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. :rolleyes:

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

[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.

[SafetyPro]

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.

[SafetyPro]

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..... :rolleyes:

....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...

[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

[jtpaintball70]

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. :D

[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 :censored::censored::censored::censored::censored:ed 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/:censored::censored::censored::censored::censored: 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