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Development and Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia: A Retrospective Study

Published online by Cambridge University Press:  28 June 2012

Randy H. Thompson  and
Robert W. Wolford
Randy H. Thompson
Affiliation:
University of IllinoisCollege of Medicine at Peoria, Peoria, Illinois
Robert W. Wolford*
Affiliation:
University of IllinoisCollege of Medicine at Peoria, Peoria, Illinois Department of Emergency Medicine, Saint Francis Medical Center, Peoria, Illinois
*
Department of Emergency Medicine, Saint Francis Medical Center, 530 N.E. Glen Oak Avenue, Peoria, Illinois 61637, USA
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Abstract

Introduction:

A retrospective study of patients transported by paramedics to a community teaching hospital was conducted to: 1) determine the response of hypoglycemic patients to prehospital treatments, 2) develop criteria to identify patients who safely could be released without transport to a hospital, and 3) evaluate the prehospital release criteria.

Methods:

Patients presenting to EMT-paramedics with an altered level of consciousness were identified retrospectively. Pre- and post-treatment blood glucose levels were measured and response to treatment noted (Phase 1). Criteria were established using these data and a second sample was evaluated using these criteria (Phase 2).

Results:

During a 12-month period, 60 patients with an altered level of consciousness (ALOC) were encountered. Of the 60 patients, 27 (45%) were documented to be hypoglycemic (blood glucose [BG] <80 mg/dl, mean 27±13 mg/dl). Of the 27 hypoglycemic patients, 24 (89%) were discharged from the emergency department (ED) and three patients (11%) were admitted. Criteria were developed to identify patients who could be treated and released safely without transport to a hospital: 1) history of insulin (IDDM) or non-insulin (NIDDM) dependent diabetes mellitus; 2) pre-treatment BG <80 mg/dl; 3) post-treatment BG >80 mg/dl; 4) return to normal mental status within 10 minutes of treatment; and 5) absence of complicating factors (renal dialysis, chest pain, arrhythmia, dyspnea, seizures, alcohol intoxication, focal neurological signs/symptoms). The criteria were applied retrospectively to 27 hypoglycemic (mean BG=28±14 mg/dl) patients during a different 10-month period. Of the 27 hypoglycemic patients, 23 (85%) were discharged from the ED, and prehospital release criteria correctly identified 19 of 23 (83%). The prehospital release criteria did not select for release any patient who required an additional, major intervention or who was admitted.

Conclusion:

This study demonstrates that there is a group of hypoglycemic patients who respond favorably to paramedic interventions. Retrospectively, the prehospital release criteria were successful in selecting patients who did not require additional interventions. A larger prospective study must be conducted before prehospital treatment and release can be recommended for general practice.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 6 , Issue 3 , September 1991 , pp. 309 - 313
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

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