# Does your BLS protocal incl. glucose monitor finger-stick?



## Freddy_NYC (Jun 22, 2009)

Does your BLS protocal include glucose monitoring finger-stick? New York City doesn't have one. I'm trying to understand why? If your BLS protocols include glucose finger-sticks do you find it to be necessary and accurate?


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## marineman (Jun 22, 2009)

Yes we have it, and yes it's necessary. Accuracy depends on how you maintain it and how often you calibrate it. The methods we use in the field are obviously less accurate and quite limited in comparison to the lab tests done at the hospital but for our uses as long as you keep on top of it, it's accurate enough. Do you have oral glucose and/or glucagon in your BLS protocols? Why would you carry a medication without being able to test to see if it's indicated or not? Above and beyond administering those two meds the BGL can be useful in determining or ruling out other problems. A BGL is another vital sign required on every report that we write.


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## MRE (Jun 22, 2009)

We carry a glucometer on my ambulance.  It is nice to have, and is one more thing we can do prior to ALS arrival if it is that kind of call.  

Is it necessary?  No.  

Is it accurate?  Only as accurate as the meters you get at WalMart, though I'm not sure how good or bad that is.


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## WolfmanHarris (Jun 22, 2009)

Yes we have it. Yes it is necessary.
As a BLS provider I carry oral glucose and glucagon.
I also have two years of college education in order to practice.
I do not advocate increasing scope without the requisite education.


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## marineman (Jun 22, 2009)

WolfmanHarris said:


> Yes we have it. Yes it is necessary.
> As a BLS provider I carry oral glucose and glucagon.
> I also have two years of college education in order to practice.
> I do not advocate increasing scope without the requisite education.



I'm assuming you're not from the U.S. with a 2 year education to be a BLS provider?


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## Shishkabob (Jun 22, 2009)

In Texas, yes.


It's one of those gray areas.  Yes, it's "invasive", but the TexDSHS basically whistles and walks away when asked if basics can do it.

So as such, basics do BGL readings in Texas.


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## WolfmanHarris (Jun 22, 2009)

marineman said:


> I'm assuming you're not from the U.S. with a 2 year education to be a BLS provider?



Ontario, Canada.


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## Sasha (Jun 22, 2009)

WolfmanHarris said:


> Yes we have it. Yes it is necessary.
> As a BLS provider I carry oral glucose and glucagon.
> I also have two years of college education in order to practice.
> I do not advocate increasing scope without the requisite education.



I think some disagree that it's necessary as they are not always accurate and too many providers will rely on the magic 80-120 numbers. In some areas giving oral glucose depends on th EMT's ability to assess for and recognize the signs and symptoms of hypoglycemia without depending on a finger stick.


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## WolfmanHarris (Jun 22, 2009)

Sasha said:


> I think some disagree that it's necessary as they are not always accurate and too many providers will rely on the magic 80-120 numbers. In some areas giving oral glucose depends on th EMT's ability to assess for and recognize the signs and symptoms of hypoglycemia without depending on a finger stick.



It's necessary for glucagon as well a building a good differential. Any decreased LOA/LOC gets glucometry with me.

How much does proper maintenance correct for inaccuracy? We do a high/lo test on the glucometers to calibrate them twice a week. I wasn't aware of issues with accuracy.


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## VentMedic (Jun 22, 2009)

Sasha said:


> In some areas giving oral glucose depends on th EMT's ability to assess for and recognize the signs and symptoms of hypoglycemia without depending on a finger stick.


 
Which is why the two years of education can be a good argument for extending the scope.  There is knowledge to go along with the "skill".

One could also compare this to the OPALS study of ALS vs BLS. Americans who took this argument to be a support of EMT-Bs didn't realize that "BLS" where this study was done meant 1- 2 years of education and not 120 hours.


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## ResTech (Jun 22, 2009)

I am all for expanding skill sets and allowing more when proper training follows but BLS using glucometers is something I have always viewed as non-essential and a skill that will not alter the treatment plan of your patient.

As an EMT, what are you really gonna be able to do any differently having a numerical value of the patient's BG level? With a good assessment of the patient and their medical history and current meds, along with talking to family, 9 out of 10 times you can be sure a patient is having a hypoglycemic emergency without the glucometer. 

I know in my many years as a BLS provider on a BLS ambulance coming out of a fire station and ALS coming from the hospital as chase, a glucometer would not have affected my care of the many diabetic patients I cared for.


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## Scout (Jun 22, 2009)

Handy but not nessisary.

Glucojel can be given based on "known diabetic with ALOC". MOST of the time you can tell by the S+S and the way they present.


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## Aidey (Jun 22, 2009)

I think it can be helpful when determining care plans in pts that are maybe not fully symptomatic, or have an atypical presentation (ie the pt with a CC of hand weakness with no hx and a sugar of 54). It can also be very helpful in areas with BLS first response. I love it when I get on scene of the ALOC pt, or probably intoxicated pt, or postictal pt and the crew has already done a blood sugar. It allows me to formulate my differential diagnosis more efficently, and eliminate a possible potential issue.


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## ResTech (Jun 22, 2009)

Most medics will always repeat their own glucose check prior to ne treatment ne way.


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## Sasha (Jun 22, 2009)

Aidey said:


> I think it can be helpful when determining care plans in pts that are maybe not fully symptomatic, or have an atypical presentation (ie the pt with a CC of hand weakness with no hx and a sugar of 54). It can also be very helpful in areas with BLS first response. I love it when I get on scene of the ALOC pt, or probably intoxicated pt, or postictal pt and the crew has already done a blood sugar. It allows me to formulate my differential diagnosis more efficently, and eliminate a possible potential issue.



But you also have to remember that the glucometer may not always be correct and that patients may have different norms that don't fit into the 80-120 number and to not let the numerical number side track you.


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## TransportJockey (Jun 22, 2009)

Yes. NM has a more broad scope than some other states for their basics, so we do have a few invasive skills (IM/SQ, MLA, LMA)


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## MendoEMT (Jun 22, 2009)

Not allowed to do it where I'm at, although I think that's a load of toss.  I don't think a finger :censored::censored::censored::censored::censored: should be considered "invasive", it's certainly less invasive than cramming an NPA in someone's nose!  "Wake up sleepy!"

As far as giving oral glucose is concerned, as long as the pt can swallow I don't think giving it will hurt much, even if the pt is hyperglycemic as opposed to hypo.  The amount that a tube of oral glucose will raise a BG level isn't really a whole lot in the scheme of things so a person with a BG of 400 or up really won't be hurting because of it.  Besides, hyperglycemic emergencies tend to have a longer onset, whereas hypo is acute so getting a good history if possible is key, and getting some sugar into someone who you suspect may be running low can make a big difference in a hurry.  If a tube doesn't change their status then don't give 'em any more and quit standing around, bring their bum in.


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## TransportJockey (Jun 23, 2009)

MendoEMT said:


> Not allowed to do it where I'm at, although I think that's a load of toss.  I don't think a finger :censored::censored::censored::censored::censored: should be considered "invasive", it's certainly less invasive than cramming an NPA in someone's nose!  "Wake up sleepy!"
> 
> As far as giving oral glucose is concerned, as long as the pt can swallow I don't think giving it will hurt much, even if the pt is hyperglycemic as opposed to hypo.  The amount that a tube of oral glucose will raise a BG level isn't really a whole lot in the scheme of things so a person with a BG of 400 or up really won't be hurting because of it.  Besides, hyperglycemic emergencies tend to have a longer onset, whereas hypo is acute so getting a good history if possible is key, and getting some sugar into someone who you suspect may be running low can make a big difference in a hurry.  If a tube doesn't change their status then don't give 'em any more and quit standing around, bring their bum in.



All that depends on the patients weight, body structure, metabolism and other things. I would not trust any basic giving a diabetic glucose unless they can do some kind of glucose testing in the field. I've seen a hyperactive basic give glucose to someone they thought was 'a little low' (close to 90) and just that tube shot up the BGL to well past 350. Brittle diabetics can have very unpredictable results.


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## Ped101 (Jun 23, 2009)

We have a glucometer, and as someone said, while we don't rely 100% on it, we still have it as a back up to the diagnostic

But evaluating px. History, Medical Condition, Medications, Last Meal and Vitals, you can get the diagnosis


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## CAOX3 (Jun 23, 2009)

Yes it does.


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## WuLabsWuTecH (Jun 23, 2009)

We have oral glucose and a glucometer.

Just like any piece of equipment it has to be calibrated to make sure it's accurate and yes, it makes a difference.

Why are we giving oral glucose to someone with a blood sugar of 400?


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## rhan101277 (Jun 23, 2009)

They are on the trucks, but here in Mississippi EMT-Basic's can't use them.  If you happen to work in Alabama you can :wacko:

Otherwise you rely on signs and symptoms, history, ALOC etc. when giving oral glucose.


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## Captain 24 (Jun 23, 2009)

West Virginia 

According to the Protocols that we follow it states that the blood sugar reading must be below 80 in order to give oral glucose.  it does not matter weither if they are awake enough or not.  If they cant swallow you just put it between the cheek and gum.


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## Katie Elaine (Jun 23, 2009)

In the state of Connecticut, as basic level providers we are allowed to use a glucometer. Personally, I use it if the patient is showing AMS, ALOC, abnormal behavior, has a Hx, is showing standard S&S, or the call type asks for it (ie a fall). But there are other people on my department who tend to use it every call that there may be the slightest chance the patient is hypo- or hyperglycemic.

And we only administer oral glucose if the patient is alert and oriented, and can swallow. If the patient can't swallow I don't put ANYTHING into their mouth.

I actually went to an EMS conferance a few months ago, and many people were taken aback that CT EMT-Bs are allowed to do a finger stick, because it is "invasive."


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## boingo (Jun 23, 2009)

R/O hypoglycemia is important for pts suspected of CVA.  If you have the option of transporting to a stroke center v.s. the local hospital, obtaining a blood glucose would be beneficial.


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## WuLabsWuTecH (Jun 23, 2009)

Katie Elaine said:


> In the state of Connecticut, as basic level providers we are allowed to use a glucometer. Personally, I use it if the patient is showing AMS, ALOC, abnormal behavior, has a Hx, is showing standard S&S, or the call type asks for it (ie a fall). But there are other people on my department who tend to use it every call that there may be the slightest chance the patient is hypo- or hyperglycemic.
> 
> And we only administer oral glucose if the patient is alert and oriented, and can swallow. If the patient can't swallow I don't put ANYTHING into their mouth.
> 
> I actually went to an EMS conferance a few months ago, and many people were taken aback that CT EMT-Bs are allowed to do a finger stick, because it is "invasive."


Katie, imagine the looks I get when I tell doctors at the medical school attached to my undergrad institution that in Ohio we can intubate (Oral tracheal only, no nasal for us) and start CPAP!

What further confuses them is that I have no idea how to start a line or how to draw blood, something that EMT-B's can do in Missouri when under direct medical control (such as in the hospital they work at).

can CT basics give epi pens then or sub-Q epi or is that too considered invasive?


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## VentMedic (Jun 23, 2009)

WuLabsWuTecH said:


> Katie, imagine the looks I get when I tell doctors at the medical school attached to my undergrad institution that in Ohio we can intubate (Oral tracheal only, no nasal for us) and start CPAP!


I can only imagine what they think.   



WuLabsWuTecH said:


> What further confuses them is that I have no idea how to start a line or how to draw blood, something that EMT-B's can do in Missouri when under direct medical control (such as in the hospital they work at).


 
The EMT-Bs at the hospital are probably not working under their EMT-B cert. That would be way too limiting. Hospitals will usually only look at the EMT(P) certs as a proof that you have had some medical training. The hospital will then have a job description for the ER Tech which will meet the guidelines in their state for nonlicensed personnel and satisfy the requirements for the accrediting agencies geared toward hospitals and NOT prehospital.


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## PapaBear434 (Jun 23, 2009)

We can give glucose checks at our discretion, but we need to get a Doc's signature after the fact and be able to justify it.  Not that it matters though, as the Doc's usually take it, sign it without looking or asking why or what they are signing (goes for ALS too), and the signature is little more than a circular scribble that I could easily copy with very little effort.

Anyone with AMS gets a glucose check off the bat, so long as they're aren't any other obvious signs like a head wound or something.


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## Jac [ITA] (Jun 23, 2009)

Over here we don't use, as BLS, it but we have in the ambulance....


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## DHarris52 (Jun 23, 2009)

New Jersey

We carry oral glucose but are not permitted to take BGL. Go figure. Usually a family member is present and I give it the old "I'm not allowed to do it, but if you want to take his blood sugar while I run out to the rig to grab something, I can't stop you". Works every time.


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## VentMedic (Jun 23, 2009)

DHarris52 said:


> New Jersey
> 
> We carry oral glucose but are not permitted to take BGL. Go figure. Usually a family member is present and I give it the old "I'm not allowed to do it, but if you want to take his blood sugar while I run out to the rig to grab something, I can't stop you". Works every time.


 
Why are you running out to the rig?  Leaving the patient?

If the patient has his/her own machine a family member will probably be more than happy to do a stick if they haven't already.


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## JPINFV (Jun 23, 2009)

VentMedic said:


> Why are you running out to the rig?  Leaving the patient?
> 
> If the patient has his/her own machine a family member will probably be more than happy to do a stick if they haven't already.



This. Same thing with nursing/assisted living staff at facilities.


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## DHarris52 (Jun 23, 2009)

VentMedic said:


> If the patient has his/her own machine a family member will probably be more than happy to do a stick if they haven't already.




That'd be great...IF it wasn't illegal for us to ask them to do that.


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## LucidResq (Jun 23, 2009)

Colorado - Yes. 

EMT-Bs can use a glucometer, but "additional local training is recommended" and "medical directors shall ensure that indivduals performing these skills and acts obtain appropriate additional training." BGL via glucometer was taught in my EMT-B program. 

In CO, we also have EMT-B with IV authorization. EMT-B IVs are allowed to use glucometers and administer D50 in addition to other skills, drugs and fluids. Almost every working EMT-B has their IV auth., and it is required by every ambulance service and hospital I've checked out.


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## VentMedic (Jun 23, 2009)

DHarris52 said:


> That'd be great...IF it wasn't illegal for us to ask them to do that.


But you don't leave the patient once you've suggested this and made it clear that you are not allowed to do the procedure. 

Is it also illegal for you to ask the patient if they have an asthma inhaler that you can assist with? ASA? Nitro? Epi-pen?

Sometimes commonsense has to prevail.


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## JPINFV (Jun 23, 2009)

DHarris52 said:


> That'd be great...IF it wasn't illegal for us to ask them to do that.



Who said that it was illegal?

"BGL at patient contact time ____ per family/staff (as appropriate)."


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## DHarris52 (Jun 23, 2009)

VentMedic said:


> But you don't leave the patient once you've suggested this and made it clear that you are not allowed to do the procedure.



Huh?



VentMedic said:


> Is it also illegal for you to ask the patient if they have an asthma inhaler that you can assist with? ASA? Nitro? Epi-pen?



Nope, it's not.



VentMedic said:


> Sometimes commonsense has to prevail.



There's this little thing called "scope of practice".


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## VentMedic (Jun 23, 2009)

DHarris52 said:


> There's this little thing called "scope of practice".


 
It is not you doing the d-stick. It is the family and they are NOT under YOUR scope of practice.

You have the opportunity to get a number and the family may already suspect the problem. Are you actually going to turn down that piece of information and attempt to treat blindly by your limited EMT-B scope of practice?

And yes, you will still have to do an assessment even with the number.


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## Shishkabob (Jun 23, 2009)

It's not illegal.

It may be against your agencies policies / protocols, but it's nowhere near illegal.


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## CAOX3 (Jun 23, 2009)

Why wouldnt a medical director allow an EMT use of a BGL monitor?


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## Sasha (Jun 23, 2009)

CAOX3 said:


> Why wouldnt a medical director allow an EMT use of a BGL monitor?



i suspect it's the same reason some don't allow for pulse ox's. Lack of education.


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## Shishkabob (Jun 23, 2009)

Sasha said:


> i suspect it's the same reason some don't allow for pulse ox's. Lack of education.



On behalf of the doc, or the basic?

Honestly, no education is required for the use of BGMs or PulseOx.   What is required is some critical thinking, which admittedly some people lack, but still.


They have the interventions, but not the tools.  That's not safe.


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## CAOX3 (Jun 23, 2009)

Sasha said:


> i suspect it's the same reason some don't allow for pulse ox's. Lack of education.



I know the amount of education needed to operate a diagnostic tool is vast. 

Im guessing its financial.


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## JPINFV (Jun 23, 2009)

Operation  is easy. Interpetation is hard.


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## Freddy_NYC (Jul 1, 2009)

thank you everyone for your terrific replys!


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## scottmcleod (Jul 3, 2009)

JPINFV said:


> Operation  is easy. Interpetation is hard.



QFT (quoted for truth), But, recording vitals can help build a better history for ALS or the hospital.

Same reason an ECG/EKG strip on first arrival can be incredibly helpful to the hospital...


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## JPINFV (Jul 3, 2009)

That may be true to an extent, but you can't expect providers to get a number and just write it down and not use it. Same reason why basics in vast majority of the country can't obtain a 3/5/12 lead for the hospital later.


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## Shishkabob (Jul 3, 2009)

As I said in the post above---

Having the intervention without having the tool is dangerous.


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## JPINFV (Jul 3, 2009)

I would hardly call oral glucose an intervention worth crying about. That's like saying we shouldn't splint an arm unless we have an x-ray machine.


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## Shishkabob (Jul 3, 2009)

Because giving someone glucose that's hyperglycemic and causing a myriad of bad things to happen is so relatable to splinting an extremity.


Splints are preventative in nature.  Glucose is to fix a problem.


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## JPINFV (Jul 3, 2009)

You aren't going to cause any drastic problems by giving someone who is hyperglycemic oral glucose and if you have the ability to administer glucagon or IV dextrose, then you should have the education to use a BGL.


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## Shishkabob (Jul 3, 2009)

You should have the education to work the glucometer regardless.


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## JPINFV (Jul 3, 2009)

Are you suggesting that the current 110 hour EMT-B curriculum (soon to be replaced, though), is enough?


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## Shishkabob (Jul 3, 2009)

Nope.

I'm saying it's a tool and should be treated as such.  Poking someone with a stylet and using a glucometer won't kill anyone (unless your names WillBeFlight).



Now, USING that info is different.  That's where common sense comes in.



/me waits for the EKG comparison.


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## JPINFV (Jul 3, 2009)

...and my argument is that there is no real reason to use a tool, regardless of how easy it may be, if you, or someone in the immediate area (e.g. hospital technicians), can not use the information. Now using the information requires not just common sense, but also education.


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## Shishkabob (Jul 3, 2009)

But obviously basics CAN use the information gathered from a glucometer, can they not? 


This is why the glucometer cannot be compared to the EKG.


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## JPINFV (Jul 3, 2009)

If by obviously, you mean read  number, apply to set range, ignore individual variance, then yes. Of course, in that case, why not give basics pulse ox, capnography (hey, just use the number), and I-stats? After all, if it's just read number, compare to memorized range, have fun, then it shouldn't be an issue.


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## Shishkabob (Jul 3, 2009)

Now you're just putting words in my mouth.

Like I said-- common sense.  If BGL reads 50, but they are AOx4, then use (generic)your brain.








PS--- we do have pulse ox down here.  Like I said, it's a tool, not the final decision, and the doctors realize that.


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## Clibby (Jul 3, 2009)

Why couldn't you use it? MA is actually implementing BGL monitoring for basics via a state waiver.

You have a patient that has an AMS and is a known diabetic. The patient is still alert and able to swallow. Protocol says give him oral glucose. But what if its high blood sugar? Yeah the glucose will most likely not harm him. But what if its a hemorrhagic stroke, then you know it will. People react differently to strokes in different parts of the brain. On a more practical note, if your called to the patient who hasn't eaten, went running, AMS, no history of diabetes, but is able to swallow. According to protocol we cannot give this pt glucose, but with a glucometer reading that says 45 you bet we can. I know we are playing the what if game, but I don't see why we don't have it in the first place. (all patients I have encountered)

I just think this particular issue is one where talking about the education issue is ridiculous. If a doc can talk it through with a patient in 10 min, how come its such an issue here. I know the system needs to be revamped heavily, but this has little to do with BGL monitoring. We aren't talking about IV glucose, we are talking about oral glucose. As it is, protocol tells us to give it whether they need it or not if a diabetic has AMS. This isn't something that requires a whole lot of understanding. For the extra 20 minutes (max) it takes to understand the whole concept, it could be a tool for basics to help ease the burden of ALS in most areas.


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## JPINFV (Jul 3, 2009)

Clibby said:


> I just think this particular issue is one where talking about the education issue is ridiculous. If a doc can talk it through with a patient in 10 min, how come its such an issue here. I know the system needs to be revamped heavily, but this has little to do with BGL monitoring. We aren't talking about IV glucose, we are talking about oral glucose. As it is, protocol tells us to give it whether they need it or not if a diabetic has AMS. This isn't something that requires a whole lot of understanding. For the extra 20 minutes (max) it takes to understand the whole concept, it could be a tool for basics to help ease the burden of ALS in most areas.



Oh, this argument? You know, some patients are on ventilators at home. Heck, it's just a bunch of knobs and the basics can be taught to families for home care. Why not let EMT-Basics use ventilators?


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## Clibby (Jul 3, 2009)

For starters, there is no need. If we need to ventilate, we have a BVM. If they need a ventilator, then there is a serious underlying problem that needs an evaluation by a physician. I really don't understand the relevance of that post.


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## JPINFV (Jul 3, 2009)

I've never bought the entire, "Well, if it can be taught to lay people, why can't we do it?" line of reasoning. In the quoted part of my last reply, it looked like you were invoking that argument. Besides, not all emergency calls start in houses or businesses. What happens when you get called to the vent dependent patient at the local nursing home?


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## reaper (Jul 3, 2009)

You do understand that there are thousands of pt's on vents at there homes. If you are called to transport as a basic, do not take them off the vent, unless there is a malfunction. You can unplug the vent and transport with pt. You can plug the vent back into power, in the truck. If the settings get changed, have a family member assist you with it. They have more knowledge of the vent then you do.


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## JPINFV (Jul 3, 2009)

Not all home vents will fit in the ambulance. Of course that was why, at my old company, there were RTs on staff.


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## WolfmanHarris (Jul 3, 2009)

Linuss said:


> Now, USING that info is different.  That's where common sense comes in.



Common sense? Umm no. Common sense is not touching a hot stove, or not stacking fragile things in an upside down pyramid. I think you're talking about clinical judgment, which requires education and honing.

[YOUTUBE]http://www.youtube.com/watch?v=G2y8Sx4B2Sk[/youtube]


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## Clibby (Jul 3, 2009)

The line of reasoning is more along the lines of, if lay people can be taught how to do it, why can't we be taught how to do it if it provides a benefit and carries little risk to the patient? In the case of BGL monitoring, there is little downside, and only benefit. The only legitimate argument I can see is a cost vs. benefit argument.

Vent dependent patient: A. What was I called for? B. Why wasn't ALS at least dispatched as well. C. I would call Medical Control anyway.


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## JPINFV (Jul 3, 2009)

Why can't basics be required to take an actual anatomy and physiology course? (for that manner, why aren't paramedics required to take a real A/P course?) Now that would go a lot further in me feeling comfortable with expanding the score of practice for basics.


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## Clibby (Jul 3, 2009)

Sure, the system needs to be revamped. (Not this thread) I still don't see how knowing A&P would change anything in relation to taking a BGL measurement. Knowing A&P doesn't change glucose levels, nor the need or lack of a need for oral glucose. This isn't really expanding the scope of an EMT-B's responsibilities, it is giving them a tool to narrow a responsibility they already have. No basic is about to stick a patient and push D50, but if someone needs glucose, even if they aren't diabetic, we should be able to administer oral glucose. I guess that's technically an expansion, but I don't think its anything that puts patients at risk. 

We could go on and argue about different ways in which the EMS system should run, but that's a different thread and quite frankly I hate getting into it on a forum.


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## Shishkabob (Jul 3, 2009)

JP,

I agree, A&P is a necessity for EMS provider, but please, tell me how A&P, knowing how alpha and beta cells work, and the role of the pancreas will in anyway effect your decision about a D-stick?

It shouldn't.

As far as a basic is concerned with, hate to say it "most protocols";
Low BS and AMS? Most likely oral glucose.
Low BS but no AMS?  Chances are no oral glucose.
High BS and AMS?  No glucose.


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## VentMedic (Jul 3, 2009)

Clibby said:


> For starters, there is no need.* If we need to ventilate, we have a BVM.* *If they need a ventilator*, then there is a serious underlying problem that needs an evaluation by a physician. I really don't understand the relevance of that post.


 
If you are bagging a patient, they will need a ventilator so that patient DOES HAVE a serious problem. This can go either for a chronic or an acute patient.

I've already seen some serious errors with the use of the ATV due to improper education and training.  If the AHA is pushing for it on the trucks, THEY should be helping EMS agencies beef up the education.


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## Shishkabob (Jul 3, 2009)

VentMedic said:


> I've already seen some serious errors with the use of the ATV due to improper education and training.




What such errors?


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## VentMedic (Jul 3, 2009)

Pneumothoraces and hemodynamics bottomed out due to over inflation for starters.


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## Shishkabob (Jul 3, 2009)

Oh, ATV, nevermind I somehow read BGC and was confused when I saw pneumothorax...


^_^


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## Afflixion (Jul 3, 2009)

Freddy_NYC said:


> Does your BLS protocal include glucose monitoring finger-stick? New York City doesn't have one. I'm trying to understand why? If your BLS protocols include glucose finger-sticks do you find it to be necessary and accurate?



At both services I worked for yes they did. I believe it was necessary and as far as accuracy goes that was dependent on if our supply calibrated them properly or not. Bear in mind both services I worked for were 911. We did not have basic/ basic trucks. In Tucson we had medic/ basic or intermediate only, in El Paso (county) we had medic/basic or intermediate and more often than not intermediate/ basic trucks. El Paso county is VERY short staffed (or was) on medics the service had maybe about 4 on the schedule full time. The role of the basic is to assist the medic and the ability for a basic to perform glucose monitoring and SPO2 monitoring was maybe not so much necessary as much as convenience  as it frees medics to perform other tasks providing better quality patient treatment.

How has this topic gone from asking about glucose monitoring to ventilators and EKGs? I'm sure the drastic jump occurred somewhere but I'm not going back to reading all that fun stuff.


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## LucidResq (Jul 3, 2009)

Afflixion said:


> in El Paso (county) we had medic/basic or intermediate and more often than not intermediate/ basic trucks.



Texas or CO?


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## Afflixion (Jul 3, 2009)

El Paso, TX and Tucson, AZ sorry left out states forgot there are multiple other towns with same names.


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## VentMedic (Jul 3, 2009)

Afflixion said:


> How has this topic gone from asking about glucose monitoring to ventilators and EKGs? I'm sure the drastic jump occurred somewhere but I'm not going back to reading all that fun stuff.


 
Because again all the medical things are reduced to "skills" with very little education, training or knowledge. "I can poke a finger and put the blood into a machine just as good as anybody with a license". "I can turn a knob on a ventilator too". "I can put 10 little stickies on a chest and get a pretty picture".


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## Afflixion (Jul 3, 2009)

VentMedic said:


> Because again all the medical things are reduced to "skills" with very little education, training or knowledge. "I can poke a finger and put the blood into a machine just as good as anybody with a license". "I can turn a knob on a ventilator too". "I can put 10 little stickies on a chest and get a pretty picture".



I do realize the importance of trying to get away from the whole "skills" aspect of EMS. My point was that If I'm busy doing something else why shouldn't I be allowed to have a basic get a glucose reading or SPO2 reading? It's not as though they are interpreting it.


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## Shishkabob (Jul 3, 2009)

I have yet to see a single realistic argument as to why a basic shouldn't do a BGL test.  Mainly just "Not enough A&P"



If you want to fight, fight the oral glucose.  Fight the thing that can effect the outcome, not the tool that can *help* you decide if it's the right move or not.


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## Afflixion (Jul 3, 2009)

Linuss said:


> I have yet to see a single realistic argument as to why a basic shouldn't do a BGL test.  Mainly just "Not enough A&P"
> 
> 
> 
> If you want to fight, fight the oral glucose.  Fight the thing that can effect the outcome, not the tool that can *help* you decide if it's the right move or not.



I agree a basic should be allowed to obtain glucose readings(depending on the situation at hand). A lot of people seem to think of the basic as a provider when they are to assist the medic, at least in my neck of the proverbial EMS woods. As the medic is the provider the basic should not be doing the interpreting. Granted different areas are run differently with BLS only rigs and such but that brings up why you A ) need to standardize EMS or B ) have different protocols for different ares.


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## VentMedic (Jul 3, 2009)

Someday all the EMT-Bs and Is will just have to stop making excuses for not getting their Paramedic patch...Period.    Then there would not be such a shortage as described above.   What is the problem?  Too much education? Too much responsibility?   The program to be a Paramedic is only a few hundred hours. It is not a 4 year degree.   What is with all the whining just to do a BGL?  That patient still deserves the benefit of a Paramedic assessment and whatever knowledge/skills that Paramedic has to offer.   The ideal situation is still a two Paramedic truck and then there is a possibility of that service advancing to hypothermia and RSI protocols rather than catering to a mixed crew and the lowest denominator dragging them down.


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## Shishkabob (Jul 3, 2009)

Not debating that one bit Vent (hence why I'm in medic school)


But if someones going to argue to take something away, they need a valid reason, and not just fall back on "Basics don't have A&P"


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## Afflixion (Jul 3, 2009)

VentMedic said:


> Someday all the EMT-Bs and Is will just have to stop making excuses for not getting their Paramedic patch...Period.    Then there would not be such a shortage as described above.   What is the problem?  Too much education? Too much responsibility?   The program to be a Paramedic is only a few hundred hours. It is not a 4 year degree.   What is with all the whining just to do a BGL?  That patient still deserves the benefit of a Paramedic assessment and whatever knowledge/skills that Paramedic has to offer.   The ideal situation is still a two Paramedic truck and then there is a possibility of that service advancing to hypothermia and RSI protocols rather than catering to a mixed crew and the lowest denominator dragging them down.



Strong words. I will concede to your point, there is no reason for the whole EMT alphabet. If they just scrapped the Intermediate and Basic altogether you will lose those who don't care enough to further advance themselves and their careers and you will have none of this ridiculous banter about "what skills should  BLS be able to perform." I will freely admit that I went to a medic mill and that I am not the most educated medic around and though I kick myself every time I think about it, I did take the next step and am currently working on fixing the education problem.


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## JPINFV (Jul 3, 2009)

Linuss said:


> Not debating that one bit Vent (hence why I'm in medic school)
> 
> 
> But if someones going to argue to take something away, they need a valid reason, and not just fall back on "Basics don't have A&P"



How about if we're trying to add something, the argument goes past, "Well, the technical skill is so easy a caveman can do it."


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## JPINFV (Jul 3, 2009)

Afflixion said:


> The role of the basic is to assist the medic and the ability for a basic to perform glucose monitoring and SPO2 monitoring was maybe not so much necessary as much as convenience  as it frees medics to perform other tasks providing better quality patient treatment.



Really? Who, exactly, am I assisting when there isn't a medic on my unit? If the medic is there, then yes, but a medic isn't always present.


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## VentMedic (Jul 3, 2009)

Linuss said:


> But if someones going to argue to take something away, they need a valid reason, and not just fall back on "Basics don't have A&P"


 
EMT-Basics are trained primarily for first-aid and have very little "training" or education about and for medical emergencies which actually makes them a poor choice for even doing dialysis or NH transfers.


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## Afflixion (Jul 3, 2009)

JPINFV said:


> Really? Who, exactly, am I assisting when there isn't a medic on my unit? If the medic is there, then yes, but a medic isn't always present.



Nice way to cut out the rest of the quote.



> Granted different areas are run differently with BLS only rigs and such but that brings up why you A ) need to standardize EMS or B ) have different protocols for different ares.


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## JPINFV (Jul 3, 2009)

VentMedic said:


> EMT-Basics are trained primarily for first-aid and have very little "training" or education about and for medical emergencies which actually makes them a poor choice for even doing dialysis or NH transfers.



Actually, I've taken a different view. EMT-Bs are poor for NH/dialysis because we have very little education in chronic disease, basic patient care, and body mechanics.


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## Clibby (Jul 3, 2009)

I'm not whining, my reason is that by the time I would finish medic school, I will hopefully be in medical school. I just don't understand the problem with basic's having a BGL test as a tool to assess whether to give the oral glucose they already are certified to give. I have worked for a company that uses them and it has come in handy a few times for basics.

Quite frankly there should be 2 levels EMT and Paramedic. EMT should cover all the skills of EMT-I and be able to prep a patient for a medic and treat simple diabetic emergencies. That way a medic will still be able to have experience in EMS before they are allowed to be educated how to give drugs; then licensed to provide care. EMS will not be able to move forward as its own profession until those involved are licensed and forced to act upon their license, not their protocols under the license of someone else.  

So there you have my opinion, but nothing changes the fact that I think the arguments so far against basics having them are not very good ones.


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## Shishkabob (Jul 3, 2009)

JPINFV said:


> How about if we're trying to add something, the argument goes past, "Well, the technical skill is so easy a caveman can do it."



Again, arguing a tool over an intervention is rather strange.  Tools make no change in condition by themselves.  Interventions do.  


If a medic were to push Adenosine without first looking at an EKG, he'd be called dangerous.  Why is it some of you want basics to administer glucose without first checking a BGC?


See where the silliness comes in?


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## Afflixion (Jul 3, 2009)

Clibby said:


> I'm not whining, my reason is that by the time I would finish medic school, I will hopefully be in medical school. I just don't understand the problem with basic's having a BGL test as a tool to assess whether to give the oral glucose they already are certified to give. I have worked for a company that uses them and it has come in handy a few times for basics.
> 
> *Quite frankly there should be 2 levels EMT and Paramedic. EMT should cover all the skills of EMT-I and be able to prep a patient for a medic and treat simple diabetic emergencies. That way a medic will still be able to have experience in EMS before they are allowed to be educated how to give drugs; then licensed to provide care*. EMS will not be able to move forward as its own profession until those involved are licensed and forced to act upon their license, not their protocols under the license of someone else.
> 
> So there you have my opinion, but nothing changes the fact that I think the arguments so far against basics having them are not very good ones.



Why 2 levels? You state so they are educated prior to administering drugs but  what about nurses? They do have "two levels" per say with the LVN and RN (which is in the process of being phased out but most RNs were  never LVNs prior and seem to do just fine. having two levels in EMS will not accomplish much and will still be sacrificing patient care.


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## Clibby (Jul 3, 2009)

Why? Because a typical paramedic doesn't have a good enough education to treat patients without help effectively when they come out of medic school.  Pre-hospital medicine is different than hospital medicine. Just look at nurses for instance. Part of pre-hospital medicine often involves rescue and the logistics of moving patients that nurses don't have to worry about.  When a nurse begins working in a hospital, s/he is part of a team. There are many other nurses around the new nurse to show her the ropes. The best part is ultimately, the doctor makes the call. See with nurses they are not the one directing care, they are part of a team lead by a doctor. This is why it is so competative for a nurse to shift to pre-hospital medicine such as med-flight. There are other classes they must take and it is preferred that they are also paramedics.

Lets look a doctors who are in charge of patient care. Not only do they have a base education during undergrad, but they have medical school, and at least one residency before they are licensed to provide care on their own. Now their scope is much higher, but you see the how they have a progression where they work under an experienced provider before doing so on their own. 

Now paramedics are by no means doctors, but they must make calls in the field on their own; without a team around them. In order to do so, I believe they need to see it done, then do it in school, then they should be eligible to be licensed. While paramedics are part of the overall health care team, in the field they often are the ones making the calls. 

The other reason I have for the two tiered system is that if EMTs were phased out, we would be even more understaffed than we already are. Boston may be okay with staffing, but the rural areas would be devastated. Especially since licensing paramedics would require more education such as preferably a B.S. in Para-Medicine, but a A.S. minimum in a college setting.


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## VentMedic (Jul 3, 2009)

Clibby said:


> See with nurses they are not the one directing care, they are part of a team lead by a doctor. This is why it is so difficult for a nurse to shift to pre-hospital medicine such as med-flight. There are other classes for that.


 
Careful. RNs *know* their 2 or 4 years of education is just the beginning. Some EMT(P)s believe their training is the end all to all education and there is little more they need to know. Meanwhile, nurses gain initial experience while deciding on a specialty. They can have as much or as little responsibility as they want but they are adequately prepared through education and experience. RNs also have little problem making the shift to prehospital because they take the responsibilty seriously. When we fly to another country to pick up a sick child, there is not a doctor telling us what to do. Nurses may also have been lead on Code and Rapid Response teams which also may not have a doctor readily available. Actually, one reason why a Rapid Response team was created in some hospitals was the lack of an available doctor. Paramedics on the other hand have a very difficult time if they join a Flight team that does IFT because they have no ICU experience to draw from. Many also do not have a solid education experience to build from. 

A Flight RN can usually challenge the Paramedic exam but still keep the RN seat. A Paramedic who wants to be a Flight RN must complete the education required which is at least a 2 year degree, 4 preferred, and then obtain 3 - 5 years of ICU experience before they can apply as a Flight RN even if they are working for that company as a Paramedic. Essentially the 5 years of experience better prepares the RN for Flight than the 3 years of EMS for the Paramedic in many places. Learning the ropes for the field is not that difficult if you are already accustomed to working at least two high acuity patients every shift for several years or managing 10 -15 floor or ED patients when the RN floats. 

A med flight does NOT put new RNs on board and rarely puts new Paramedics on. However, some HEMS run with the same protocols as the ground without any extra skills or responsibilty.



> Now paramedics are by no means doctors, but they must make calls in the field on their own; without a team around them.


They also have a doctor who is just a phone call away. They also have protocols or in some cases recipes that pretty much spell everything out. In many areas a Paramedic can not fart without calling for permission. Also, some have a very limited scope with few meds. CA is an example which is why an MICN does the CCTs there and their flight teams are usually RN/RN.


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## daedalus (Jul 3, 2009)

JPINFV said:


> Actually, I've taken a different view. EMT-Bs are poor for NH/dialysis because we have very little education in chronic disease, basic patient care, and body mechanics.



Thats my stance as well.


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## Clibby (Jul 3, 2009)

That's why I corrected my wording to competitive as soon as I read my own words.

Inevitably the doc is in charge of every patient, but I'm talking about if a patient is in cardiac or respiratory arrest. Who is making the call about the next move in an ambulance? The paramedic is, even if he is only following protocols. But then again I think we need to move towards licensing them.

That's pretty much what I was trying to say about nursing Vent. When a nurse enters the hospital and decides they want to go into pre-hospital medicine they have to educate themselves to get there. 

I was by no means trying to insult nurses. My point was that pre-hospital and hospital medicine are different. On an ambulance, the paramedic is in charge. In flight if a doc isn't riding, a nurse is in charge. This is different than being in a hospital where the doc is making the call on every patient.


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## VentMedic (Jul 3, 2009)

Clibby said:


> This is different than being in a hospital where the doc is making the call on every patient.


 
No a doctor is not always present 24 hours a day. RNs are expected to follow protocols and titrate drips their entire shift and may not even see a doctor. 

As for the Paramedic, sometimes the education by "hours", which in some states is very minimum, coupled with poor mentorship on the job scares the hell out of me when you think about what they are allowed to do. Many come out of school lacking the preparation and some have not even intubated a live patient. Yet, they get the patch and after a brief orientation of their protocol book, they are allowed to do patient care on their own. It doesn't mean they are proficient. RNs at least respect the words competency and proficient before accepting a patient that is out of their comfort zone. Some Paramedics come out of school without knowing what they don't know. 

This article gets circulated occasionally and while I do not agree with it for the future of the Paramedic, much of what it states is how many ALS agencies and their Medical Directors think. If you go over to the Fire forums, and this is not a bash by any means on FFs, you can read some of their comments on being a Paramedic. Most think it is just another cert or hurdle to get hired or advanced and it is no big deal. And, even with that attitude many still perform as a Paramedic very well because they do the skills as written. 

http://www.fd-doc.com/2000Hours.htm


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## daedalus (Jul 3, 2009)

VentMedic said:


> No a doctor is not always present 24 hours a day. RNs are expected to follow protocols and titrate drips their entire shift and may not even see a doctor.
> 
> As for the Paramedic, sometimes the education by "hours", which in some states is very minimum, coupled with poor mentorship on the job scares the hell out of me when you think about what they are allowed to do. Many come out of school lacking the preparation and some have not even intubated a live patient. Yet, they get the patch and after a brief orientation of their protocol book, they are allowed to do patient care on their own. It doesn't mean they are proficient. RNs at least respect the words competency and proficient before accepting a patient that is out of their comfort zone. Some Paramedics come out of school without knowing what they don't know.
> 
> ...


Holly crap! Wow, I feel reduced to an idiot now...

That article SUCKS.


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## VentMedic (Jul 3, 2009)

daedalus said:


> Holly crap! Wow, I feel reduced to an idiot now...
> 
> That article SUCKS.


 
Getting back to the topic with the BLS and EMT discussion, do you see any similarities?

Some are arguing just for a simple skill and recipe rather than knowing why because they just do it and there is no need to go beyond that one point.


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## Clibby (Jul 3, 2009)

I agree with you Vent. I worked with a few medics who scared the hell out of me, and I'm a basic. The problem is that until EMS providers are paid more, EMS will not attract higher quality career providers, and until we attract more and better career providers the standards will not be able to improve without losing too many people to sustain the current system. We really grew out of fire departments and are still burdened by it. (That doesn't mean all firefighters are bad medics, but EMS needs to be its own profession if we are to advance)

The article is an interesting read, but that's not where the profession needs to go. The ED is burdened enough as it is and currently basics call for ALS for most patients that really do need to go to the hospital.


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## medic417 (Jul 3, 2009)

daedalus said:


> Holly crap! Wow, I feel reduced to an idiot now...
> 
> That article SUCKS.



I second that.  The author should be decertified immediately.


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## VentMedic (Jul 3, 2009)

Clibby said:


> We really grew out of fire departments and are still burdened by it. (That doesn't mean all firefighters are bad medics, but EMS needs to be its own profession if we are to advance)


 
But in many areas it is the FDs pushing for ALS.  Granted they may have their own agendas but some areas would still be all volunteer BLS ambulances if the FDs has not taken the reins.  Unfortunately it would be the EMTs on the BLS squad that would be arguing their care is more than adequate and may have never pushed the issue thus giving the FD an open door.


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## Medic744 (Jul 3, 2009)

We have it in the protocols for Basics here but do not run BLS trucks unless it is a rare volunteer truck.  They are nice to have as a tool to point you in the right direction (if its working correctly) but we treat the patient not the equipment.


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## Shishkabob (Jul 3, 2009)

2,000 hours for Ohio?

Texas only requires 624


So... Texas' medics are 1/3 of Ohio medics?    :unsure:


LUCKILY, my class isn't the minimum.


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## daedalus (Jul 3, 2009)

VentMedic said:


> But in many areas it is the FDs pushing for ALS.  Granted they may have their own agendas but some areas would still be all volunteer BLS ambulances if the FDs has not taken the reins.  Unfortunately it would be the EMTs on the BLS squad that would be arguing their care is more than adequate and may have never pushed the issue thus giving the FD an open door.



 You must feel secure with another license. I am jealous. When people write articles like that t worries me than I am investing 1500 plus hours and a few thousand bucks, plus all the other classes I took to get a Paramedic AS degree when my future colleagues might have 200 hours of training.


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## Clibby (Jul 3, 2009)

That's the reason EMS grew out of fire departments. They have the funding and the influence. The problem is that its not always about patient care. Again I go back to the fact that you will not be able to significantly change the system until you attract better providers. Currently the good ones go to become RNs, respiratory therapists, etc because not only are they respected more, but they are paid significantly better. The other reason is that there is nowhere to go from paramedic: there is no upward mobility, nor is it easy to transfer knowledge to other professions to do so in another field such as nursing. If it was a degree program, the latter could be addressed. Basically, we need to attract better providers and hold on to them.


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## LucidResq (Jul 3, 2009)

Linuss said:


> Texas only requires 624



Holy!

I'm going to be doing a minimum 650 hours of clinicals alone, never mind lecture.


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## VentMedic (Jul 3, 2009)

Clibby said:


> That's the reason EMS grew out of fire departments.


 
Except for Freedom House Ambulance, the Paramedic program had its roots in the FD because of response time to the patients.   The doctors thought they could teach a few advanced life saving skills to those who could get there quicker.   Even in the 1960s the idea was for a Paramedic responder since there were already people with similar training to the EMT providing first-aid in many areas.   It was not the intent for EMS to remain at a "BLS" level of care. 



> Currently the good ones go to become RNs, respiratory therapists, etc because not only are they respected more, but they are paid significantly better.


 
They are paid better because the education requirements are higher for entry level and that has also provided them a stance with the insurers for reimbursement. 

How can you compare a 4 year college degree or even a 2 year degree with 634 hours of training?


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## Shishkabob (Jul 3, 2009)

LucidResq said:


> Holy!
> 
> I'm going to be doing a minimum 650 hours of clinicals alone, never mind lecture.



My school requires a minimum of ~400, but of course I'll be doing more.


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## joshellis625 (Jul 3, 2009)

we have a glucometer in each ambulances O2 bag (that's what we call it).


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## Clibby (Jul 3, 2009)

You can't and not all programs are the same. The best way is to start by moving all training to educational institutions (colleges). Even a certificate program from a collage is going to be of a higher quality because the courses are taught to a standard. Currently there is no standard other that being able to pass a test.

BTW how did we digress so far. As to the topic itself my position still stands: As long as basics are giving oral glucose, which they should be allowed to, there is nothing wrong with giving them the tool to determine whether the treatment they are about to give is necessary. BGL testing should be a BLS skill.


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## jtb_E10 (Jul 3, 2009)

thats a negative in Indiana....only EMT-Advanced and up can here...


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## VentMedic (Jul 3, 2009)

Clibby said:


> BGL testing should be a BLS skill.


 
How I hate the term BLS or even ALS. One should not look at patient care in these terms. Patients deserve better than to be labeled by these EMS terms that only serve to provide job security for the lowest common denominators.



jtb_E10 said:


> thats a negative in Indiana....only EMT-Advanced and up can here...


 
Or to add another cert to the 50+ that already exist.


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## CAOX3 (Jul 5, 2009)

VentMedic said:


> How I hate the term BLS or even ALS. One should not look at patient care in these terms. Patients deserve better than to be labeled by these EMS terms that only serve to provide job security for the lowest common denominators.
> 
> Or to add another cert to the 50+ that already exist.



I agree it should be referred to as patient care, as far as job security there is about two-hundred people below me.


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## JonTullos (Jul 5, 2009)

In Mississippi a Basic can't check BGL because the state considers it an invasive procedure.  My instructors think this is stupid, most medics think it's stupid and I think it's stupid.  I've known how to check BGL since I was a kid (I'm hypoglycemic).  It's not like it's complicated so I don't get it.  Oh well.


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## rmellish (Jul 5, 2009)

JonTullos said:


> In Mississippi a Basic can't check BGL because the state considers it an invasive procedure.  My instructors think this is stupid, most medics think it's stupid and I think it's stupid.  I've known how to check BGL since I was a kid (I'm hypoglycemic).  It's not like it's complicated so I don't get it.  Oh well.



Playing devil's advocate here, but how would a BGL reading change your interventions as a basic?



jtb_E10 said:


> thats a negative in Indiana....only EMT-Advanced and up can here...



But advanced emts still can't administer anything but oral glucose, so it really doesn't change a whole lot in your treatment of an unresponsive, or severely altered patient. You'd still be requesting a medic and/or moving towards definitive care. 

The capability isn't bad thing to have, especially if you already have a flash chamber full of blood to test on. The ER will generally check it again as part of their assessment though. 



VentMedic said:


> Or to add another cert to the 50+ that already exist.



Yeah, scary thing is that it's classified as ALS up here.


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## Katie Elaine (Jul 5, 2009)

WuLabsWuTecH said:


> can CT basics give epi pens then or sub-Q epi or is that too considered invasive?



We can give epi pens, nothing sub-Q though.


Doing a BGL check isn't going to change my treatement by a whole hell of a lot, but it will give an indication on what I'm dealing with, and whether or not to administer Oral Glucose. Granted, if the pt is so far gone that they cant swallow, then it's not going to matter. I'm always going to contact a medic if its a diabetic-related emergency and the call calls for a medic, but getting a BGL reading sometimes helps narrow down what the issue may be and how to go about the issue. But I also do not go stricktly off of the 80-120 rule. If my pt has a 75 blood sugar reading, I'm not going to load them up on oral glucose.


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## firemoose0827 (Jul 7, 2009)

rmellish said:


> Playing devil's advocate here, but how would a BGL reading change your interventions as a basic?



Just makes it quicker for the arriving medic, he/she already has a reading now they can do their job faster, instead of wasting another 5 minutes to grab a reading.





> *But advanced emts still can't administer anything but oral glucose, so it really doesn't change a whole lot in your treatment *of an unresponsive, or severely altered patient. You'd still be requesting a medic and/or moving towards definitive care.



What is the protocol for your state for ALS providers?  Advanced EMT's in my state can push Dextrose IV, so it does change the treatment of the patient.  Just to remind you to think outside the box a little, and think about different states having different protocols.  Stay safe everyone, and hello by the way!  Im brand new here and looking forward to chatting with you all.


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## rmellish (Jul 7, 2009)

In terms of scope of practice, I was referring to advanced EMTs in my state. 

And it takes less than a minute to get a BGL reading. Trust me, I'm all for expanding the scope, but with all other factors remaining the same, adding BGL for basics wouldn't change a whole lot in terms of patient care.


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## firemoose0827 (Jul 7, 2009)

rmellish said:


> In terms of scope of practice, I was referring to advanced EMTs in my state.
> 
> And it takes less than a minute to get a BGL reading. Trust me, I'm all for expanding the scope, but with all other factors remaining the same, adding BGL for basics wouldn't change a whole lot in terms of patient care.



Well said.  We all have our opinions, and I am not trying to change yours in any way.  Just simply stating that the introduction of BGL wont hurt anything either, so why not at least let them obtain a reading and use it as another diagnostic tool to better attempt to diagnose what the underlying medical problem is.  The more info we obtain for the ER the better, after all, we are an extension of the ER and they "Guide" us via med control, so why not try to get as much as we can in the field, if not for immediate use than for an ongoing assessment of the patients condition.  Good points, thanks for the chat.


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## JPINFV (Jul 7, 2009)

firemoose0827 said:


> What is the protocol for your state for ALS providers?  Advanced EMT's in my state can push Dextrose IV, so it does change the treatment of the patient.  Just to remind you to think outside the box a little, and think about different states having different protocols.  Stay safe everyone, and hello by the way!  Im brand new here and looking forward to chatting with you all.



Wait. You have providers pushing dextrose who aren't allowed to take a BGL?


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## ResTech (Jul 7, 2009)

A BG level wont really be of any time savings if done by BLS.... all of the ALS providers I have ran with have all said they would do their own BG level check with their services glucometer before administering any treatment. And I agree.


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## VentMedic (Jul 7, 2009)

ResTech said:


> A BG level wont really be of any time savings if done by BLS.... all of the ALS providers I have ran with have all said they would do their own BG level check with their services glucometer before administering any treatment. And I agree.


 
This is the same for the ED.  As well, emergent glucometer results are checked with a value from the hospital lab.


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## Ridryder911 (Jul 7, 2009)

I say let the basics check glucose the old fashioned way.... check the urine.. per taste.


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## Shishkabob (Jul 7, 2009)

Ridryder911 said:


> I say let the basics check glucose the old fashioned way.... check the urine.. per taste.



Sorry, not enough A&P!  Only for advanced providers!  ^_^


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## reaper (Jul 7, 2009)

I tried to teach that to the EMT students, but they would not do it! What's up with the new kids, no real medical skills! hehe


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## firecoins (Jul 7, 2009)

Freddy_NYC said:


> Does your BLS protocal include glucose monitoring finger-stick? New York City doesn't have one. I'm trying to understand why? If your BLS protocols include glucose finger-sticks do you find it to be necessary and accurate?



NYC doesn't have one because the triage nurse will do it after the 5 minutes it takes you to transport.


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## TotowaEMT (Jul 8, 2009)

like someone said before..in NJ we dont carry them, but we carry oral glucose.  indication for oral glucose is diabetic history with altered mental status.  contraindication is they are too "out of it" to swallow.  lots of times the family is there and knows how to check the BGL with their monitor, I have no issue with letting them do it, but the number doesn't really mean anything to me.


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## daedalus (Jul 8, 2009)

Ridryder911 said:


> I say let the basics check glucose the old fashioned way.... check the urine.. per taste.



I love it!


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## CAOX3 (Jul 8, 2009)

daedalus said:


> I love it!



You love it?  Tasting urine?  

To each his own I guess.

We do carry them and we record a BGL before and after all treatment of diabetic patients  CQI.


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## JPINFV (Jul 8, 2009)

[YOUTUBE]http://www.youtube.com/watch?v=1VDdZ1xD6Yw[/YOUTUBE]

Unfortunately, I can't find the actual clip from Dodgeball.


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## timmy84 (Jul 13, 2009)

WOW you guys can really hit all the points on this forum!  LOL  I don't know about invasive though... I do plenty of glucose sticks a day as a CNA on a surgical floor... many more if I am pulled to the ICU.  Just my newbie couple cents.


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## firemoose0827 (Jul 14, 2009)

JPINFV said:


> Wait. You have providers pushing dextrose who aren't allowed to take a BGL?



Where did I state that?

In New York, we have the following levels;
EMT Basic-  vitals, backboard, collar, bleeding control, fracture management, SPO2, Emergency Child Birth, Oxygen, Assist with Patients ASA, NTG, and Epi Pens, Blood Glucose Monitoring after being cleared by Med Control Doctor.

EMT-Intermediate (EMT-I) can do all above plus intubate and start IV.

EMT-Critical Care (EMT-CC) can do all the above plus drugs, ECG reading, Manual defib, cardiovert, pace, needle chest decompression, IO lines.  Just cant push Pitocin and do emergency cricothyrotomy (Sorry, spelling is horrible!)

Paramedic-  All above plus use of pitocin and cricothyrotomy. 

May have missed a few things but thats the basics of what can be done by whom.  My question was for the gentleman that asked why an "Advanced EMT" could use the BGL if they couldnt do anything for the pt.  Advanced people here CAN by pushing D50 IV.


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## firemoose0827 (Jul 14, 2009)

ResTech said:


> A BG level wont really be of any time savings if done by BLS.... all of the ALS providers I have ran with have all said they would do their own BG level check with their services glucometer before administering any treatment. And I agree.



Well thats fine.  But with my hospitals in the area I work, they love to get all the info they can from EMS to use as a timeline of the patients condition.  Check the progression of events and the severity of the signs and symptoms from the time EMS picked them up to the current time.  If we provide BG level, SPO2 readings pre and post O2 administration, lung sounds pre and post O2, all of these diagnostic checks and tools will assist the ED in making an accurate diagnosis, and I have been told this by nurses and ED docs.  So I grab the reading all the time.  Just the way we do it and I was expressing my opinion.
Stay Safe


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## Seaglass (Jul 14, 2009)

One county I'm in: no. (But we can use blood if we didn't draw the blood ourselves, oddly enough.) But we can feed them oral glucose if indicated.
Another county: yes.


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## JPINFV (Jul 15, 2009)

firemoose0827 said:


> Where did I state that?



Bah... I misread your original post.


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## firemoose0827 (Jul 15, 2009)

JPINFV said:


> Bah... I misread your original post.



No problem.  Stay Safe.


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