Can paramedics safely treat and discharge hypoglycemic patients in the field?

• Published in: The American journal of emergency medicine Vol. 21; no. 2; pp. 115 - 120
• Main Authors: Lerner, E.Brooke, Billittier, Anthony J., Lance, Daniel R., Janicke, David M., Teuscher, Josette A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01-03-2003; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Brain Diseases - etiology; Consent Forms; Cost control; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes. Impaired glucose tolerance; Emergency medical care; Emergency Medical Services; Emergency Medical Technicians; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Enrollments; expanded scope; Female; Glucose; Glucose - therapeutic use; Hospitalization; Humans; Hypoglycemia; Hypoglycemia - complications; Hypoglycemia - therapy; Intravenous administration; Long-term care; Male; Management. Various non-drug treatments. Langerhans islet grafts; Medical sciences; Middle Aged; Observational studies; Paramedics; Patient Discharge; Patients; Prospective Studies; Questionnaires; Recurrence; Thiamine - therapeutic use; Vitamin B; emergency medical services; expanded scope; Hypoglycemia; Endocrinopathy; Human; Immunopathology; Intravenous administration; Autoimmune disease; Insulin; Dextrose; Protein hormone; Chemotherapy; Hypoglycemic agent; Treatment; Insulin dependent diabetes; Nurse
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1053/ajem.2003.50014

To determine whether paramedics can safely treat and discharge insulin-dependent diabetic patients experiencing uncomplicated hypoglycemic events, we conducted a prospective, observational study with a convenience sample of diabetic patients whose hypoglycemia resolved after intravenous administration of dextrose and before they were transported by paramedics. On-line medical control was contacted to obtain approval and informed consent for participation from interested patients who met all eligibility criteria for the study. Participating patients were given instructions upon discharge from the study and were contacted by telephone 24 hours later to ascertain their medical outcomes and their opinions of the study protocol. We enrolled a total of 36 patients with 38 incidents of hypoglycemia. Of these, 91% reported no complications after discharge. Two patients developed recurrent hypoglycemia but treated themselves and did not require further emergency care. One further patient was found unresponsive on the morning following discharge and was subsequently admitted to a long-term care facility with hypoglycemic encephalopathy. Of the study participants, 85% were very satisfied with not being transported to an emergency department (ED) and 91% were very satisfied with the care they had received. All (100%) of the patients surveyed favored a permanent protocol allowing discharge of hypoglycemic patients without admission to an ED. We conclude that paramedics successfully treated, without complication, most of the patients with uncomplicated hypoglycemic events who were examined in our study. These patients generally preferred discharge without transportation to an ED. (Am J Emerg Med 2003;21:115-120. Copyright 2003, Elsevier Science (USA). All rights reserved.)