Glucometers and Test Strips on BLS?

[jrm818]

In Mass, BLS units can administer oral glucose, but we cannot carry glucometers. To me, it would make a lot of sense for us to be able to get a read on a pt before giving glucose. As a basic, we are trained and can use the glucometer and lancets only if we are working on a P/B unit (since we take the P/B assist course that covers glucometers, spiking IV bags, 12-leads, assisting with ET tubes, etc...). Most of the time if we are working with a medic, we just get the blood drop from the IV site, so finger sticks are not used that much.

Actually in MA it is a "service option" for solo -B crews to be trained in the use of the glucometer.


and to add to the list, in PA it is not allowed (though apparently that may be changing)

 

[EMT007]

Our medical director hasn't approved them for us yet, which is odd, since diabetic emergencies aren't ALS criteria for us. I agree with the big sentiments in this thread so far - its a great tool that allows for a more accurate assessment of a patient's condition with a minimum of invasiveness and really should be a standard BLS tool.

 

[Gbro]

You bet!
I'm diabetic and you wont find me withought at least one tube of gel on me. They're all over, my car, my house, my desk, and several in my turnout gear.
It just makes sence.

I have never had someone open up for oral glucose, they all complain.
We carry test strips, oral glucose/tabs and glucogon.

I save the expired oral glucose for my hunting pack. I want to think it would come in handy if i were down or lost. Not like the candy bar that was eaten the 1st day out.

 

[KEVD18]

we can carry glucometers on -b truck in ma. i think its a very useful tool to have. my service required that if we used the meter, we had to call als. and we were only to use it in the event of ams or ? cva.

 

[emtwacker710]

NYS has changed their protocol and is now allowing basics to check blood sugar, their sqaud has to hold thier own glucometer traing and then submitt all the trained names to the state and then the state will certify our agency to allow basics to do that, of course in my area we do not have BLS and ALS units, our rigs are set up for both and people respond accordingly for whatever the call may be

 

[TransportJockey]

Most BLS units in ABQ carry them. And they're definately in the scope for EMT-B's out here

 

[katgrl2003]

Basics aren't allowed to use them in Indy. My company has had only one run in recent memory where they used oral glucose, and their patient has her own glucometer. Personally, I would love to see them on all our trucks.

-Kat

 

[EMT19053]

In south dakota we carry glucometers on BLS rigs and do not need any required periodic training to use them like we do for combitubes and epi-pens.

 

[AZFF/EMT]

We work in ALS/BLS pairs on our rescues and 2 medics, 2 emts on our engines. On every patient we do a blood glucose. If it's a diabetic call, or ALOC ect, as I am placing the patient on the monitor I do the stick for a reading, If it's any other call, I get the blood from the IV cath after the line is placed.


MCSOMED? I heard somethings about volunteering for the rescue posse, could you point me in the right direction, I dont have a whole lot of time but I would like to help someway, also my wife will be an RN soon and would like to do some volunteer work as well if RN's are included.

 

[Katie]

We can carry them but from what I've been told it's up to the station whether or not the BLS units carry them. The ALS have them though. In my EMT class we discussed carrying them but never really went over how to use them because it's not mandatory.

 

[TKO]

I think everyone should be allowed to do a BGT on a pt with an ALOC. A finger poke isn't anything to be concerned with and a decent monitor is usually very reliable. It only holds everything up at the H if you haven't done one anyway.

Now, in Canada everyone can do a blood-glucose test, but that comes with some responsibility. I see a lot of people wanting to just poke anyone and everyone. That's not necessary. I don't see the need to rule out a sugar problem for someone that broke their arm. I only stick if my pts have ALOC or syncopal episodes, is a diabetic or has been in a situation where I question if they have adequate nutrition, or if the pt is wasting my time (you know the ones; I'll stick an IV in them too if I can justify it).

My issue however with BGT sticks is that I see a lot of people that do it improperly. I have seen a lot of people (medics and pts) that just clean the finger with alcohol and poke. This is a very common practice, but like any procedure, do it right or don't do it at all. The correct method is to clean the site with alcohol and then wipe it dry with a 2x2 or whatever. Then poke. Problem with leaving the alcohol on the finger is that it can dilute the blood and alter the result.

But I'm sure everyone knows this.

 

[yowzer]

If it's any other call, I get the blood from the IV cath after the line is placed.

I know a lot of people who can start IVs do this because it's convenient and saves on pokes, but: Typical glucometers are calibrated for capillary blood, and the venous blood from an IV puncture will give an inaccurate reading due to the different oxygenation levels (Venous usually reads higher.)

See http://emj.bmj.com/cgi/content/abstract/22/3/177

 

[jordanfstop]

In NY they're protocol. Nobody in this county (Rockland) carries them, however because of the simultaneous ALS dispatch it's not the biggest deal since ALS usually gets to the scene before the bus.

 

[AZFF/EMT]

yower. Good point and we do note if the blood was from a finger or a cath. We do it no matter what and it will usually get you in the ballpark or a good idea if its a major issue. When it does read Hi or Low you can begin to start treatment and then get finger samples. For the most part it is usually within just a few points of each other.

 

[triemal04]

I know a lot of people who can start IVs do this because it's convenient and saves on pokes, but: Typical glucometers are calibrated for capillary blood, and the venous blood from an IV puncture will give an inaccurate reading due to the different oxygenation levels (Venous usually reads higher.)

See http://emj.bmj.com/cgi/content/abstract/22/3/177

Did you bother to read your own link, or did you just not understand it? The difference that was found there between venous and capillary would be around 15mg/dL. Not exactly super signifigant, and probably not going to change the treatement given (by a paramedic that is).

That's not to say that it isn't appropriate to know that there will be a difference in the reading with capillary/venous blood; if you're doing something you should be well educated in how it works and the variables that affect it. Just saying that 15...that ain't that big a number when it comes to blood sugar.

 

[BossyCow]

We are not only allowed but are required to report a BGM on all patients we bring into the ER. As far as taking the information from the pt., family or caregiver, we've had multiple incidents with inaccurate readings by those well meaning folks, the best one was a guy who had been eating ice cream and had sticky hands from the ice cream. The sugar on his skin gave him a high reading. I've also seen inaccurate readings resulting from the stick being done while the alcohol residue is still on the skin and unevaporated, diluting the sample.

If an IV has been started, I prefer to use the blood from the cath for the test. No possibility of contamination and one less painful poke for the pt. But, I do note on the MIR where the blood came from.

 

[makphisto]

Our service does blood sugar tests on almost every patient, unless it's contraindicated for some reason. It gives good, sometimes valuable, information; it's easy for most patients to tolerate; and it's good practice for the EMTs.

 

[TKO]

but it can be unpleasant, so if it isn't necessary, why do it? I hated being pricked in class and my instructors used to get quite annoyed when we poked one another without cause, not because we were wasting time, but because it showed we didn't know what we were doing otherwise.

Like a pt c/o a broken finger from a crush injury, and auscultating the lungs during the RBS/focused. Just unnecessary and a waste of everyone's time.

Knowing when to use it is and when not to use it is much more efficient and the RNs won't think you're a sadistic biatch/prick for poking everyone. If you don't if you should or shouldn't poke, then you err on the side of poking. But you should know when not to.

 

[Ridryder911]

Our service does blood sugar tests on almost every patient, unless it's contraindicated for some reason. It gives good, sometimes valuable, information; it's easy for most patients to tolerate; and it's good practice for the EMTs.

Everything we do and perform should be able to be justified. If you performed a procedure not warranted and not needed then you treated the patient inappropriately. If one does it because they can or something they can do.. again, if I asked you why, you should be able to justify upon why.. not, because we can or it is the protocol.

If it is going to assist in diagnosis, check because of history, or assist in unknown etiology, then one can justify it and should perform it, otherwise it was an unnecessary procedure and you did wrong.

R/r 911