, then oral glucose isn't really appropriate, is it?

Seattle AMR EMTs would regularly transport hypoglycemia patients to the ED as an "unknown unconscious" because there might not be a medic dispatched and there was no way from them to check a sugar.


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## medicsb (Sep 25, 2013)

FireWA1 said:


> Then I guess the answer is that EMT-B's should have a glucometer since they can do something about it.



If the EMT is any good, they'll treat empirically and do not need a glucometer to do so.


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## NomadicMedic (Sep 25, 2013)

medicsb said:


> If the EMT is any good, they'll treat empirically and do not need a glucometer to do so.



Then why do paramedics have glucometers? If what your saying is true, we should just treat all unconscious patients empirically? Coma cocktail anybody?


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## medicsb (Sep 25, 2013)

DEmedic said:


> Then why do paramedics have glucometers? If what your saying is true, we should just treat all unconscious patients empirically? Coma cocktail anybody?



a;wodihgfdklsnv;LKas f;ldsv;ladgslsdv

Paramedics often have the means to react to a glucose measurement, whether normal or abnormal.  Again, the crux of my point has been using the information to alter treatment or disposition of the patient.  Do I need to type that in. every. single. response?  Again, I have been arguing against BLS glucometry in the context of an "all-ALS" setting.


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## PotatoMedic (Sep 25, 2013)

medicsb said:


> If the EMT is any good, they'll treat empirically and do not need a glucometer to do so.



Except for the fact where I work if I call in a short to a hospital for a DLOC the RN will ask me for a BGL.  Yes if the patient has a hx of diabetes and they are clammy and unresponsive they are probably hypoglycemic.  Does not change the fact that the ER wants a BGL, no.  Anyways if the pt is able to follow commands and swallow I can give them oral glucose (or a pb and j sandwich).  

The nice thing about a glucometer is that it HELPS me confirm or redirect my assessment of a patient depending on the results.  And if I have ALS coming it give me one more bit of solid information I can give to the medics to help them start their assessment.  (Granted you have already said you don't trust your basics so my last argument has no effect on you.)

EDIT: I am going to leave my post but I don't think I have a place in this argument since I do not work in an all ALS system.


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## NomadicMedic (Sep 26, 2013)

medicsb said:


> a;wodihgfdklsnv;LKas f;ldsv;ladgslsdv
> 
> Paramedics often have the means to react to a glucose measurement, whether normal or abnormal.  Again, the crux of my point has been using the information to alter treatment or disposition of the patient.  Do I need to type that in. every. single. response?  Again, I have been arguing against BLS glucometry in the context of an "all-ALS" setting.



An all ALS service wouldn't have BLS making a response, a paramedic would be on EVERY CALL. In a TIERED system with BLS response, glucometery is a reasonable tool for these first responders to obtain information that most certainly can alter treatment for the patient. 

Anecdotally, I can cite a recent instance where ALS was requested for a CVA. On my arrival, the BLS crew was moving the patient to the ambulance, on a backboard, with supplemental O2. If they had checked a CBG, they would have seen the sugar was 22 and they could have waited in the house until ALS arrived, managed the issue and left the patient home. 

(Incidentally, the BLS providers are able to check sugars here, and usually do, but this call was dispatched as altered mental status and they tunnel visioned on the PTs stroke history, not noticing that she was cool and sweaty.) 

I count on BLS providers to be able to provide me with answers and a set of vitals when I arrive. In an altered mental status patient, a sugar is part of that.


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## Christopher (Sep 26, 2013)

medicsb said:


> 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.



Why can't EMT's call a stroke alert?


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## medicsb (Sep 26, 2013)

DEmedic said:


> An all ALS service wouldn't have BLS making a response, a paramedic would be on EVERY CALL.



There can still be some component that is BLS.  This is common in many places.  E.g. ALS ambulance, BLS engines.  ALS engines, BLS ambulances. ALS ambulances, BLS volunteers going right to the scene.  At least to me, "all-ALS" is any system where a medic is sent on every call, which is the overwhelming majority of EMS systems.  



> In a TIERED system with BLS response, glucometery is a reasonable tool for these first responders to obtain information that most certainly can alter treatment for the patient.



So, we agree. (Or are we going to have to go over this a few more times?)



> Anecdotally, I can cite a recent instance where ALS was requested for a CVA. On my arrival, the BLS crew was moving the patient to the ambulance, on a backboard, with supplemental O2. If they had checked a CBG, they would have seen the sugar was 22 and they could have waited in the house until ALS arrived, managed the issue and left the patient home.
> 
> (Incidentally, the BLS providers are able to check sugars here, and usually do, but this call was dispatched as altered mental status and they tunnel visioned on the PTs stroke history, not noticing that she was cool and sweaty.)



Yeah... that is the sort of thing I used to see that'd have me question the assessment of certain BLS crews (or whole squads/services).  Some squads, I set my expectations as low as them just showing up with a working ambulance, with anything beyond that (e.g. vitals, working suction, etc.) being a bonus.  Others, I expected a lot more.  

Anyhow, I assume you woke her up in the ambulance before transporting and let her decide whether or not she wanted to go to the hospital.  I did that plenty of times.  It was always nice when BLS actually gave oral glucose so that we could assess and then triage back to BLS if the BGL was "normal" and mentation back to baseline (could do this even if they already initiated transport).


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## Bullets (Sep 26, 2013)

medicsb said:


> a;wodihgfdklsnv;LKas f;ldsv;ladgslsdv
> 
> Paramedics often have the means to react to a glucose measurement, whether normal or abnormal.  Again, the crux of my point has been using the information to alter treatment or disposition of the patient.  Do I need to type that in. every. single. response?  Again, I have been arguing against BLS glucometry in the context of an "all-ALS" setting.



BLS would use the information to determine hypoglycemia, an ALS call, from Stroke, a BLS call.

At least around here, hypoglycemia ends up being an RMA. BLS arrives, "assist" the family with getting a BGL, find it low and wait for ALS to come, give D50, guy wakes up, RMA

No point in waiting for ALS on a LA Scale positive patient, lets go to the comprehensive stroke center


There are places that send ALS on EVERY CALL!?!? That seems like a misuse of resources


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## ffemt8978 (Sep 26, 2013)

medicsb said:


> There can still be some component that is BLS.  This is common in many places.  E.g. ALS ambulance, BLS engines.  ALS engines, BLS ambulances. ALS ambulances, BLS volunteers going right to the scene.  At least to me, "all-ALS" is any system where a medic is sent on every call, which is the overwhelming majority of EMS systems.



No, it's not the "overwhelming majority of EMS systems".  My county, for example, has about 18 different EMS agencies, only 3 of which are ALS.  

Just because that's the way it is in urban areas does not mean it is the same across the entire country.  Unless you have actual proof of your claim that I'm not aware of, I'm calling BS on this one.


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## Christopher (Sep 26, 2013)

ffemt8978 said:


> No, it's not the "overwhelming majority of EMS systems".  My county, for example, has about 18 different EMS agencies, only 3 of which are ALS.
> 
> Just because that's the way it is in urban areas does not mean it is the same across the entire country.  Unless you have actual proof of your claim that I'm not aware of, I'm calling BS on this one.



All but a few of the 100 counties in NC are ALS transport, and a good number are BLS first response. A tiny fraction have BLS transports in rotation with ALS transports, and none tier their response (as far as I'm aware).


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## ffemt8978 (Sep 26, 2013)

Christopher said:


> All but a few of the 100 counties in NC are ALS transport, and a good number are BLS first response. A tiny fraction have BLS transports in rotation with ALS transports, and none tier their response (as far as I'm aware).



Which goes to prove my point that it is regionally dependent.  One of the counties that borders mine only has BLS ambulances, despite the fact that one of the agencies is hospital based.  Some areas of the state are strictly ALS, some are BLS, and some are a mix/tiered system.


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## unleashedfury (Sep 27, 2013)

BGL would be great if a BLS provider could do more about it. 

Most known diabetics have a Glucometer so since someone had to call 911 to find them unresponsive a simple "assist of the family with use of the patients glucometer" can tell you if the patient has a sugar issue. 

But as a BLS provider what can you do about a low blood sugar. If they offered to expand the scope of practice to add glucagon pens to the BLS skill. Or IV skills with the administration of D5W or D50. I could see where BGL would be beneficial. 

Now to address the stroke patient issue not everyone has a Stroke center with a short transport time. Our closest is 45 mins away. So meeting with an ALS buggy within a 45 minute transport time is feasible.


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## Jambi (Sep 27, 2013)

This has been pretty much been beaten like a dead horse, but here is a post I did when discussing our county protocols and EMS checks on BGLs




> Yup, still a no go really. Though I suppose it comes down to the ability to do something about the reading that's obtained, and it's really a moot point when considering that a person must have an altered mental status to receive oral glucose anyways, especially when taken into consideration that diabetic patients are far more likely to by hypoglycemic when altered than hyperglycemic.
> 
> Before using the glucometer EMTs, AEMTs, and paramedics must:
> 7 1. Follow the manufacturer’s guidelines regarding calibration and cleaning
> ...


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## hogwiley (Sep 27, 2013)

This is something I've never been able to understand, and its never been adequately explained to me why in some areas EMTs cant check BGL. It's totally idiotic. Does it make much difference when they cant check it? Probably not, but its sort of the principle of the thing, it shows absolutely zero trust in your EMTs. 

If you can trust someone to safely drive an ambulance, you can trust them to check blood sugar and do a control test now and then, its that simple. If someone is too dumb to check blood sugar, they are too dumb to safely navigate an ambulance to a scene and transport a patient.

My guess is the main reason is usually cost. Lancets and test strips have to be purchased, control tests have to be done, and sharps have to be disposed of, which costs money.

There's no other logical reason why an EMT cant do this.


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## medicsb (Sep 27, 2013)

ffemt8978 said:


> No, it's not the "overwhelming majority of EMS systems".  My county, for example, has about 18 different EMS agencies, only 3 of which are ALS.
> 
> Just because that's the way it is in urban areas does not mean it is the same across the entire country.  Unless you have actual proof of your claim that I'm not aware of, I'm calling BS on this one.



So, you're in the minority.  I'll admit, maybe I shouldn't have used "overwhelming", I guess it is up to your own imagination as to what that means.  I suppose to some people it is like saying 99.99999% when it could mean 80%.  My bad.



hogwiley said:


> Does it make much difference when they cant check it? Probably not, but its sort of the principle of the thing, it shows absolutely zero trust in your EMTs.



Ok, so, by your logic, even though it probably makes no difference in terms of patient care, EMTs should be allowed to use glucometers so that they _feel_ trusted.  



> If you can trust someone to safely drive an ambulance, you can trust them to check blood sugar and do a control test now and then, its that simple. If someone is too dumb to check blood sugar, they are too dumb to safely navigate an ambulance to a scene and transport a patient.



No one has argued that EMTs are unable to check a blood glucose properly, or that they couldn't interpret it.  



> My guess is the main reason is usually cost. Lancets and test strips have to be purchased, control tests have to be done, and sharps have to be disposed of, which costs money.
> 
> There's no other logical reason why an EMT cant do this.



You've just stated logical reasons: "Does it make much of a difference... probably not" AND "...costs money".

BAM.  There you go.  Two SOLID reasons to not allow something.  

Again, to put it out there for those who haven't read previous posts: My argument is that if it doesn't change patient care or disposition, then it is not needed.  If it is an "all-ALS" system (i.e. a medic is sent in some way to EVERY patient), then glucometry for BLS will change nothing for the patient.


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## VirginiaEMT (Sep 27, 2013)

cspinebrah said:


> Heard a rumor going around that in Jan.2014 EMT-B's will be able to check pt's Blood Suger. Anyone heard of anything? What do you all think? ^_^



They do that in our area now....


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## VirginiaEMT (Sep 27, 2013)

Aprz said:


> I don't know about checking blood glucose level (BGL) for EMTs, but pulse oximetry (SpO2) will become part of the basic scope of practice for EMTs in California. Mycrofft posted it awhile ago.
> 
> http://www.emtlife.com/showthread.php?p=484324#post484324
> 
> *Edit:* The link in his post is broken. Something similar can be found at http://www.emsa.ca.gov/emsa_dispatch_june_2013#EMTandParamedicRegulationChanges




The pulse oximeter has made EMTs lazy. I absolutely loathe seeing them get the pulse rate off of a pulse ox.


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## PotatoMedic (Sep 27, 2013)

First pulse is always palpated.  Second is off pulsox if the first few beats match what I get while palpating to make sure it is accurate.


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## chaz90 (Sep 27, 2013)

FireWA1 said:


> First pulse is always palpated.  Second is off pulsox if the first few beats match what I get while palpating to make sure it is accurate.



I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...


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## ffemt8978 (Sep 27, 2013)

medicsb said:


> So, you're in the minority.  I'll admit, maybe I shouldn't have used "overwhelming", I guess it is up to your own imagination as to what that means.  I suppose to some people it is like saying 99.99999% when it could mean 80%.  My bad.



What is the basis for your claim that ALS services are the majority of services out there?  You made the claim, now lets see the proof.  Or is it a case of you think it's that way but can't prove it?


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## broken stretcher (Sep 27, 2013)

i check BGL in NYS however in the scope of things how does it really change my treatment as BLS?


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## medicsb (Sep 27, 2013)

ffemt8978 said:


> What is the basis for your claim that ALS services are the majority of services out there?



That was not my claim.  I NEVER said that the majority of services are ALS.  I'll let you go back and read what I wrote.  If you need clarification, let me know.  (As you are now straying from the topic, shouldn't you make another thread?  )


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## ffemt8978 (Sep 27, 2013)

medicsb said:


> There can still be some component that is BLS.  This is common in many places.  E.g. ALS ambulance, BLS engines.  ALS engines, BLS ambulances. ALS ambulances, BLS volunteers going right to the scene.  At least to me, "all-ALS" is any system where a medic is sent on every call, which is the overwhelming majority of EMS systems.
> 
> 
> 
> ...





medicsb said:


> So, you're in the minority.  I'll admit, maybe I shouldn't have used "overwhelming", I guess it is up to your own imagination as to what that means.  I suppose to some people it is like saying 99.99999% when it could mean 80%.  My bad.
> 
> 
> 
> ...





medicsb said:


> That was not my claim.  I NEVER said that the majority of services are ALS.  I'll let you go back and read what I wrote.  If you need clarification, let me know.  (As you are now straying from the topic, shouldn't you make another thread?  )


Let me highlight what you said, which is in red.

You made the claim, now back it up.  You said that ALS is the "overwhelming majority" of EMS systems.

Prove it...if you can.


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## medicsb (Sep 29, 2013)

ffemt8978 said:


> Let me highlight what you said, which is in red.
> 
> You made the claim, now back it up.  You said that ALS is the "overwhelming majority" of EMS systems.
> 
> Prove it...if you can.



Yes, with good reading comprehension, I did say that the "overwhelming majority" of EMS _systems_ (not services) are "all-ALS".  But, sure, you win, I can not definitively prove that the majority are "all-ALS".  (Though, I could ask you to prove that the majority are not "all-ALS".)  

You did make a point of stating that not all systems are "urban", etc. (thanks for emphasizing that which most of us know).  Be that as it may, about 70% of the US population is within "urbanized areas" and another ~10% live in urban clusters (http://www.census.gov/geo/reference/ua/urban-rural-2010.html).  So, if I was a betting man, I'd still bet on the majority being all-ALS.  For what its worth, I would love to know of more tiered EMS systems, so please divulge any you know of.


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## unleashedfury (Sep 29, 2013)

chaz90 said:


> I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...



A lot of medics around my ways make you take manual vitals. I know one that when they are doing a BLS transport with a EMT/Medic crew he will take the Monitor and the Pulse oximiter and place them in the front seat with him. His opinion is how many EMT's rely heavily on the automatic cuffs and pulse oximeters for vitals so they can't take manual vitals. Now you don't have a choice.


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## Rockies (Oct 1, 2013)

Wait, we could'nt do that?


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## Mariemt (Oct 1, 2013)

unleashedfury said:


> A lot of medics around my ways make you take manual vitals. I know one that when they are doing a BLS transport with a EMT/Medic crew he will take the Monitor and the Pulse oximiter and place them in the front seat with him. His opinion is how many EMT's rely heavily on the automatic cuffs and pulse oximeters for vitals so they can't take manual vitals. Now you don't have a choice.



The medic drives as the EMT monitors the pt? If he is going to complain, I'd make him do it! .
I'd be pissed if he took my equipment. For one, we titrate all our o2. Yes I realize o2 SATs are just a tool in titration, but an important tool. I need my pulse ox.  For another, he isn't my father. I take all my vitals manually the first time. If we are moving and the automated cuff has an odd reading, I will palpate the BP. Heart rate ? Always.


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## Sandog (Oct 2, 2013)

VirginiaEMT said:


> The pulse oximeter has made EMTs lazy. I absolutely loathe seeing them get the pulse rate off of a pulse ox.



Well, that is your issue. 

If an EMT wants to do more, then that EMT should put in the time for medic or RN training, or even higher. The EMT is but just a stepping stone, and those that wish to transverse it will. As most EMT's are young, they will find their path in due time. Good things come to those that work for it.


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## exodus (Oct 2, 2013)

chaz90 said:


> I don't have a problem with that. I lose my mind when I'm told by an EMT with a pulse oximeter that the HR "keeps going all slow" because the pulse ox loses contact due to low perfusion or whatever else. Palpate the radial artery and realize it's regular and a normal rate! It's either that or them calling us for a HR of 180 when they never took a manual pulse and realized it was a consistent 80...



Way I do it, I throw them on the pulse ox and palpate at the same time and see if the beats are coordinated to the "waveform bars" on the lcd display. If they are, and it's not irregular, perfectly fine to use that number as your heart rate.

Edit, if it's irregular, or seems off. Then a manual is is obtained.


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## unleashedfury (Oct 2, 2013)

Mariemt said:


> The medic drives as the EMT monitors the pt? If he is going to complain, I'd make him do it! .
> I'd be pissed if he took my equipment. For one, we titrate all our o2. Yes I realize o2 SATs are just a tool in titration, but an important tool. I need my pulse ox.  For another, he isn't my father. I take all my vitals manually the first time. If we are moving and the automated cuff has an odd reading, I will palpate the BP. Heart rate ? Always.



You are one of the few. a lot of EMTs I ran into use the automated cuffs or wait till a medic arrives so they don't have to do manual vitals. 

if the patient is complaining of respiratory distress it would be an ALS call requiring 02 titration thus a pulse oximeter is needed. 

If its a patient who fell and hurt his ankle. with no other complaints, some EMT's (not all) will just grab the life pack and place them on the SP02 and automated cuff for vitals. I am a strong believer in one solid set of manual vitals to get your baseline.


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## Akulahawk (Oct 2, 2013)

Mariemt said:


> The medic drives as the EMT monitors the pt? If he is going to complain, I'd make him do it! .
> *I'd be pissed if he took my equipment*. For one, we titrate all our o2. Yes I realize o2 SATs are just a tool in titration, but an important tool. I need my pulse ox.  For another, he isn't my father. I take all my vitals manually the first time. If we are moving and the automated cuff has an odd reading, I will palpate the BP. Heart rate ? Always.


There are times when I "delegate" VS tasks to the machine... and there are times that I do it myself via the manual method. If I take equipment away from my EMT partner, it's for a good reason, and would have been discussed ahead of time. Now if it's a medic that is doing the driving and he's not part of _my_ crew, I would be exceedingly angry about him taking the equipment because _I'm_ responsible for that equipment and if _he_ breaks it, it's on _me._


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## EEEMMMTTT (Oct 5, 2013)

I vote no for glucometer for EMT.  There's no point to it.


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## usalsfyre (Oct 6, 2013)

EEEMMMTTT said:


> I vote no for glucometer for EMT.  There's no point to it.



Huh? How do you figure?


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## Akulahawk (Oct 6, 2013)

EEEMMMTTT said:


> I vote no for glucometer for EMT.  There's no point to it.


Really? As an EMT, I would have loved to be able to use the glucometer. Why? When we go to a suspected stroke patient, one of the things I want to know is the blood glucose level because if that is out of the normal range (especially if low), then it very well could make a difference whether I take the patient to a hospital that's a stroke center or not. I may not be able to _do_ something about the symptoms right then, but since transport _is_ a treatment that I can provide (along with an appropriate destination), that one piece of information may actually change what I do and where I take that patient.


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## Glucatron (Dec 20, 2013)

Here in CO, we can: 1.start IVs and administer NaCl 2. Monitor pulse ox, 3. Test blood sugar, 4. Give D50 (if ALS), narcan, ASA, nitro, 5. Put in King, combitube airways. 6. Place 12 leads. It wouldn't surprise me if in 5-10yrs they start to allow EMT-Bs to do IOs. There are a lot of things we can unofficially do if our partner trusts us such as medication administration during a cor, IO drilling, giving zofran or other non-narcotic medications. Again this is for an ALS ambulance. I can understand lower SOP in low call volume areas but if you are in a busier system they really should be raising the SOP.


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## Tigger (Dec 20, 2013)

BLS agencies in Colorado can carry D50, and EMTS are permitted under Chapter 2 rules to administer medications under the direction of a paramedic if the patient is in extremis.  There are also several agencies statewide that allow EMTs to perform IOs under waivers.


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## toxik153 (Dec 20, 2013)

EMT's should be able to check blood glucose levels. I have enough patients in my IFT transports that are diabetics, picking them up from ALF's or their residence going to an ER and I feel like I'm lacking information to report such as BGL's and o2 SAT.


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## BigBad (Dec 24, 2013)

My emts can drill IOs, give narcan and give adrenalin IM because epi pens are too expensive


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## Merck (Dec 24, 2013)

Never occurred to me that they couldn't check glucose.  Up here the EMTs (PCPs as we call them) start IVs, defib, blood glucose, starting a 12-lead cath lab trial, give neb ventolin, ASA, narcan, D10W, glucagon, nitro (if previously prescribed), epi for anaphylaxis.  For a hypoglycemic pt they will determine low sugar and likely cancel ALS, administer D10W and transport themselves.


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## TransportJockey (Dec 24, 2013)

Merck said:


> Never occurred to me that they couldn't check glucose.  Up here the EMTs (PCPs as we call them) start IVs, defib, blood glucose, starting a 12-lead cath lab trial, give neb ventolin, ASA, narcan, D10W, glucagon, nitro (if previously prescribed), epi for anaphylaxis.  For a hypoglycemic pt they will determine low sugar and likely cancel ALS, administer D10W and transport themselves.



But they actually are educated up there. Not so here


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## Medic Tim (Dec 24, 2013)

Merck said:


> Never occurred to me that they couldn't check glucose.  Up here the EMTs (PCPs as we call them) start IVs, defib, blood glucose, starting a 12-lead cath lab trial, give neb ventolin, ASA, narcan, D10W, glucagon, nitro (if previously prescribed), epi for anaphylaxis.  For a hypoglycemic pt they will determine low sugar and likely cancel ALS, administer D10W and transport themselves.




The EMT basic in the US is similar to the EMR up here.


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## Merck (Dec 24, 2013)

Medic Tim said:


> The EMT basic in the US is similar to the EMR up here.



Ah, that makes sense then.  We do have EMRs in smaller communities but the majority are PCP.  It's been a big change.  When I started our scope was about the same as what's been discussed here for EMTs.


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