If you have been in EMS for any length of time, then you have undoubtedly run into diabetic patients who are unconscious due to a severely low blood glucose. Some of us load the patients up and head for the ER, administering the Dextrose en route, while others do this on scene and wait for the patient to regain consciousness before making the next move. I have heard valid arguments for both methods of treatment, but I still lean towards the load-and-go method for several reasons. Long scene times, increased liability and possible deterioration of the patients status are just a few.
Sitting on scene to attempt IV access, administer Dextrose and wait for a response, takes too much time. If successful, then it’s arguable that the time on scene wasn’t really wasted and the patient improved. But if unsuccessful, then you just spent 10-15 minutes in the patient’s living room when you could have been at the back doors of the ER. There are several schools of thought here. Some argue that waiting until you are in the ambulance to administer Dextrose is just as risky. I personally would rather spend 2 extra minutes loading my patient and beginning transport then waiting around on scene and possibly accomplishing nothing. This way, if I’m unable to establish an IV, or administration of medication doesn’t work, then I’m already half way to the hospital.
Another reason I frown upon the “stay and play” method is the fact that those patients often end up refusing further treatment. We would all probably agree that 90% of these patients do just that. While that may get us back to the station quicker, it doesn’t do much good for the patient. Just because we increased their blood glucose, doesn’t mean we fixed their problem. Diabetic patients often run into these problems when their insulin doses are adjusted, start new medications, or flat out aren’t taking care of themselves. Either way, they need help that goes beyond our scope and certainly beyond what they can accomplish at home. Remember, everything happens for a reason, so by not addressing the reason why their blood glucose dropped in the first place, we are not doing them any good.
I look at these patients like I look at people suffering from head trauma. I wouldn’t even consider leaving a patient on scene who had completely lost consciousness from a traumatic injury. Just because they seem OK now, doesn’t mean they wont be back on the floor in 10 minutes. Well the same applies to diabetics. For starters, Dextrose is fast acting and therefore quickly dies off. So if the patient was careless and didn’t eat before taking their insulin, then are you going to trust them to do the right thing this time? Load these people up and get them the help they need.
Over the years of my career I have seen too many diabetics use the EMS system as a crutch. They don’t really worry about taking care of themselves because we will always be there in under 8 minutes to get them back on their feet. In some cases, the same person calls several times a week. If we just show up, give them some Dextrose and send them on their way, we aren’t addressing the core issue. People like this need education, and they need to know that there are consequences for their actions. If I had to spend half a day in the ER every time my blood glucose dropped, I would either start taking care of myself, or most likely get placed in a facility where someone would do it for me.
I realize that there are always exceptions to these scenarios, like the diabetic who lives on the top floor of a 10 story building with a broken elevator. I’ll give you that, but the overwhelming majority of the time, I think it’s much more beneficial to get moving towards a hospital while starting your treatment. If anyone has any other opinions on the subject, I would love to hear about it.