Diabetic Emergency...and a subsequent complaint. Your opinions, please?

[Handsome Robb]

I give diabetics food and drinks all the time...


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[EpiEMS]

EMS can't give this by mouth, but himself or his family can with recommendation from EMS.

Since when can't I make somebody a PB&J or give them a glass of orange juice?

 

[NomadicMedic]

Since when can't I make somebody a PB&J or give them a glass of orange juice?

Apparently it's verboten in PA.

I also do it all the time.

 

[EpiEMS]

Apparently it's verboten in PA.

I also do it all the time.

Strange. It seems like sound practice (and probably more fiscally sound). Heck, it's referenced in my protocols.

 

[NomadicMedic]

Strange. It seems like sound practice (and probably more fiscally sound). Heck, it's referenced in my protocols.

I was being facetious. The person who made the original statement about not being allowed to give the diabetic any food or drink is an EMT student in PA with no field experience.

 

[MikeC]

I was being facetious. The person who made the original statement about not being allowed to give the diabetic any food or drink is an EMT student in PA with no field experience.

" Hypoglycemia is suspected if patient has a history of diabetes or takes insulin or oral diabetes medications. If the patient can’t swallow but still has gag reflex, oral glucose may be placed between the cheek and gum in small amounts"
http://pehsc.org/wp-content/uploads/2014/05/Statewide_BLS_Protocols_Final_020915.pdf

"Do not permit the patient to drink if altered mental status or abdominal pain"
http://pehsc.org/wp-content/uploads/2014/05/Statewide_BLS_Protocols_Final_020915.pdf

The local protocol is to use a tube of oral glucose inserted into the side of the cheek. Anyone demonstrating an altered mental status should not be given anything by mouth. Oral glucose is the exception if they have an intact gag reflex.

 

[EpiEMS]

Anyone demonstrating an altered mental status should not be given anything by mouth. Oral glucose is the exception if they have an intact gag reflex.

There are some subtleties there that are much easier to recognize in reality than in writing. There's no reason why somebody who is OK other than being a bit altered due to hypoglycemia can't be safely given food or drink. Obviously, you have to follow your protocols, but they are really poorly done if that is what they prescribe.

Protocols are no excuse for not having or using good clinical judgement.

 

[MikeC]

There are some subtleties there that are much easier to recognize in reality than in writing. There's no reason why somebody who is OK other than being a bit altered due to hypoglycemia can't be safely given food or drink. Obviously, you have to follow your protocols, but they are really poorly done if that is what they prescribe.

Protocols are no excuse for not having or using good clinical judgement.

Thanks for the response. I'm under the impression that to step outside of protocols could get the EMS provider into legal trouble.

 

[EpiEMS]

Thanks for the response. I'm under the impression that to step outside of protocols could get the EMS provider into legal trouble.

No problem. By no means do I want to encourage you to go outside your protocols (it's usually bad practice to do that ) - however, I would encourage you to question them and advocate for positive change. I would also suggest that you look at other states' and regions' protocols to get a sense for other approaches.

Plus, don't forget, once the patient has returned to their baseline, no reason you couldn't encourage them to consume some complex carbohydrates.

 

[STXmedic]

Thanks for the response. I'm under the impression that to step outside of protocols could get the EMS provider into legal trouble.

That depends on where you work. In some places, if you step outside of protocols you could be fired. In other places, protocols are more of guidelines and it's expected you use critical thinking and sound judgement to treat your patient, since most of medicine is not black and white and the aforementioned subtleties can't be completely covered by a protocol binder.

 

[MikeC]

That depends on where you work. In some places, if you step outside of protocols you could be fired. In other places, protocols are more of guidelines and it's expected you use critical thinking and sound judgement to treat your patient, since most of medicine is not black and white and the aforementioned subtleties can't be completely covered by a protocol binder.

It is my understanding that the protocols dictate the "standard of care", which if are not followed and end up resulting in patient injury, could open up grounds legally to claim "gross negligence" of the provider.

So if by chance the patient chokes on a sandwich given to a pt with hypoglycemia, when it does not explicitly say so in protocol, and any negative consequences happen, the provider could be liable to civil and/or potentially criminal penalties (depending on the severity).

So stepping outside of protocols is basically stepping out of the doctor's liability cover into yours. I don't think there's much flexibility here if this would happen to go to court. The OP's case here sounds like it could very well go to court also.

If the protocols don't explicitly state it or Medical Command directs it, I do not feel comfortable giving anything other than what is written.

 

[EpiEMS]

@MikeC, stepping out of protocols is a bigger discussion than the scope of the thread, I think. I suggest you read this lovely piece. Here's a highlight:

In order to prove a negligence claim based on a breach of protocol, one must first prove that deviating from protocol breached the duty to the patient. In other words, the plaintiff is going to have to prove that the protocols represent the current standard of care. In many cases, many EMS systems have outdated protocols that do not represent the standard of care. For example, look how many EMS systems still backboard the majority of trauma patients or require high-flow oxygen for all patients. In the case of high-flow oxygen for cardiac and stroke patients, the current science in fact reflects that high-flow oxygen actually harms patients. Next, the plaintiff will have to prove that the deviation from protocol caused harm to the patient and that the harm caused damages. That’s a high burden to overcome. In other words, the plaintiff is going to have to prove that what you did or didn’t do was the reason there’s a bad outcome. Especially in critical or high acuity patients who had a bad outcome (IE, death), there’s often an argument to be made that, no matter what EMS or other medical providers did, the patient might have died regardless.

So let's put it simply: Protocols *should* represent the standard of care, but often do not. You, as a medical professional, have the obligation to question orders that are wrong.

 

[STXmedic]

As others have pointed out, you obviously have all the answers. Your expansive understanding of how things work obviously trumps everyone else's knowledge and experience.

 

[MikeC]

@MikeC, stepping out of protocols is a bigger discussion than the scope of the thread, I think. I suggest you read this lovely piece. Here's a highlight:

So let's put it simply: Protocols *should* represent the standard of care, but often do not. You, as a medical professional, have the obligation to question orders that are wrong.

Thank you good read.

 

[MikeC]

As others have pointed out, you obviously have all the answers. Your expansive understanding of how things work obviously trumps everyone else's knowledge and experience.

I'm merely discussing my perspective on this discussion board. Everything stated was valid, and someone responded with an educated rebuttal to it, which is what I was looking for.