BLS and Glucometers

[brentoli]

I have already debated this specific thing in an earlier thread but....

In Saskatchewan we were under protocol to lye the Pt. on thier side and swab thier cheek with Glucose. (Even if they were on a spine board)

And NO I would never do it.

Ah yeah, forgot about that thread.

Still, seems like the US standard is oral to an awake and oriented pt only.

[akflightmedic]

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I would rather have a Basic learn how to use a glucometer than not. Anyone can buy a glucometer off the shelf at any drug store and teach themselves how to use one. Diabetics use them every day of their lives and the are not even BLS trained. Glucometers are not difficult and they provide a useful piece of information. Someone here gave the example of EKG and 12 leads. How about the fact that AED's are getting more common place and you don't have to be a basic to use those either.

I do not believe anyone is debating the fact that they can be trained to use them as they are no more complicated than my universal remote.

What they are debating and the point that several have missed, is why is it necessary for them to do so?

Does knowing what their BGL is change the end result as a BLS crew? No, it does not. The treatment will be maintain airway and transport or call for ALS or ALS intercept if that is what happens in that area.

What checking the BGL does do is waste time learning something that they can do nothing about. See? The end result is the same regardless of it being normal, low or high. You maintain and transport. Even if you administer oral glucose and "wake" them up, you should not be getting a refusal as a BLS crew, transport should still be required.

Now my next statement is in no way representative of ALL BLS crews, however I have seen first hand what typically takes place. By the time they get through their rote memorization checklist of SAMPLE and all the other BS and do vitals and then consider "What can we do next" and remember a BGL, they have already wasted too much time; giving the oral glucose and waiting for improvement again is wasting time. Now consider how much time has been wasted for a number or treatment that in no way changes their end course of action. I am not saying withold the glucose if they are able to swallow, but time should not be wasted sitting on scene checking for numbers and administering a drug.

As we all know, time gets away from us on scene. Many times I have been caught up myself and relaized I was on scene way longer than what I recalled. Dispatch times do not lie and I have been shocked and said "No way" many times...LOL.

I witnessed a similar phenomenon when pulse oximeters first hit the streets. (Yes kids, there was a time we did not have that fancy gadget and I am not that old). I would come on scene and see a patient in obvious distress or even in mild distress and there would be no oxygen on the patient. When I ask why, I am told that the pulse oximeter reads 99 percent so the patient does not need it. See the correlation anyone?

Our reliance on gadgets and numbers instead of solid education and thorough assessment based on our past knowledge is one of the pitfalls of EMS. Yes, they are handy but not always needed.

As for the scenario of giving oral glucose to a patient with hemmoraghic stroke, I am going to claim ignorance in regards to whether or not would this make a significant difference. Is it enough to worsen the situation? I do not know.

I do know I have given patients with low BGLs and presenting with CVA symptoms IV D50 many times, usually start with a half amp per med control. Out of the all the times I have done this, only one of them was actually having a CVA along with hypoglycemia. Did this make him worse? I do not know and can not say, however I did administer the D50 with online medical direction as I was conflicted on what to do in this particular case. (I passed the buck, so to say).

Well, thats my ramblings for now, hope they made sense.

[JPINFV]

Why not take BP cuffs away from basics too while your at it since they can't start a fluid bolus either? A lower level of education doesn't make the information any less valuable. Even if an EMT-B is unable to do anything about it having the information to the hospital prior to a patients arrival is worthwhile.

Yes it does. BP cuffs are a bad example since a patient's blood pressure will dictate if paramedics are needed and/or rapid transport. Similarly, if a patient has an altered level of consciousness, then they should get rapid transport and a paramedic. BGL doesn't come into play.

Besides there are many places where bls is able to do something for an unconscious diabetic.

Please don't compare Canadian PCPs to American EMT-Bs. That's just ignorant [not knowing any better] and dragging PCPs down to our level.

[chelleak]

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It may not change treatment for a BLS crew (we run ALS) but it will change the information given to the receiving hospital when report is given. In that way you may actually be cutting down the time that hospital personnel are using to do rule outs.

So if it's no more complicated that using your universal remote. Why not teach it.

If you have lay people giving defib shocks with AED's why not teach a BLS person who is more medically trained than that bystander at the airport using the AED how to use a glucometer? :roll:

[JPINFV]

Can we first train Basics not to shock each other with the defibs though?

http://www.turnto23.com/health/8027465/detail.html

[akflightmedic]

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It may not change treatment for a BLS crew (we run ALS) but it will change the information given to the receiving hospital when report is given. In that way you may actually be cutting down the time that hospital personnel are using to do rule outs.

So if it's no more complicated that using your universal remote. Why not teach it.

If you have lay people giving defib shocks with AED's why not teach a BLS person who is more medically trained than that bystander at the airport using the AED how to use a glucometer? :roll:

Ok, did you not read my post where I made the point that it is a time waster and how I expanded on that fact with examples and even admitted doing it myself as a medic?

It is not the fact that they can not be trained to use it, it is the fact that it will waste time on information that is unecessary for what they need to do and could potentially delay the patient transport. Remember the patient..the person who needs help? It is about them and what is best for them...NOT what is best or most cool for the EMT.

I bolded the word "may" in your above post as that is exactly what it is. It MAY as in possibly speed their time.

Now I say, no it does not. First, most labs are repeated almost immediately upon arrival, especially when you say you are responding with a AMS or unconcious patient. These are "critical" patients until certain tests are performed, so I do not see how a hospital report saying the pt is unconcious with BGL of 12 versus them saying an unconcious patient unknown BGL with delay their treatment at the ER. The triage process is going to be the same, they will get the same rapid care as this is an emergency situation and once again the end result is the same.

What I am finding when a lot of people respond to these posts, they are thinking of the exception rather than the rule. They think of how they were personally as an EMT or think of the few exceptional ones that stood out with a thirst for knowledge and desire to advance and do what is best for the patient.

However again, you must consider that when discussing treatments for EMTs and for medics, usually the skills, protocols, guidelines, whatever are geared for the lowest common denominator. Keeping that fact in mind, then apply it to a large portion of the country where rural volunteers exist and where call volumes and exposure to new experiences are limited and see how this applies to them.

What is best for the patient is a transport without delay.

[CBEMT]

Besides there are many places where bls is able to do something for an unconscious diabetic.

Please don't compare Canadian PCPs to American EMT-Bs. That's just ignorant [not knowing any better] and dragging PCPs down to our level.

That's not necessarily what he's talking about.

For example, our Basics have Glucagon on standing order for any hypoglycemic unable to accept oral glucose.

[chelleak]

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Anybody ever heard of using a glucometer in the back of an ambulance. Doesn't always have to be done on scene. And in rural areas, you're more likely to load and go and continue treatment in the back of the bus. Have a good night folks.

[akflightmedic]

Again you are thinking of the exception, not the rule.

Yes in the back of an ambo is fine but the scenario I described is very real and what occurs more often than not.

You must keep an open mind and always cater to the lowest common denominator, which again is one of the largest problems with EMS.

[Dustdevil]

If you have lay people giving defib shocks with AED's why not teach a BLS person who is more medically trained than that bystander at the airport using the AED how to use a glucometer? :roll:

This is probably the worst, most illogical, and least relevant analogy I have ever seen on EMT City.

There simply is no valid comparison between those two. One is a diagnostic technique. The other is a medical intervention. The AED diagnoses and treats an immediately life-threatening problem on a clinically dead patient. The glucometer just gives a person, without the medical education to understand it, a number to write on their report. It serves no purpose. Zero. It does not change your plan, which is to transport regardless of what number you get. It is invasive and potentially harmful itself to the patient. If you are going to perform an invasive, potentially harmful procedure on a human being -- especially one who you are probably operating under implied consent with -- you had damn well better have a better justification for it than, "because we can". And FAILURE to recognise that only boldly illustrates the lack of understanding that those providers have of the procedure, the results, the implications, and the patients, that leads to educated medical professionals saying "no way."

You unhappy with your job as an EMT? You want more toys to play with? Go back to school like the rest of us did.

:roll: right back at you.