I’d like to ask a question to all of you medical-type folks out there, and for this one I’d like other healthcare professionals to weigh in, not just EMS. Of course, Paramedics and EMTs are encouraged to answer this question, but so are Physicians and Nurses (RN and LPNs), as well as CNAs and Techs.
A conversation I had on Twitter regarding administration of 10% Dextrose IV (D-10) as opposed to 50% Dextrose IV (D-50) for hypoglycemic ambulance patients has me wondering something about how we paramedics can create major savings and improve patient care in a short amount of time. We need to look for more “Low Hanging Fruit”.
It is common practice for known diabetic patients presenting with low blood sugar (hypoglycemia) to receive a treatment with IV D-50, IM Glucagon, oral Glucose, or even with the “Kaiser Cocktail” and then sign off with an AMA refusal. The patients are encouraged to eat something containing protein and complex carbohydrates and are usually left in the care of one of their family members and/or friends who can watch them for a while and make sure they’re ok.
I’d say that calls like this make up a fairly large percentage of all calls for an ambulance. While I have no statistics to back me up, I would guess that it could be something like 5% or better. This complaint and resultant treatment pathway is something I do quite frequently in my own practice. Judging from my own experience, I would say it happens quite frequently in most other paramedics’ practices as well.
The question about administering D-10, as brought up by my twitter peep @un_ojo, is if all patients getting treatment with D-10 as opposed to D-50 should be transported to an Emergency Room. My answer was that I believe a 100% transport policy in this case would result in a lot of people being transported to an ER when they probably didn’t really need to be. This would result in a large population of non-emergent ambulance patients going to the ER who in the past would have been “treated and released” (at least under the guise of an AMA refusal) by EMS crews.
And that got me thinking about this question:
If paramedics did not currently have the means to treat hypoglycemia and every one of those patients were being transported to the ER, how much of a burden on the emergency healthcare system would be removed simply by giving paramedics D-50? Probably quite a bit, right?
What other common medical cases would be as appropriate for field “treat and release” (or “Treat and AMA”) care by EMS? If we save a few hundred trips to the ER by being able to sweeten-up and then release common hypoglycemics, what other conditions might we be doing the same for as safely and effectively?
Would this require some easily attainable training? What about new medications and/or equipment?
I look at this as the “Low Hanging Fruit” if you will, of EMS 2.0, and also of healthcare reform. I am a proponent of EMS crews handling more primary care duties, or failing that, of at least having more options in regards to treatment pathways.
That’s what I’m looking for here, folks. What could we do within six months that would make a big impact?
Also, would you do me a favor and invite some of the other healthcare people to the party? I’d love to get some of their opinions on this.