National Scope of Practice

[JPINFV]

I never mentioned pulse ox, but now that you mention it, several BLS services utilize it.

The point is that if you do a search on any web forum, including this one, you will find plenty of posts that basically say, "ZOMG, pulse ox is so easy, it's just a finger clip." It's essentially the same argument being put forth here. If a non-medically licensed person can do it to themselves, why can't we do it to other people?.

Much like a basic isn't going to administer 0.5mg of atropine to a patient with a heart rate of 48 , but they still take a pulse; of course we don't have to poke a finger to do it.

The difference, though, is that a person with an abnormal pulse will change treatments, even for basics. If I've got a patient with no medical history, generally normal on exam, but with an irregular pulse rate, I'm going to seriously consider calling for a paramedic. Similarly, if I'm running a nursing home call for a confirmed electrolyte imbalance, or a patient with renal problems, a non-normal pulse rate (either not irregular, or not one consistent with the patient's medical history without lab values) will get a paramedic response and/or rapid transport. An altered patient should be transported immediately regardless of what a glucometer says. If the person can eat, sure give them some oral glucose, but the value really changes very little.

[Christopher.Collins]

I've never really understood why the BGL is considered an advanced skill... I mean.. if you can teach grandma to do her BGL at home, why can't a Basic do it? It's another piece of information, even if they can't obtain IV access to correct it.

Grandma? You can teach a 10 year old to check BGL!!! Diabetes kinda runs in my family and alot of my friends are diabetics... checking BGL is a no brainer. Hell I think the hardest part would just be remembering what normal levels are like the rest of the vitals we take. And if you cant remember whats normal for vitals, then you should be punching a cash register.

Ive heard people say Basics shouldnt do BGL because it involves "sharps." Its just peoples opinions, and Id hope hardly the truth. Because then they might as well take epi away from us...

Ive also heard the saying that "when in doubt, give glucose." How stupid is this? Its so easy to assess high or low blood sugar, why should there be doubt? And why administer something if your in doubt over the problem to begin with?

The following is an exerpt from the June 2008 issue of the Journal of Emergency Medical Services under the Research and Review column on page 38. The column was submitted by Elizabeth Criss; NP, MED, MS, CEN, CCRN and taken from American Journal of Emergency Medicine. I personally have highlighted parts I thought to be most relavant but these highlights do not reflect within the article itself.

...but most EMTbs are required to request the assistance of a Paramedic vehicle when administering medication is required. This increases the time on scene for all vehicles and delays care...

...EMT-Bs may be just as capable as Paramedics at identifying, treating and providing instructions to the hypoglycemic patient. In this study of 402 cases of hypoglycemia, no significant difference existed between the EMT-Bs and Paramedics when the researchers evaluated the care of diabetic patients...

The article ends discussing vehicle maintinance which seemed to be a bigger concern to the author, or perhaps my misinterpritation. Regardless... it makes some valid points though it does slightly deviate from the actual topic of this thread.

I cant say how many diabetic emergencies Ive been to where we'd assess and treat and by the time the medic arrives the patient is already at normal mental status signing a refusal. And I cant tell you how many times Ive worked ALS and as a Basic been left to care for the patient even if they chose to be transported.

Furthermore... wouldnt it be nice when we BLS units are sent out to pick up an ETOH if we could further assess them if we suspect diabetes? Rather than have to call and wait for ALS backup?

[VentMedic]

Wow! With all this logic of "no brainer", "Grandma can do it", "a child can do it", "just a finger poke", "just clip on the pulse ox", along with the "nothing to it" stuff in the EMT-B intubation thread, it is a wonder there is any need promote EMS providers as medical professionals.

It's like expecting the magic box (glucometer) or pulse ox to provide the answers. Uh oh, what if the numbers are "normal" and the patient is still unresponsive and/or short of breath?

Do you know how many other diseases and meds cause abnormal glucose values?

Again, only the "skill" is stressed. That is enough for the FD, insurance companies and law makers to hear and keep the profession at a "tech" status for reimbursement, wage issues and professional status.

Arguing for the "skill" before the education is going about it the wrong way. If the education is only a short lecture on a couple of pointers about the glucometer, how much is missed in the assessment that may go unrecognized because of the infatuation with this "skill"? I've already seen enough of that with the almighty pulse ox and inadequate education. Both the pulse ox and the glucometer are good tools but are not a replacement for solid education to provide a good assessment. Learning just on piece of a very large medical picture takes things out of context and can lead one down the wrong path of assessment or stop the assessment because one thinks they "fixed" everything.

If the educational foundation is built, the skills will follow.

[Christopher.Collins]

I stand corrected...

Didnt really intend to make the theory behind it sound so simple. Mostly just the skill itself.

I appologize for the arrogance.

[VentMedic]

I stand corrected...

Didnt really intend to make the theory behind it sound so simple. Mostly just the skill itself.

I appologize for the arrogance.

Don't apologize, EDUCATE!

You, of all people, with your family history of diabetes, should be most aware of other things that can go wrong with the diabetic patient since this disease can affect any and all systems. Looking at one piece of the puzzle is great but other things should also be assessed. Even things like caring for the site after puncture to make sure it stays clean can be a big deal for the very brittle diabetics. Endocrinology is usually not a strong point in an EMT or Paramedic's education. Even the questions to ask are vague and not direct enough to get a good idea of what is happening in the patient's life. Use what you've learned from personal experience and combine that with your education to stress the importance of good technique, assessment and education.

[JPINFV]

"just clip on the pulse ox",

Just to be clearm the "just clip on the pulse ox" came into the thread as an example of the stupidity of the "Well, the skill is so easy it's just..." mentality.