Blood Glucose Testing Protocols/Standing Orders

My motivation for wanting it is as a time saving tool, because I dont know how many times ive had an ER nurse get mad at me for showing up to the ER and not having a sugar reading even after telling the nurse in my report that we are a BLS transport. So if we could grab a quick number and have it read for the ER it would save time in treating the PT once we arrive. also in my county, our protocols dictate we cant transport blood sugars below a certain level, but we can transport ALOC on BLS, so if its an ALOC because of a sugar issue and we transport then technically we are violating protocol because we done know what the sugar level is. I mean sure I admit we could live with out it, but if its available why not have the one more piece of the puzzle. So basically its not that we have to have it, but more like why should we have it. And i know everyone has the argument is it wont change our treatment when at least the way I see it, it can, like in administering oral glucose. Cause if a pt is a known diabetic that can swallow and all that jazz we can administer oral glucose. but say we do a finger stick and their sugar is fine, then we can save the pt from having to swallow that nasty stuff and we have one more piece of info to give the ER when we arrive.
 
Okay. Seems you guys out there work a bit differently than we do--and my area of response was the basis of my argument. It may not be applicable in all locales.

Here, if they're altered, they're supposed to be ALS anyway, so it's really out of a B's hands. PA pretty much makes you upgrade everything the other side of a cannula, a 4x4 and a SAM splint (and some locales, even the SAM splint is pushing it).

My fault for not taking local differences into consideration.


Later!

--Coop
 
MowingMonk,
I think I work in the same county as you. When I work BLS and it's an interfacility transport from a nursing home, and I feel that a BSL is indicated, I'll ask the nursing staff to take one last check on the glucometer. That way at least you can document a recent BSL done by the on-scene staff. I've never had a problem from the NH staff when I've asked this.

Incidentally, when I've worked BLS and take patients to the ER, I've never had a nurse poo-poo me for not getting a blood sugar...if they ask I usually let them know we're not a paramedic ambulance and they're cool with that. If this is a persistent problem you might want to tell your chain of command...have an EMS coordinator mention it to the nurse manager on site that hey, our County doesn't let us do what Title 22 is suppose to allow us to do so stop talking smack to our EMTs!
 
Markhk said:
MowingMonk,
I think I work in the same county as you. When I work BLS and it's an interfacility transport from a nursing home, and I feel that a BSL is indicated, I'll ask the nursing staff to take one last check on the glucometer. That way at least you can document a recent BSL done by the on-scene staff. I've never had a problem from the NH staff when I've asked this.

Incidentally, when I've worked BLS and take patients to the ER, I've never had a nurse poo-poo me for not getting a blood sugar...if they ask I usually let them know we're not a paramedic ambulance and they're cool with that. If this is a persistent problem you might want to tell your chain of command...have an EMS coordinator mention it to the nurse manager on site that hey, our County doesn't let us do what Title 22 is suppose to allow us to do so stop talking smack to our EMTs!
Click to expand...

lol, i like your style, yeah, about 60% of the time I can get a BSL from a nurse at the facility, the rest of the time ether the nurse disappears or at one SNF that calls us frequently they can never seem to find their equipment....like send out a guy with a fever and not being able to find there thermometer to get a current temp and the last temp was taken an hour ago....gotta love SNFs
 
I had a nice long post being written about this section, but my browser crashed.

In essence, I doubt that this will get approved for the following reasons:

1. D-sticks are an optional skill packaged with a variety of medications including activated charcoal, glucagon, sub-q epi, nitro, ASA, and broncodilators.

2. Proficiency must be shown in the entire package every 6 months.

3. The medical director must show a need to use an optional skills package to the state for approval. After approval, they must show that it's benefiting patients. I doubt that making snippety and stupid ER RNs (heck, I've been yelled at for not calling medics when my transport time was under a minute. Just because one RN was a blithering idiot doesn't mean that all are or that I'm going to be calling paramedics when I can see the ER from the patient's room) happy is going to be a reason. If paramedics are readily available, then you will have a really hard time justifying the optional skill,
 
Where did the six months proficiency thing come from?
 
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Not that it's not a good rule . . . but can you think of a LEMSA who actually does this?
 
It would be nice if we had them here for relaying information to the ED over the radio. Many times I'll be bringing a patient in with abnormal vitals, I'll be asked what the Pts blood glucose level is only to have to have to restate that we're a basic unit (though they should have picked that up by the B in my unit number, eh?).
 
AnthonyM83 said:
Not that it's not a good rule . . . but can you think of a LEMSA who actually does this?
Click to expand...

I would imagine that the same small, rural systems that get approval for EMT-II use (there are a handful of counties that do use them and the amount of EMT-IIs in California are less than 200 from the last report I saw) would be the same counties that could be approved for this and be small enough to implement it. I agree, though, that it is essentially impossible to properly monitor in a county that has hundreds or thousands of EMT-Bs (LA, OC, SD, SF, etc. After all, in the systems with this approval, everyone is going to be trying to get approved to do the interventions). Of course these small systems are also going to be the system that would have a lack of medic service that would give them a need to have the optional skills.
 
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Found a county that utilizes some of the optional skills. Imperial County covers 4,482 square miles with a population of 142,000 people and a population density of 34 people/square mile (source: wiki) (to compare, San Diego County has a population density of 671 people/sq mile). Imperial uses both EMT-IIs (but they don't have any EMT-II courses in the county) as well as combitubes, the medication package (discussed in this thread), and the IV package (IV starts, normal saline and dextrose only).
The protocol concerning the optional skills package can be found here:
http://www.icphd.org/menu_file/Policy_2200_rev_6-07.pdf?u_id=1
 
NM states EMT-Bs can do a finger stick anytime it is warranted. I take one if I'm transporting a DM patient and don't have one from the last 2 hours or so (or if they got fed right before we take em)
 
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