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When I came across an article entitled “Emergency medical technician treatment of hypoglycemia without transport,” the first thought that flashed across my mind was some of the lower-quality EMTs I’ve worked with wielding syringes of glucagon, and leaving butchered diabetics in homes everywhere, probably to die.

Fortunately, I managed to read the article.  In an observation of 402 cases (not a randomized trial), EMTs performed as well on paramedics on every aspect of management tested, which included:

1. Whether the diabetic called his/her family doctor
2. Whether the diabetic changed insulin dosages
3. Whether the diabetic was watched for 6 hours
4. Repeat 911 calls
5. Repeat low blood sugars
6. Transports to the hospital
7. Receipt of standardized, pre-printed instructions

There were two very important bits that limit how much this can be generalized to the rest of the EMS world.  First, people were eligible for EMT treatment if they were insulin-only diabetics able to take oral glucose–in other words, the EMTs were essentially doing something an untrained relative of the diabetics could do.  Second, this study was in King County, WA, which is probably the EMS system with the best quality assurance program in this country.  There are two ways to get high quality medical care from someone:  lots of education, or lots of oversight, and as long as an EMT class is less than 200 hours of training, only oversight will do.

King County Medic One has enough people checking up on its providers’ work to pull this sort of stuff off.  Does your service?

Filed under: EMS Research