Changing Standing orders

[Scriptor]

This is some what of a question. How does one go about changing some of the standing orders given to the EMT-B, I and P? My case is this:

For diabetic emergencies, we are told that if the patient is awake and able, that we should provide oral glucose, using a tongue depressor to spread the creamy substance along the gum line. However, when a diabetic becomes unconscious (indicating a lack of glucose to the brain) we can't do much more besides keeping the lower extremities raised, keeping O2 flowing and keeping the patient warm. However, with the emergency glucagon kit provided by most endocrinologists for the home use of a diabetic, we could have that diabetic up and demanding we let them go in a matter of minutes.

Basically, how can I go about changing standing orders to allow us to carry and use this very useful method of treating hypoglycemic patients who have fallen unconscious?

Any tips or ideas on how to begin my journey through this legal channel, please let me know.

 

[redcrossemt]

It's all up to your medical control authority board and ultimately your service's or authority's physician medical director.

Find out if there's regular meetings and attend. Barring that, find out who your medical director is and schedule a meeting with them to discuss your ideas!

 

[MMiz]

In met with the Medical Control and doctor in a small town. They ended up not changing things because "We do it because that's the way it has always been done".

I don't know of any service that allows EMT-Basics to administer glucagon, but if you do a search you'll find that as a teacher I'm allowed to administer it with less than half an hour of training. The training took two minutes, and the next 28 was spent talking about other random stuff.

 

[CAOX3]

Oh boy, This could get ugly.

There are actually a few states that allow the EMT to administer Glucagon.

 

[redcrossemt]

We've talked about it before and several EMT-B's on here have orders for Glucagon.

It will really depend solely on your medical director. They might have lots of reasons to not give it to you, from "ALS is close enough" to "the hospital is close enough" to "we don't feel like changing".

It won't hurt to ask and, if nothing else, hopefully you'll develop a positive relationship with your MD and can get involved in issues that come up in the system in the future.

 

[CAOX3]

I agree with the theory behind this. It can be a succesful tx if D50 is not available.

However Glucagon is not a sugar substitue. It works by stimulating production from liver glycogen stores. If these stores are already exhausted then the treatment is futile.

 

[Shishkabob]

In Texas, we're allowed oral glucose. Really, if they are unconscious they are unable to control their airway, which is a contraindication for oral glucose.


Don't agree with it, but we have to deal with it.

 

[jrm818]

I agree with the theory behind this. It can be a succesful tx if D50 is not available.

However Glucagon is not a sugar substitue. It works by stimulating production from liver glycogen stores. If these stores are already exhausted then the treatment is futile.

Which is to say: "unless they have been on a starvation diet for the last 12 hours or so, they have plenty of glycogen and it will probably work pretty well." In most (not all, but most) cases glucagon will definatly be helpful, if not complete treatment.

 

[Scott33]

However Glucagon is not a sugar substitue. It works by stimulating production from liver glycogen stores. If these stores are already exhausted then the treatment is futile.

Correct.

It is far from definitive treatment and wont always work, particularly in hypoglycemic events brought about by exercise, fasting, or ETOH ingestion.

Glucagon will only be as effective as the stores of glycogen in the body, which will vary greatly from patient to patient.

 

[reaper]

Which is to say: "unless they have been on a starvation diet for the last 12 hours or so, they have plenty of glycogen and it will probably work pretty well." In most (not all, but most) cases glucagon will definatly be helpful, if not complete treatment.

Glucagon is never a comlete treatment!

 

[Scott33]

Which is to say: "unless they have been on a starvation diet for the last 12 hours or so, they have plenty of glycogen and it will probably work pretty well." In most (not all, but most) cases glucagon will definatly be helpful, if not complete treatment.

How many times have you actually given it?

 

[Shishkabob]

Glucagon is never a comlete treatment!

Comlete?

Is that like, Medic speak I don't get?

 

[reaper]

No that is a "P" button that does not always work!!!!!!!!!

 

[emtfarva]

Ok, I know Glucagon is not a complete remedy, neither is oral glucose. What they could do is put Glucagon in an auto injector like EPI. What do you all think?

 

[daedalus]

go to paramedic school.

 

[CAOX3]

Which is to say: "unless they have been on a starvation diet for the last 12 hours or so, they have plenty of glycogen and it will probably work pretty well." In most (not all, but most) cases glucagon will definatly be helpful, if not complete treatment.

Actually, Glucagon can have little effect on chronic diabetics and alcoholics.

It is not a source of sugar replacemnt. It uses stored reserves. The problem still needs to be dealt with either by sugar consumption, like a meal or a trip to the ER where they can provide a difinitive treatment.

We use to carry this, it had to be administered enroute to the hospital these people should never be allowed to refuse care, this is not glucagon. They will encounter the same problem again shortly, glucagon is not a fix. it can be helpful but it wont fix the underlying problem.

 

[TransportJockey]

NM Basics can give oral glucose only. An I or medic can give glucagon. I don't think that should change any, mainly due to the fact that if the glucagon doesn't work, you still need to get glucose on board ASAP. Intermediates and medics can do that w/ D50, a Basic would be screwed at that point

 

[Juxel]

A little off topic, but part of the reason glucagon is supposed to be a 'last resort' (besides the fact that it's a very temporary fix that depletes the internal stores) is cost. Glucagon costs between $72-157 a dose depending on what type you carry. It's one of the most expensive drugs on most ambulances.

It should be quite rare you can't administer D50. If you can't get an IV (hit an EJ if you need to) you can always give it rectally.

Back on topic. Here our county medical directors meet every 2 years to review protocols and anyone in the system (EMT to Dr.) can submit a request to change protocols. You fill out a form that asks for the proposal, the rational, and the supporting scientific evidence. If you support it with evidence it is usually discussed quite seriously.

 

[Scriptor]

recap

Thanks for everyones input. just to clarify things, I realize it's not a permanent fix, but if it can get a diabetic awake enough to injest oral glucose, then we may be able to avoid a potentially life threatening low blood sugar very quickly. Ive had the glucagon used on me before and it woke me up from a mumbling stupor in about 5 minutes, and I didn't even get a full dose. TO sum it up, it's better to have something than nothing. Be prepared.

Again, thanks for the help.

 

[Scott33]

Ive had the glucagon used on me before and it woke me up from a mumbling stupor in about 5 minutes, and I didn't even get a full dose

So who is the idiot who would only give a partial dose?

Why would (s)he only give a partial dose? - It is only 1mg in 1ml into the muscle, and is not supposed to be titrated.