What can your EMT-B's do??

[p3medic]

Patients on oral agents that present with hypoglycemia should not be fed and released if at all possible....

[CBEMT]

Patients on oral agents that present with hypoglycemia should not be fed and released if at all possible....

Man... around here there's barely a diabetic NOT on some med or another.

Or did you mean oral diabetic meds? (Glyburide, Glipizide, etc.)

Either way, I'm man enough to admit that I learned something today. My apologies for the 'tude, Doc.

That said, I think it's still within the realm of possibility that this be written into a hypoglycemia protocol. Ada County, ID for example has a checklist that is used to guide when patients can and cannot be released. It would be pretty easy to add such a caveat. "Is the patient's medication list free of any oral medications that may affect their BGL?"

[ERDoc]

Without getting into the pathophys and mechanics of all of the diabetic meds (I'll let you do that on your own) any pt on oral hypoglycemics need to be admitted to the hospital. It is mostly the sulfonylureas that are like this. They are long acting and can cause hypoglycemia for up to 24 hours. Other oral diabetic meds, such as the glitazones and biguanides do not cause hypoglycemia and therefore do not warrant admission. They can be treated and streeted. It is the little nuances of medicine such as this that will get EMTs into trouble if they are given enough rope to hang themselves.

[Dustdevil]

That said, I think it's still within the realm of possibility that this be written into a hypoglycemia protocol. Ada County, ID for example has a checklist that is used to guide when patients can and cannot be released. It would be pretty easy to add such a caveat. "Is the patient's medication list free of any oral medications that may affect their BGL?"

Or you could do something really crazy, like -- and I know this is such a potentially radical idea that it could totally blow your mind, but -- maybe just send out properly educated medical professionals who fully understand the pathophysiology of diabetes enough to evaluate and treat these people in the first place, so that it is not necessary to sit down and read the cookbook during each run to make sure you didn't overlook one caveat out of an extensive list of things that you really don't understand anyhow. I know, I know... call me crazy to suggest that medical professionals should be in the business of taking care of medical problems. What am I smoking, right? But seriously, as extreme as this idea may be, I really think it could work! Sure, for awhile we'll have a lot of unemployed kids roaming the streets with no hobby to keep them out of trouble anymore. And Galls stock prices could take a serious dive. Obviously, there are problems to be worked out. And those things are certainly a lot more important than the lives of my diabetic mother or my asthmatic daughter. But hey... if even the Canadians can do it, why can't we?

[ERDoc]

Sure, for awhile we'll have a lot of unemployed kids roaming the streets with no hobby to keep them out of trouble anymore. And Galls stock prices could take a serious dive. Obviously, there are problems to be worked out.

Isn't that what volunteer fire departments are for?

[CBEMT]

Right, so back in reality, how about we do something simple nowto prevent things like this from being overlooked while we move towards a better-educated EMS workforce?

It's called "compromise." It's kind of a neat concept.

[Dustdevil]

It's called "compromise." It's kind of a neat concept.

Neat is not what we're looking for. It's not about appearances. It's not about seeing how well we can get along with everybody, or how the new system makes them "feel." Compromise is completely ineffective. Compromise is why nothing gets done in Washington. Compromise is what is killing the Republican party.

The Canadians didn't compromise. Why should they? Why should we? Are we really that concerned about a few people with three weeks of night school suddenly facing the prospect of improving themselves or finding a new job? I'm not. Like I say, the lives of my family are more important.

[AnthonyM83]

CBEMT does bring up a valid point. How do we do something NOW. We talk a lot about "perfect system" or "ideal medic school". It gives us something to shoot for and keep in mind as we become more involved in the system and take on roles such as instructors, system advisors, etc . . . but knowing how the ideal medic school or EMS system is supposed to run doesn't do us that much good to help our immediate problems when we go to work the next day.

[Dustdevil]

You're absolutely right. And the best that even the "perfect" system can do is to raise the level of mediocrity. The level of excellence is always defined by the individual practitioners. That means each and every one of us -- regardless of position or level -- can be an integral part of catalysing our profession to grow. All it takes is a professional commitment from you to become the best educated medic you can possibly be. The more you know, the better a practitioner you will be. And the better the greater number of medics are, the more pressure there will be for the profession itself to grow along with us. And, of course, the more it will make the lame players stick out from the rest of us, forcing them to either elevate their game or get out.

Anybody can be a leader in EMS. All it takes is a commitment to professional excellence. Practising that excellence everyday, as an example to those around you, is about the most important kind of leadership to EMS today. It can and will make a difference.

[Asysin2leads]

Neat is not what we're looking for. It's not about appearances. It's not about seeing how well we can get along with everybody, or how the new system makes them "feel." Compromise is completely ineffective. Compromise is why nothing gets done in Washington. Compromise is what is killing the Republican party.

I think Tom Delay, Mark Foley, and Larry Craig , and Cheney's aim might have something to do with it too. It was "stay the course" that brought about November 2006, anyway, not "compromise".