Glucometers and Test Strips on BLS?

[MMiz]

Once again this is always one of those ones that puzzled me. Our BLS units, along with all units in the county, do not carry Diabetic Glucometers and Test Strips. Protocols state that an ALS unit must be dispatched for a diabetic emergency, but every so often BLS gets there a minute or two before ALS.

Again, working in a county where BLS units are primarily private, I understand the cost factor.

I'm wondering how many BLS units carry Glucometers and Test Strips, as it really is something i'd like to see on the units.

 

[rescuecpt]

I think they're great - minimally invasive, not hard to use, and clinically definitive.

I also think they're underused, because people don't think to check glucose UNLESS someone has diabetes or unexplained AMS. I've seen low blood sugar cause several car accidents and trip & falls.

 

[Ray1129]

We have them on the units, but up until a few months ago BLS providers weren't allowed to use them. The use of glucometers are just now entering our BLS protocols, so many of the BLS providers around here are unsure of them. I don't even think many of our providers know we even have one.

I love that little machine. ALS shows up and you can tell them what to do....

 

[ffemt8978]

We have them in all of our ambulances, and our protocols allow BLS to use them. Unfortunately, they are underused (like rescuelt stated) for whatever reason.

 

[cbdemt]

We have them and use them alot. I think its safe to say that 95% of pt's that ride will get a finger stic. Its a great way to rule out or ID a potential problem, thats pretty easy to fix.

 

[SafetyPro2]

It's not allowed in our protocol, unfortunately. Quite often though, a family member (or the patient themselves if they're A&O when we arrive) will run a test with their own equipment and we'll document that.

 

[rescuecpt]

Yeah, while I was in my critical care training, I had a pt with a diabetic emergency. We were 24'd (mutal aided) at 4:45am (the original call was put in at 4am). The patient had since come around pretty well, as his wife was pumping him full of OJ mixed with sugar. Since I didn't have a preceptor, I couldn't run the call as ALS since I was only a student. So I asked the wife if she would take a glucose reading. I could still give glucose as BLS (but not dextrose). It worked out well in the end, and didn't delay treatment any further.

 

[MCSOMED54]

Glucometers are part of the Arizona BLS protocol as long as you have an ALS Base hospital for approval and control. We had to write our own protocol to make sure QC on the meters was maintained and logged. It is up to the individual EMT whether they carry a meter or not.

We must remember that a Glucometer is only a tool to use to conform your assessment, not to substitute for it. I don't need a meter to treat possible low blood sugar if I have a known diabetic that is "feeling funny" or has ALOC, but can swallow and follow commands. Anything else, you're waiting for ALS anyway. B)

 

[Alpha752]

Again, not working a squad I cant say for sure, but I recall in basic class being told that we do not carry, and can not administer glucose tests. We can give oral glucose with Med-controll approval if the symptoms are present. Again, this is speculation, but I think that glucose testing is an ALS thing here in Ohio.

That being said, if it is the case, I think that Basics should be able to test sugar. There is no reason to deny BLS such a lifesaving, minimally invasive, diagnostic test. I think that Ohio sees it as poking a PT with a needle, so it goes to ALS. Then again, it could be a per medical director thing.

When I was a Care Attendant at a Assisted Living home, I took glucose tests all the time with out problem, but as a certified EMT I can not? Weird.

Russ

 

[rescuecpt]

My glucometer wouldn't calibrate today, so I couldn't use it. :angry: And boy, did I wanna poke a hole in this guy!

 

[MA-EMT76]

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.

 

[rescuecpt]

The theory behind BLS giving glucose without performing an invasive procedure (finger stick) is that the glucose won't hurt someone who has too much sugar already, but it will help someone who doesn't have enough... so it's considered a win-win situation to administer glucose if the indicators for a diabetic emergency are there.

 

[SafetyPro2]

Yeah, we give oral glucose all the time, and exactly as Erika said, the theory we're taught is that giving it to someone with a high sugar level isn't going to hurt them (at least in the short time it takes to transport), but that if they're low, it'll definitely help. We tend to run a lot of diabetic calls and we go through a lot of glucose tubes.

As an interesting side note, and I'm not sure if others have noticed this, I'm beginning to see more and more diabetic patients who keep their own tubes of oral glucose with them rather than relying on the old "orange juice treatment".

 

[cbdemt]

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.

 

[Ray1129]

The theory behind BLS giving glucose without performing an invasive procedure (finger stick) is that the glucose won't hurt someone who has too much sugar already, but it will help someone who doesn't have enough... so it's considered a win-win situation to administer glucose if the indicators for a diabetic emergency are there.

That's quite true. However, it is also nice to be able take a finger stick, call ALS for low blood sugar, give glucose, take another finger stick, and cancel ALS because the meter shows that your pt.'s level has raised to a decent level. Of course, I know that 9 out of 10 pt's are never that close to their normal range by the time we get there.....

....but then at least we could tell the EMTP whether or not they need to give Dextrose or not. And it also tells the B whether or not they need to spend more time trying to give the oral glucose or spend more time figuring out what could actually be the problem if the level is normal....

 

[lastcode]

Finger sticks are so far not allowed in NY for BLS. I always feel retarded when I show up to a house where the wife expects us to do something, then asking her to stick her husband because we are not allowed.

 

[rescuecpt]

Help is on the way... or so I've been told - in the next year or so they will decide in NY whether BLS can do finger sticks.

Beyond that though, give glucose, pack 'em up and move 'em out... don't give the family the chance to realize that there's not much you can do.

 

[TTLWHKR]

...

 

[rescuecpt]

Technically in NYS basics can't give anything but the insta-glucose, however, in situations where someone won't take the insta-glucose, I will improvise since it's in the best interest of the patient - it's better for them to drink a coke or some gatorade than nothing at all.

Now that I'm ALS though, people are a lot more willing to take the insta-glucose since the other option is to poke a hole in them and push Dextrose.

 

[ki4mus]

everyone of our jump bags has a Glucometer on it, and we (EMT-B's) are allowed to check blood sugar readings and give oral glucose without any orders.

this said, there is a county in our region that EMT-I's have to call and get orders before they can test blood sugar...