Diabetic EMT/Paramedic

[AMESEMT]

I think I am about to venture into an area that could have some controversial sides (could be wrong though), and also somewhat unknown area too......so here it goes. I am a newly certified EMT-Basic, who is also a diabetic. I recently was hired by a company as an EMT-B. This company required a pre-employment physicall. I completed that with flying colors (I am as healthy as a horse). However, the occupational health doctor recommended I not drive (commercially) since I am diabetic. I talked to the doc and he said that he would not certify any diabetics no matter how well controlled their condition is. (Side note: I am talking about Type I or insulin dependent). I am on an insulin pump and am very controlled. I was wondering if there are any other EMT/Paramedics out there that have encountered the same thing, or anyone out there that knows one that has encountered the same thing. If so, what did you/they do to get around this? It is quite frustrating to be told by the Iowa Bureau of EMS and the NREMT organizations to tell you, yes, we trust what your endocrinologist says and we have and will certify you for the EMT and Paramedic levels. Whereas someone else says, no we will not let you since you are diabetic and we don't care what your endocrinologist says. Any help would be greatly appreciated!!

Chris

[Dustdevil]

I have mixed feelings. I have a very good friend who is one of the sharpest medics I ever worked with (graduated with Dr. Bledsoe back in the 70s), and who is also diabetic. I remember him frequently getting a bit lethargic on the job and it being a problem. His eyesight started going really bad, but he kept on working and compensating with the help of a good partner. They finally pushed him out of the field after a little over 15 years when he was discovered unconscious in the back of the ambo with his patient, upon arrival at the ER. And, of course, when you leave EMS, you take no pension or retirement with you because there isn't much chance you have actually worked for the same employer for very long.

Now, with the pump, you are a little better off in that you don't have to remember your shots as often. However, you still have to carefully manage your diet and other factors just to stay conscious everyday. That is a significant risk in this business, where lunch breaks are not a right, but an anomaly. I am no endocrinologist, but I think the Occupational Health Physician has a significant point. Maybe we're not too far away from things being different, but for now yeah... it's a risk that not every employer is willing to take, and it's their dollar and reputation on the line.

Of course, a big part of the problem is that there are about twenty-billion EMT-Bs in the country, so you are not particularly a hot commodity that is in demand. Otherwise, they might be a little more accommodating.

All that said, if you are just a glutton for punishment, and stupid enough to actually fight for a shitty, abusive, poverty-wage, blue collar labour job as an ambulance driver that you'll lose or quit within five years at the very most, then I have one piece of advice. Don't get all hung up on this one employer. Again, they have absolutely zero reason or motivation to hire you. They don't need you. And there's fifty other applications on their desk right now from guys who can pass the physical, so don't fool yourself into thinking they are going to make some sort of exception for you. Move on. There are other employers to call on. And if you don't know who and where they are, then minus 10 for not doing your research before shelling out the $$ for your 120 hour first aid course.

You will get a job. No doubt about it. But seriously consider if this is what is best for you, your family, and your patients/partner before you go wasting a lot of time and effort for nothing. Good luck!

[paramedicmike]

I had a diabetic partner for a short time. He was on the pump, too.

At first I didn't think too much about it. But after a while it started to make me really nervous. For the most part his diabetes was well controlled. All you had to do was ask him...he'd tell you. But it was a little unnerving to find him, at 2am when you've been dispatched to a call, with his head buried in the fridge because he needed food. And then I was supposed to trust him to drive me and a potentially sick patient?

Like Dust's friend, he was a smart guy and was a good, sharp paramedic. He was pretty good at knowing when he needed to eat (unless it was 2am). But the volatility of the disease was such that I didn't always feel safe working with him. And damned if I'm going to let that go unchecked.

He stopped working as a field paramedic after he wrecked his truck while going to work one morning. He refused to tell anyone what his BGL was when the ambulance crew woke him up. While it was never confirmed officially, he wrecked his truck because his sugar dropped and he passed out.

What's more, I can't tell you how many accidents I've run where diabetics, on the pump or not, have crashed because their sugar dropped. And I can't think of a single one where the diabetic driver didn't say, "But I'm so well controlled.". Suffice it to say that I've run enough that I don't think diabetics should be allowed to drive at all...commercial or otherwise.

The rest of my thoughts on the issue will only echo what Dust has already said. So I won't repeat his words.

I think it's great you want to work in EMS. I just don't trust you to do it. Good luck to you.

-be safe

[AZCEP]

The concerns are valid, but must be taken on a case by case basis.

I'm also a Type I diabetic, and have been for a very long time. In 15 years of EMS, I've had two, count them two, episodes that caused a problem while on duty. One middle of the night hypoglycemic episode and didn't hear a page. Another, and August afternoon (~120 degrees ambient temp.) very lethargic.

There are many ways to manage the situation that is concerning Dust and Mike. The easiest is to keep your BGL a bit higher than normal when you are on duty. Set your pump to a lower rate, or eat something every chance you get. Keeping food near by can work, but becomes pretty tedious fast.

I may be a bit biased, but I would trust a diabetic that knows their situation as much or more than someone with any number of other medical conditions that a out there. If your doctor won't certify you to work in EMS, that is his perogative. You could seek protection under the Americans with Disabilities Act if you like the insides of courtrooms.

[asrnj77]

I am also a type 1 and I had to get a lawyer to get on my volunteer squad. The lawyer and the rep from the American Diabetes Association informed the personnel office (The volleys are same personnel office as paid members) that what they were doing was illegal. Then they came out to me and said "Oh we thought you wanted to be a firefighter...oh a medic..that's fine". They went on to tell me that I couldn't be a ff because my insulin pump might melt....of course as a ff there is a chance that my face might melt too but that never seemed to stop anybody from getting hired. Either way they are still wrong about a blanket ban on diabetic firefighters but I left that fight alone for now. I am also in law enforcement and everybody wants to say what if your sugar gets low while you are arresting somebody...well then I didn't check it properly during the day. The benefit of a pump is that you don't have to eat at certain times during the day like with regular insulin shots. My pump uses humalog and is set that if I didn't eat at all, I would be fine (albeit hungry...). At the same time I feel your pain but driving the bus actually sucks and if they didn't want me to do it, I would be fine with that. There is a story that may shed some hope for you..it's from Diabetes Forecast magazine 9/2001 and the legal department at ADA can send it to you. It's about Sarah Garrison and her lawyer Dale Larabee whom successfully challenged the California courts and DMV to allow her to obtain the license she needed to drive an ambulance with type 1 so that she could obtain her paramedic certification. Highly recomend getting it because it sounds identical to your situation. It's a litigious society....take advantage of it.

[akflightmedic]

I would certainly take a diabetic who may have an occurrence rather than the many other partners I have endured with different conditions that affect them (and me) every single time we work togther.

I dont want to continually have to compensate because you are too fat to get in some areas, too weak to lift, bad knees dont allow you to do something, bad back wont allow this, or your asthma keeps you from doing continuous compressions or gets triggered every time there is some excitement coupled with required activity.

And the worst disability of all...... I also dont want a partner addicted to cigarettes causing all of us to smell, requiring frequent breaks and the inability to do a report, clean, whatever, until such time that they have been able to smoke. Anytime something minimiaaly exciting happens, it requires them to puff on one of these things...and no I dont want you standing next to me assisting with cleaning and a cigarette hanging out your mouth.

I have had many partners with different conditions and out of all of them, a diabetic just is not going to get me in trouble or hurt me potentially as much as the others might. I will grant the sudden epsiode while driving could be hazardous but hopefully you and your partner will know enough to recognize when this may start occurring and prevent it.

[brentoli]

And the worst disability of all...... I also dont want a partner addicted to cigarettes causing all of us to smell, requiring frequent breaks and the inability to do a report, clean, whatever, until such time that they have been able to smoke. Anytime something minimiaaly exciting happens, it requires them to puff on one of these things...and no I dont want you standing next to me assisting with cleaning and a cigarette hanging out your mouth.

Racist. Discriminator. Un-Equalizer. Denier of rights. Communist.

Its an addiction that the can't control! It grips their body and won't let go! How can you deny basic civil liberties!

THE GOOD LORD MADE TOBACCO AND SAID I CAN SMOKE IT!

Ok this is ALL tongue in cheek. I can't belive how many medical professionals I see smoking, when they see first hand all the things that will be happening to them in 20 years. Sigh. Someday.

[align=center:83f851fbd2]EDIT TO BE ON TOPIC:[/align:83f851fbd2]

Our department requires basicly the same physical a CDL requires, and I think a diabetic is automaticly DQ'ed from a CDL.

Honestly, I don't have a problem with the diabetic. I work with quite a few in dispatch. However don't forget, there are other places an EMT-B/P can work. Blood centers, ER, clinics. So don't get too frustrated

[AMESEMT]

asrnj77,

Thanks for the info, I am looking up the legal department of the ADA to try and get more info. I hope it does not have to resort to getting a lawyer, I don't like them or court rooms. I don't mind driving since I need experience somehow. I want some before I start the paramedic program in January.

And thanks everyone else who has wrote encouraging words!

[Dustdevil]

I trust diabetics.

But I don't trust the judgement of anybody who would actually get a lawyer just to join a VOLUNTEER department.

Hobbies are too easy to come by to go to court for one. :roll:

Plus 10 to AMES for at least taking the professional route.

[AMESEMT]

I have thought about the ER but where I am that is an ER tech (only thing an EMT-B can do) where all I do is data input (e.g. doctors orders and stuff like that), I don't get the pt. interaction or help with their care. Blood centers?! As well as clinics, I am assuming would be pretty similar to an ER tech here, in regards to the EMT-B. I am looking for experience before I start the paramedic program, otherwise I would not go to all this trouble. I want to be exposed to what it is like in the real world and not just clinical time since you do have someone looking over your shoulder.

With regards to the CDL, the company I would be working for does not require it, all they require is a Class D chauffeurs license and I am eligible for that. Federally, I would be disqualified but there is the Federal Exemption (which takes forever to get, like 6 months) which would take care of that.

Oh...Dustdevil...Not to be an jerk or rude, but I have seen posts where someone posts something like you just did and the topic goes to crap. I appreciate your input and your trust in diabetics, but for asrnj77 it might not be a hobby, it might be his/her only option at the moment and really wants the experience (like me).

So more clarification, it is actually an occupational health doctor who did my physical that is recommending I not drive, even though I passed everything else with flying colors. He does not certify insulin dependent diabetics at all, even with a Federal Exemption. That is where the problem lies. I talked to the employer and he really wants me to work there but he has to take the word of the doc into consideration as well (I am assuming to cover his rear legally). Personally, I think it is terrible that this doc is doing this when NREMT and the Iowa Bureau of EMS have certified me to work as an EMT-B, and my endocrinologist say it is fine for me to work/drive as an EMT-B. I did talk to that doc and found out that if another doc or my endocrinologist is willing to sign me off then it should be fine. Which would be great because my endocrinologist has written a letter stating I can drive as long as I monitor my blood glucose (which I have given the letter to my hopefully new employer). I should find out today what his decision is.....thanks again for everyone's input, it has be very helpful and inspiring to know there are other diabetics out there in the field and are doing good, and others out there that trust a diabetic EMT/Paramedic! I will keep you informed!

AMESEMT