PotatoMedic
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Then I guess the answer is that EMT-B's should have a glucometer since they can do something about it.
EMT's checking BS
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Then I guess the answer is that EMT-B's should have a glucometer since they can do something about it.
NomadicMedic
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Well, if the patient is so obtunded that the only way to know about hypoglycemia is through a CBG, then oral glucose isn't really appropriate, is it?
Seattle AMR EMTs would regularly transport hypoglycemia patients to the ED as an "unknown unconscious" because there might not be a medic dispatched and there was no way from them to check a sugar.
Seattle AMR EMTs would regularly transport hypoglycemia patients to the ED as an "unknown unconscious" because there might not be a medic dispatched and there was no way from them to check a sugar.
If the EMT is any good, they'll treat empirically and do not need a glucometer to do so.
NomadicMedic
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Then why do paramedics have glucometers? If what your saying is true, we should just treat all unconscious patients empirically? Coma cocktail anybody?
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Paramedics often have the means to react to a glucose measurement, whether normal or abnormal. Again, the crux of my point has been using the information to alter treatment or disposition of the patient. Do I need to type that in. every. single. response? Again, I have been arguing against BLS glucometry in the context of an "all-ALS" setting.
PotatoMedic
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Except for the fact where I work if I call in a short to a hospital for a DLOC the RN will ask me for a BGL. Yes if the patient has a hx of diabetes and they are clammy and unresponsive they are probably hypoglycemic. Does not change the fact that the ER wants a BGL, no. Anyways if the pt is able to follow commands and swallow I can give them oral glucose (or a pb and j sandwich).
The nice thing about a glucometer is that it HELPS me confirm or redirect my assessment of a patient depending on the results. And if I have ALS coming it give me one more bit of solid information I can give to the medics to help them start their assessment. (Granted you have already said you don't trust your basics so my last argument has no effect on you.)
EDIT: I am going to leave my post but I don't think I have a place in this argument since I do not work in an all ALS system.
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NomadicMedic
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An all ALS service wouldn't have BLS making a response, a paramedic would be on EVERY CALL. In a TIERED system with BLS response, glucometery is a reasonable tool for these first responders to obtain information that most certainly can alter treatment for the patient.
Anecdotally, I can cite a recent instance where ALS was requested for a CVA. On my arrival, the BLS crew was moving the patient to the ambulance, on a backboard, with supplemental O2. If they had checked a CBG, they would have seen the sugar was 22 and they could have waited in the house until ALS arrived, managed the issue and left the patient home.
(Incidentally, the BLS providers are able to check sugars here, and usually do, but this call was dispatched as altered mental status and they tunnel visioned on the PTs stroke history, not noticing that she was cool and sweaty.)
I count on BLS providers to be able to provide me with answers and a set of vitals when I arrive. In an altered mental status patient, a sugar is part of that.
Christopher
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Why can't EMT's call a stroke alert?
There can still be some component that is BLS. This is common in many places. E.g. ALS ambulance, BLS engines. ALS engines, BLS ambulances. ALS ambulances, BLS volunteers going right to the scene. At least to me, "all-ALS" is any system where a medic is sent on every call, which is the overwhelming majority of EMS systems.
So, we agree. (Or are we going to have to go over this a few more times?)
Yeah... that is the sort of thing I used to see that'd have me question the assessment of certain BLS crews (or whole squads/services). Some squads, I set my expectations as low as them just showing up with a working ambulance, with anything beyond that (e.g. vitals, working suction, etc.) being a bonus. Others, I expected a lot more.
Anyhow, I assume you woke her up in the ambulance before transporting and let her decide whether or not she wanted to go to the hospital. I did that plenty of times. It was always nice when BLS actually gave oral glucose so that we could assess and then triage back to BLS if the BGL was "normal" and mentation back to baseline (could do this even if they already initiated transport).
Bullets
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BLS would use the information to determine hypoglycemia, an ALS call, from Stroke, a BLS call.
At least around here, hypoglycemia ends up being an RMA. BLS arrives, "assist" the family with getting a BGL, find it low and wait for ALS to come, give D50, guy wakes up, RMA
No point in waiting for ALS on a LA Scale positive patient, lets go to the comprehensive stroke center
There are places that send ALS on EVERY CALL!?!? That seems like a misuse of resources
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No, it's not the "overwhelming majority of EMS systems". My county, for example, has about 18 different EMS agencies, only 3 of which are ALS.
Just because that's the way it is in urban areas does not mean it is the same across the entire country. Unless you have actual proof of your claim that I'm not aware of, I'm calling BS on this one.
Christopher
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All but a few of the 100 counties in NC are ALS transport, and a good number are BLS first response. A tiny fraction have BLS transports in rotation with ALS transports, and none tier their response (as far as I'm aware).
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Which goes to prove my point that it is regionally dependent. One of the counties that borders mine only has BLS ambulances, despite the fact that one of the agencies is hospital based. Some areas of the state are strictly ALS, some are BLS, and some are a mix/tiered system.
unleashedfury
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BGL would be great if a BLS provider could do more about it.
Most known diabetics have a Glucometer so since someone had to call 911 to find them unresponsive a simple "assist of the family with use of the patients glucometer" can tell you if the patient has a sugar issue.
But as a BLS provider what can you do about a low blood sugar. If they offered to expand the scope of practice to add glucagon pens to the BLS skill. Or IV skills with the administration of D5W or D50. I could see where BGL would be beneficial.
Now to address the stroke patient issue not everyone has a Stroke center with a short transport time. Our closest is 45 mins away. So meeting with an ALS buggy within a 45 minute transport time is feasible.
Most known diabetics have a Glucometer so since someone had to call 911 to find them unresponsive a simple "assist of the family with use of the patients glucometer" can tell you if the patient has a sugar issue.
But as a BLS provider what can you do about a low blood sugar. If they offered to expand the scope of practice to add glucagon pens to the BLS skill. Or IV skills with the administration of D5W or D50. I could see where BGL would be beneficial.
Now to address the stroke patient issue not everyone has a Stroke center with a short transport time. Our closest is 45 mins away. So meeting with an ALS buggy within a 45 minute transport time is feasible.
Jambi
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This has been pretty much been beaten like a dead horse, but here is a post I did when discussing our county protocols and EMS checks on BGLs
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This is something I've never been able to understand, and its never been adequately explained to me why in some areas EMTs cant check BGL. It's totally idiotic. Does it make much difference when they cant check it? Probably not, but its sort of the principle of the thing, it shows absolutely zero trust in your EMTs.
If you can trust someone to safely drive an ambulance, you can trust them to check blood sugar and do a control test now and then, its that simple. If someone is too dumb to check blood sugar, they are too dumb to safely navigate an ambulance to a scene and transport a patient.
My guess is the main reason is usually cost. Lancets and test strips have to be purchased, control tests have to be done, and sharps have to be disposed of, which costs money.
There's no other logical reason why an EMT cant do this.
If you can trust someone to safely drive an ambulance, you can trust them to check blood sugar and do a control test now and then, its that simple. If someone is too dumb to check blood sugar, they are too dumb to safely navigate an ambulance to a scene and transport a patient.
My guess is the main reason is usually cost. Lancets and test strips have to be purchased, control tests have to be done, and sharps have to be disposed of, which costs money.
There's no other logical reason why an EMT cant do this.
So, you're in the minority. I'll admit, maybe I shouldn't have used "overwhelming", I guess it is up to your own imagination as to what that means. I suppose to some people it is like saying 99.99999% when it could mean 80%. My bad.
Ok, so, by your logic, even though it probably makes no difference in terms of patient care, EMTs should be allowed to use glucometers so that they feel trusted.
No one has argued that EMTs are unable to check a blood glucose properly, or that they couldn't interpret it.
You've just stated logical reasons: "Does it make much of a difference... probably not" AND "...costs money".
BAM. There you go. Two SOLID reasons to not allow something.
Again, to put it out there for those who haven't read previous posts: My argument is that if it doesn't change patient care or disposition, then it is not needed. If it is an "all-ALS" system (i.e. a medic is sent in some way to EVERY patient), then glucometry for BLS will change nothing for the patient.
VirginiaEMT
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They do that in our area now....
VirginiaEMT
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The pulse oximeter has made EMTs lazy. I absolutely loathe seeing them get the pulse rate off of a pulse ox.
PotatoMedic
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First pulse is always palpated. Second is off pulsox if the first few beats match what I get while palpating to make sure it is accurate.