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[IP] EMS and Diabetics

    I would like to give everyone some information on Emergency Medical Services and diabetic related emergencies.  I am a Nationally Registered Paramedic, and I practice in Georgia, where I am also a Paramedic Instructor.  As a side note, I am almost finished with RN school and I am about to apply to Med Schools, so I am familiar with many aspects of health care.  Most importantly, I have been a Type I for almost 14 years and a pumper for over four years.  Please bare with me on this explanation, I am trying to make it as brief yet informative as possible.
    Without being too technical, it helps to know that there are roughly four different groups of people that you could come in contact with in an emergency: first responders, EMT-basics, EMT-intermediates, and EMT-paramedics.  The titles of these people can vary from state to state, and there can be other levels, but almost all responders fit into these categories.
    When the EMS system is activated, the type of information that is provided to the dispatchers dictates the type of response that will be given.  In most diabetic emergencies that require an ambulance, the patient is unconscious, which warrants a full response.  This usually means that you will get an initial response from first responders, basics, intermediates, and possibly paramedics, who will arrive before the advanced units.  The initial response may be from the fire department, the police department or another agency.  Advanced units will have intermediates or paramedics with them.  The ambulance that arrives may or may not have advanced personnel on it, but if the patients condition requires care from advanced personnel, such personnel will ride in with the ambulance if they are on the scene.  Again, based on your location, and especially in rural areas, it is possible that you will get no advanced response.
    The majority of EMS courses in the United States are based on a nationally standardized curriculum.  This national standard covers the handling of diabetic emergencies.  All EMS courses, to my knowledge, even when not based on the national standard, cover the handling of diabetic emergencies.  While all providers are taught the signs and symptoms of diabetic emergencies, based on their training, they will handle the emergencies differently.  In the case of insulin pumps, they are not part of the national curriculum at this time.  Most instructors, however, are familiar with the pump and will give an overview to their class, especially at the advanced levels.  I always do a show and tell for my students and allow them to "play" with the pump so they can get used to it, and I advise them of how to handle a pump in an emergency.
    We will always check a blood sugar if our certification level permits.  Some EMS providers will have glucometers, while others will have chemstrips for visual interpretation.  Chemstrips (visual) allow us to gather enough information to judge high / low, even if we don't get a perfect reading.  In the case of hypoglycemia, advanced providers will administer glucose orally if the patient is conscious and with an intact gag reflex, or intravenously if necessary.  Glucagon, injected intramuscularly, will be given if IV access is unavailable.  In the case of hyperglycemia, IV fluids will be administered, as well as anti - nausea medications as needed.  While paramedics are allowed to perform any procedure that a doctor certifies them to perform (by most state laws), insulin administration is not a common practice in the field, and I know of no EMS provider who gives insulin.  We do not have lab tests in the field, and we cannot accurately dose insulin without labs, among other things.
    Again, it is possible that you will not have an advanced provider in an emergency.  Basic level providers will handle the situation based on their training, and are able to make life saving interventions.  The EMS system is not always perfect, and paramedics are not always available, especially in rural areas.
    If you are a diabetic, please remember to wear a medic alert bracelet, and carry a wallet card if you have an insulin pump.  WE ALWAYS check for medic alert tags.  The sad thing is, I rarely find them on diabetics.  While providers who are so trained will always check a blood sugar on an unconscious or altered mental status patient, it always helps us to know your medical history.  In a cardiac arrest situation, which, in a diabetic, could possibly be caused by hypoglycemia, medic alert tags are critical, as they help us "piece together the puzzle" which allows us to save lives.
    I can't promise that all EMS providers will be without fault.  I am sorry if you have had contact with any that have been less than perfect.  We work together as a team, though, and we make things happen.  Please help us to stay educated on insulin pumps and diabetics by volunteering your time to your local EMS service as a teacher.
    If I can answer any questions or be of assistance, please E-mail me.
Hunter Hughes, NREMT-P