The glucagon discussion

[medic53226]

I'm not going to get into the intubation issue, but for the glucagon issue I have given glucagon many times and have never seen a response in mins, I will give glucagon but still attempt to get a IV and if I do I will give them D50. I don't really like glucagon, but basics here aren't allowed to do sugar reading it is out of the scope of practice per the state, and I don't see why they can't but they can't just like they are nolonger allowed to use pulse OX's, because emts were basing their decison on what the pulse ox said and not on what the pt's condition was, I don't know really how I feel about Basics giving a med and diabeties being a very confusing disease, and hypoglycemia changing in a mintues notice, I feel that is best left to the persons or persons that can do something about any other problems that might arise.

Thank you

[mediccjh]

I used Glucagon on a pediatric beta blocker OD once w/ wonderful effects.

Oh, and Whit, I'll take the 23 y/o PRPG as a partner anytime before the older you.

And I'm only 25, and work in the biggest and busiest EMS systems in the nation.

[p3sibley]

I know I am late getting into this discussion, but why do so many people believe that EMTs or primary care paramedics are incapable of administering glucagon. In Nova Scotia anyways, all PCPs have a thorough knowledge of A+P and the pathophysiology of diabetes. PCPs can also measure blood glucose and administer IM injections, both BLS skills. Complications of glucagon are rare and the benefit when given to a hypoglycemic patient is significant. Why in the world would this drug be limited to Advanced Care Paramedics? That is ludicrous. And the inappropriate administration of glucagon is essentially impossible with a proper history and physical exam. Last, someone commented that the EMT couldn't do anything if there was an adverse effect to the glucagon, such as if the patient had the rare condition pheochromocytoma. Well what would an ACP do? We don't carry any glucagon antagonists.

Long story short. Obviously D50 is the standard of care, but an IM injection of glucagon is not rocket science. It can easily be performed by all levels of EMT and paramedics. Good lord, EMTs and PCPs are not stupid like some people in this thread think. They are trained medical professionals capable of making decisions are performing skills and treatments, treat them as such.

Second, someone mentioned about waiting until you get a hypoglycemic patient into the ambulance before you administer the D50. Why in the world would you do that? Start the IV in the house, give the D50, wake them up, get them something to eat, ensure there is a friend or family member to watch them and call back if any problems develop, fill out the treat and release form, say goodbye and leave. Obviously if you can't explain the reason for the episode, or they don't respond appropriately you need to transport. Otherwise, you've just saved that person a trip to the hospital and an ambulance bill, that is one less patient in the ER who will be seen by a doc who says check a glucose, give them something to eat, and then discharge them, and last, your ambulance is returned to service quicker. It's win-win for everyone.

p3sibley, Advanced Care Paramedic

[AZCEP]

This issue is not about our Canadian neighbor's ability. It is entirely an issue regarding the lack of education that EMT's in the U.S. receive. Can they perform the procedure, absolutely. Should they, not under the current system.

My biggest concern, is the lack of information that will be provided to these folks, in the course of their EMT class. There is no way to educate them about the way a disease like diabetes works, much less how a drug like glucagon does. I'm sure everyone would agree, pharmacologically, glucagon is a pretty complex medication. When it is used right, it is very good. When it is used wrong, it is very bad. If we are going to allow EMT's to administer any drug, besides oxygen, then we have to consider the amount of education they are going to need to do so safely.

[EMS49393]

I know I am late getting into this discussion, but why do so many people believe that EMTs or primary care paramedics are incapable of administering glucagon.

Correct me if I'm wrong, but don't the PCPs in Canada have a year or two of didactic time? They have A&P requirements? They have educations? The little I've learned about the Canadian system I've learned through here, and if I've been reading correctly, the above is in indeed true of our northern neighbors. So, let me reiterate, the EMT-B in the US has 120 hours of training, roughly. They have NO A&P requirements. The class I teach for has to do 10 hours of clinicals in the ER, and run 5 calls before they can pass the class. Can PCP's administer Glucagon and understand what it's mechanism of action is, the indications, contraindications, etc? I bet a dollar they can. Judging from the training, I'd trust them to be able to make a decision like that. Can EMT-B's do the same? Absolutely not. If you can't tell me how a medication works in a way that I know you understand it, then get your hands out of my drug box.

The one big fact that the EMTs fighting for this privilege have left out regarding glucagon... It's a one shot deal. There has to be adequate glycogen stores in the liver for this drug to work, and once you use those stores, the person then has no other way to increase their blood sugar without receiving actual glucose.

On a side note, PRPG, you can hop on my ambulance anytime. I'd take your young, yet knowing self as a partner a million times over Whit. Age doesn't always mean you know more. And Whit, if you want to push drugs so bad, do what a lot of us did... go to paramedic school and get an education. Educational shortcuts are the devil.

[whit72]

EMS 4939 wrote:

a million times over Whit

Do I know you.

I believe the question would be could you ride with me.

Unlike yourself sir, I do not pass judgement on people I dont even know.

[whit72]

medic cgh wrote:

And I'm only 25, and work in the biggest and busiest EMS systems in the nation.

I am impressed. I dont recall asking if I could ride with you. I also dont recall caring what you think.

Again sir call volume is based on resources not population.

[EMS49393]

EMS 4939 wrote:

a million times over Whit

Do I know you.

I believe the question would be could you ride with me.

Unlike yourself sir, I do not pass judgement on people I dont even know.

First, I'm a female, as my little icon indicates. Secondly, I would not ride with you. I prefer my partners understand their educational limitations and scope of practice, as I understand my own. Oh, and spellcheck rocks when it's utilized!

[whit72]

EMS 49393

1. I don't believe I requested to ride with you.

2. I don't recall caring if you wanted to ride with me.

I'm glad you understand your limitations.

Treating hypoglycemia is not a limitation for me.

So carry on and next time why don't you leave my name out of it.

Thank you

Whit

[akflightmedic]

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