whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 I believe beneficial I believe that is why it is in the protocols. I also couldnt find one person (docs and medics in my area) that could state an incident they had when giving it. Link to comment Share on other sites More sharing options...
RaceMedic Posted June 20, 2006 Share Posted June 20, 2006 personally no i have never seen a bad reaction from glucogon. I have given it many times in the field when i could not get a line for D50. If the medical director figures that EMT-B's can do an IM then who am i to argue, Its their licence in the balance not mine. My personal feelings about B's and I's giving meds. If you want to give meds when your workin with me, then go get yourself and education take a medic course and come back to see me. Be Safe Race Link to comment Share on other sites More sharing options...
whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 I think we have beaten this horse to death. Not a real horse so I don't want emails. I have found it both educational an humerus at times. Thanks to everyone that could give an opinion that didn't include derogatory comments, or name calling. later Link to comment Share on other sites More sharing options...
Scaramedic Posted June 20, 2006 Share Posted June 20, 2006 Putting aside the battling going on (I'll let you guys finish that one), is everyone here against EMTs giving meds period? Or are we talking about EMTs giving IM glucagon as standing orders? Are you more experienced guys okay with EMTs giving IM if they have medical control approval for it? People have said that skills can be taught to a monkey. Do you feel that EMTs can be taught how to give IM meds as long as they have been given approval by online medical control, especially in a case like this where you have very objective info (you know what the FS is)? How about with more subjective things (ie steroids for asthma/COPD)? Has anyone ever seen a bad reaction to glucagon (personally I have used it quite a few times both in the ER and as the medical control doc and have never had a problem with it)? If so, what did you do about it? Would it not be more beneficial to the pt to have some form of treatment instead of killing brain cells? What do you think? Doc I do not have issues with the Basics administering meds, I have issues with the reasons they are allowed to give meds. There seems to be an issue in EMS with some systems trying to get the most bang for their EMT Basic buck. The reason many urban EMS systems run BLS trucks is simple economics, they're cheaper than ALS. Therefore you can put more ambulances on the street, that can be both good and bad. If you have 10 BLS units and 3 ALS units, and three BLS units call for ALS back up you have no ALS units. This creates the need to stretch the scope of practice for Basics, and that is where I have issues. The administrators of some systems see an expanded scope as a way to make more money, or to make the money stretch further. They decide along with a Medical Control Physician to expand on the Basic scope of practice to include ALS interventions to limit the amount of ALS back ups for their BLS units. It is not just individual systems either, obviously as noted on this thread whole states are going this way also. The question then becomes what education is given to Basics to administer ALS interventions? In my opinion it is dangerous to give any medication without a thorough understanding of A&P. It is easy to say give drug A for problem C, but unless you understand what problem C is and how drug A is going to fix it you should not be administering anything. I hate to admit but this is a problem for some Medics also. If a system or state was willing to expand education along with scope I might no have a problem, unfortunately this does not seem to be the case. Sixteen hours for intubation is not near enough education to expand a Basic to that level of care. I would like to know what education is involved in the above states to expand on the Basic's knowledge in regards to ALS care. Objective or subjective S/S if the education is not there I do not want Basics administering ALS interventions. If the education is adequate and there is a real reason (i.e. rural areas) rather than economics I have no problem with Basics expanding their scope. Peace, Marty :joker: Link to comment Share on other sites More sharing options...
AZCEP Posted June 20, 2006 Share Posted June 20, 2006 ERDoc, The main issue that I have with a BLS provider using glucagon is based in the description that was given by whit. Apparently they are not being taught what all of glucagon's actions are. For an instructor to stand back and tell his EMT class that there are no side effects, and that, regardless of the underlying situation, the hypoglycemic patient should be given this drug is dangerous. I gave the description that I did because I have been on the receiving end of a glucagon injection several times. Yes it was given safely, but the fact remains it would have been a good idea to have some idea what my heart rate and blood pressure were doing as follow up. Obviously there are better, and safer ways to increase the BGL. Give EMT's all the drugs in the world, just give them the amount of education that they need to use them safely. Not too much to ask, is it? Link to comment Share on other sites More sharing options...
AZCEP Posted June 20, 2006 Share Posted June 20, 2006 Glucagon stimulates breakdown of glycogen stored in the liver. When blood glucose levels are high, large amounts of glucose are taken up by the liver. Under the influence of insulin, much of this glucose is stored in the form of glycogen. Later, when blood glucose levels begin to fall, glucagon is secreted and acts on hepatocytes to activate the enzymes that depolymerize glycogen and release glucose. Ok I must be missing somthing. Anyway The fact that I know way more then I ever wanted to know about glucagon. I have exhausted this issue completely. Thanks for the input. Whit, You may know about glucagon, but you still have a long way to go before you can say you know enough about it. Fact of the matter is there is a difference between glucose, glycogen, and glucagon. To add one more, dextrose is different from glucose. If you want to discuss a topic intelligently, use the terminology correctly. Link to comment Share on other sites More sharing options...
whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 You may be correct, what I do know is I can much more informed decision on when it needs to be given. The facts are that glucagon is a medication we use in RI, wheather you think it is effective or not for the EMT, it can and will continue to be an effective treatment method for EMT's in this area. I am sorry you have such a problem with it. Thanks for the input. Link to comment Share on other sites More sharing options...
Dustdevil Posted June 20, 2006 Share Posted June 20, 2006 ...is everyone here against EMTs giving meds period? Yes. Period. Nobody with less education than my barber and exterminator should be inserting anything into another human body for vocation, profession, or hobby. End of discussion. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted June 20, 2006 Share Posted June 20, 2006 Yes. Period. Nobody with less education than my barber and exterminator should be inserting anything into another human body for vocation, profession, or hobby. End of discussion. I agree.... actually my barber appears to have a better understanding of pathophysiology than most basics. As well, I would probably trust him more than some basics I have recently seen. At least he does not profess to be "medically trained" and is aware of his limitations. As a former bureaucrat, I can assure you just because things are allowed does not make them right. Yes, I agree.. one should follow their protocols, and I must add though that as much as that is true, one should be actively involved in changing local and state regulations and protocols. Either your part of the solution or part of the problem... and not being active or promoting change is part of the problem. R/r 911 Link to comment Share on other sites More sharing options...
Ace844 Posted June 20, 2006 Share Posted June 20, 2006 I agree with all of the above posts as they are stated......more specifically the ones which echo the $$'s issue (as an excuse, not as it being 'right'), and need for increased understanding, education, and assessment abilities on the part of BLS before being able to undertake advaced skills, and or med administration.. I also find it remarkable that noone has commented on the 'short duration' of this med, and the fact that there are many providers who would administer this medication and then take a refusal from the pt only to have the pt, not take appropriate measure to prevent a 'relapse' event of hypoglycemia. Not long ago this was a problem in this area, and it ended with the 'medics' in mass needing to call for med con before accepting or taking a pt refusal, form a diabetic who got this med, and or D50. There were a few instances where pts had 'reflex' hypoglycemia and an MI, a few even 'died'. There were also some similar incidents involving basics and cardiacs in RI as well. Sad but true.... This is just one example of why I am, and continue to be apprehensive about expanded BLS Scope without the appropriate further education.... Out here, ACE844 Link to comment Share on other sites More sharing options...
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