They Needed A Study To Figure This Out?

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Study: EMTs can’t administer glucagon

BOSTON — A recent study found that the administration of glucagon is not in the EMT scope of practice, meaning diabetic patients who call 911 only have a 1 in 4 chance that the responding EMS provider will be able to administer the lifesaving drug.

You don’t really need a study. Well, as long as you’re not a doctor, that is. All you have to do is read the Massachusetts Statewide Treatment Protocols and you’ll see that EMTs are not allowed to inject anything EXCEPT and Epi Pen. That might not make sense, but the truth is that it’s not that common that paramedics aren’t available to start an IV and give Dextrose.

Patients’ families can do a lot of things that EMTs can’t. Some of that is for good reason, some of it is regulatory silliness. Of which there is a lot in EMS.

The study also found that 911 dispatchers only told EMTs they would be responding to a diabetic call in 44 percent of the observed incidents.

I’m often critical of  dispatchers, sometimes with good reason. That being said, they can only dispatch based on what they are told. If the caller doesn’t tell them that the patient has a history of Diabetes, they aren’t going to be able to relay that information to the responding providers. During my career, I responded to thousands (no exaggeration) of calls for diabetic emergencies. Just about every time if the dispatcher knew that the patient had a history of Diabetes, they told us. On the other hand, I responded to more than one “unknown” call where someone who didn’t know the patient well (or at all) called 9-1-1. One of those cases was a diabetic who was involved in a vehicle crash. We didn’t know that because the person who called only called in to say that there was a crash with injuries. It took us a few minutes to sort it all out and our violent “head injury” patient became a calm, cooperative patient after an IV and some Dextrose.

That’s not that uncommon, so I can see why more than 50% of the time the caller wouldn’t relay the information that they didn’t have.

What the doctor didn’t talk about was the scope of the problem. That is if there is a scope of the problem. Which interestingly isn’t mentioned in the video or the text of the article.

Another case of a doctor who is completely clueless when it comes to EMS who has “suddenly” discovered a crisis that he needs to solve.

As a former coworker of mine was fond of saying, “You can be a doctor, or you can be smart, but you can’t be both.”

By the way, I was looking for an article on the six year old girl who died from the flu. The reason it’s notable is that she was seen at an urgent care center and sent home. Hours later, an ambulance was called and the parents allege that they were told that the girl didn’t need to go to the hospital. When I find an article or two about that, I’ll have a full post.

Suffice it to say that no good will come of this, no good at all.

2 COMMENTS

    • At least in my state, ALS ambulances carry three different concentrations (D50, D25, D10) for IV administration, Glucagon for IM, and Glucose paste for PO. BLS units can, actually I think it’s required, use Glucose paste. The only medication that BLS providers can give via injection is an Epi Pen. It would take a change in the scope of practice to give anything else via injection. Even Narcan can only be given intranasally by BLS providers.

      I really see this is a solution in search of a problem.

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