# BGL protocols for EMTs



## JakeEMTB (Nov 5, 2013)

What are the protocols for EMT use of glucose meters in your area? I'm from NJ where it's not allowed (we can obtain from patient or family if they take it and report results to us). I have to write a report about it and how its standards differ between the states.


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## DesertMedic66 (Nov 5, 2013)

For my area the paramedic or AEMT has to direct the EMT to get the results. So after the medic or AEMT tells us, we can test it.


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## nwhitney (Nov 5, 2013)

Obtaining a blood sugar is within the EMT scope here in Oregon.


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## yowzer (Nov 5, 2013)

It's a per-agency decision, with the exception of the largest fire department in the county, which the county-wide protocols explicitly ban from doing glucose readings at a BLS level. Every other fire department in the county, as far as I know, allows and does them on a regular basis. Private ambulance companies don't, which makes no sense to me since they can easily recoup costs by billing for it.


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## Mariemt (Nov 5, 2013)

I take a BGL on all altered patients, all possible strokes, all possible intoxicated pts or all diabetics not "feeling good "

I don't need approval and we never, ever use the patients own monitor or strips


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## rescue1 (Nov 5, 2013)

In Maryland it's a BLS skill, though I think it still depends on the individual county protocols. 
In PA it's an ALS only skill.


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## TransportJockey (Nov 6, 2013)

BLS skill here in nm. I believe even first responders may do it.


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## ZombieEMT (Nov 6, 2013)

I also am from New Jersey and of all the messed up standards we follow, I think BGL is the worst. It is a simple procedure which can go a long way in patient assessment. I can tell you that many EMTs in the county that I work in, will "Assist" a patient with obtaining a BGL even when unconscious, if you catch my drift.


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## EMT B (Nov 6, 2013)

Any patient that is altered mental, or any patient with a fever gets a BGL from me. Both states I work allow BGL at the BLS level


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## chaz90 (Nov 6, 2013)

EMT B said:


> any patient with a fever gets a BGL from me



What's your reasoning for this?


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## Christopher (Nov 6, 2013)

JakeEMTB said:


> What are the protocols for EMT use of glucose meters in your area? I'm from NJ where it's not allowed (we can obtain from patient or family if they take it and report results to us). I have to write a report about it and how its standards differ between the states.



It is a medical responder skill in North Carolina, and is commonly taught as part of first aid classes. I actually can't think of a level of medical provider who cannot assess a BGL in NC.

Even our police will grab it if they get there before we do on an unconscious diabetic (using the family's meter).


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## heshyh (Nov 6, 2013)

Mariemt said:


> I take a BGL on all altered patients, all possible strokes, all possible intoxicated pts or all diabetics not "feeling good "
> 
> I don't need approval and we never, ever use the patients own monitor or strips



Which state are you from? And. Is it allowed in your state, or this is what you do?


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## EMT B (Nov 6, 2013)

chaz90 said:


> What's your reasoning for this?



depending on the severity of the fever, they will get both a BGL and a Lactate to check for SIRS/Sepsis

i usually do both off of the IV cath so that im not sticking the patient 2-3 different times

EDIT: plus, a fever increases your metabolic rate, so we need to make sure they are getting adequate amounts of sugar


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## usalsfyre (Nov 6, 2013)

EMT B said:


> EDIT: plus, a fever increases your metabolic rate, so we need to make sure they are getting adequate amounts of sugar



You're overthinking that one, typically patient's who are in any kind of shock will show a slightly elevated BGL. That does not mean however, the cells are able to appropriately metabolize that glucose.


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## chaz90 (Nov 6, 2013)

EMT B said:


> depending on the severity of the fever, they will get both a BGL and a Lactate to check for SIRS/Sepsis
> 
> i usually do both off of the IV cath so that im not sticking the patient 2-3 different times
> 
> EDIT: plus, a fever increases your metabolic rate, so we need to make sure they are getting adequate amounts of sugar



It seems like you already realize this, but all that is fever isn't sepsis. Furthermore, what correlation do you expect to find between running a BGL on even obviously septic patients? As usalsfyre mentioned, many will have slightly elevated serum glucose levels, but it's certainly not reliable as a diagnostic criteria. And yes, illness often increases metabolic rate, but not to the point that it consumes so much extra sugar that it becomes uncompensated. How many patients have you checked a blood sugar on due to fever and found something that needed to be treated pre-hospitally or significantly added to your assessment information?

To put my two cents in on the original topic of this thread, blood glucose checks are an EMT level skill in Delaware. All BLS ambulances carry glucometers and they're fairly good about checking quickly.


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## IslandTime (Nov 6, 2013)

Mariemt said:


> I take a BGL on all altered patients, all possible strokes, all possible intoxicated pts or all diabetics not "feeling good "
> 
> I don't need approval and we never, ever use the patients own monitor or strips



Same here. WA state.


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## NomadicMedic (Nov 6, 2013)

IslandTime said:


> Same here. WA state.



Not all of WA state. More specifically, not King county.


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## Mariemt (Nov 6, 2013)

heshyh said:


> Which state are you from? And. Is it allowed in your state, or this is what you do?



Iowa, it is a local protocol. Not state. Most areas around here do not allow it. Our medical director has included it.


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## EpiEMS (Nov 6, 2013)

Are there any plausible reasons for which BGL should not be include in the EMR and EMT scope? It's quite low risk and potentially high benefit, no?


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## nwhitney (Nov 6, 2013)

EpiEMS said:


> Are there any plausible reasons for which BGL should not be include in the EMR and EMT scope? It's quite low risk and potentially high benefit, no?



I see no reason why this shouldn't be included in the scope for EMR and EMT.


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## EMT B (Nov 6, 2013)

people argue for one reason or another that it does not change your course of treatment at the BLS level


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## heshyh (Nov 6, 2013)

EMT B said:


> people argue for one reason or another that it does not change your course of treatment at the BLS level



It can In many cases e.g. ams with able to follow commands. 
But either way , even unresponsive patient. Why should the medics have to start from scratch with an assessment of the emt can give it (at least in a diabetic  case)


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## EMT B (Nov 6, 2013)

ive heard people argue that any AMS pt with an open airway can get a tube of glucose and not need an immediate BGL, because you should have ALS en route anyway. They defend that by saying that if even if the patient is hypoglycemic, 15g of sugar wont make them much worse, and that if it isn't diabetic related, then 15g of sugar still wont hurt.


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## Kevinf (Nov 7, 2013)

In PA it is an ALS skill... though BLS has oral glucose as standard equipment. Sure you don't necessarily need a gadget to diagnose low blood sugar, but I still think it's funny that we stock BLS rigs with glucose but not glucometers.


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## yowzer (Nov 7, 2013)

DEmedic said:


> Not all of WA state. More specifically, not King county.



Not Seattle, you mean. Every other fire department in the county that I'm aware of has EMTs checking sugar. SFD is the one that is singled out in our protocols to not be able to test it.


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## TheLocalMedic (Nov 8, 2013)

Here BLS cannot assess BGL (or pulse oximetry, but that's another thread…) without a prescription from the county medical director.  

Should they be allowed to do it?  Absolutely.  

Is there a need for them to have it?  Here, not so much.  Most fire departments here run ALS or have an ALS ambulance available quickly.  We don't run BLS 911 cars.


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## Mariemt (Nov 9, 2013)

Kevinf said:


> In PA it is an ALS skill... though BLS has oral glucose as standard equipment. Sure you don't necessarily need a gadget to diagnose low blood sugar, but I still think it's funny that we stock BLS rigs with glucose but not glucometers.



Our medical director wouldn't want us shoving glucose in the mouth of all stroke victims,  brain bleeds etc. 
We use it to diagnose blood sugar yes, but also to rule out things such as strokes.


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## Household6 (Nov 9, 2013)

This subject just blows my mind how some areas are so touchy about it.. BGL checking is an EMR skill here. As an EMT I'm allowed to administer oral glucose, as long as the patient can swallow and has control of their airway.. 

It's a pretty simple protocol. Can the patient swallow? No? Then they don't get glucose.

Criminy, we're even told by our bossman to stick around and help the hypoglycemic patient make some food if they refuse transport.. Eggs and toast is what we usually make, or a bowl of cereal.


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