title: The influence of emergency medical technician glucometry on paramedic involvement.
abstract: BACKGROUND
  Rapid glucose testing is a valuable tool for emergency medical services (EMS) patient evaluation and treatment. In most EMS systems, paramedics, but not emergency medical technicians (EMTs), are authorized to use glucometry.
  
  
  OBJECTIVE
  To evaluate the influence of EMT glucometry on paramedic involvement in a two-tiered EMS response system.
  
  
  METHODS
  King County, Washington, EMTs underwent training in glucometry to determine blood sugar levels for specific patient presentations. The authors conducted a prospective cohort study of the first 500 EMT uses of glucometry, from October 2003 through March 2004, during which time EMTs recorded their subjective assessments of this additional information on their decisions to involve paramedics.
  
  
  RESULTS
  Overall, glucometry results appeared to influence EMT decisions to involve paramedics. Glucometry prompted EMTs to upgrade the triage level and request paramedic evaluation for 5% of patients (n = 22); glucometry caused EMTs to downgrade the triage level, canceling already dispatched paramedics for 5% of patients (n = 23); and glucometry allowed EMTs to function without paramedics when they otherwise would have called for assistance for 11% of patients (n = 52). In an additional 12% of patients (n = 54), paramedic involvement was not actually influenced, but EMTs still indicated that glucometry would have had an effect on triage had paramedics not been present.
  
  
  CONCLUSIONS
  Use of glucometry by EMTs appears to influence the decision to involve paramedics, potentially enabling more efficient and appropriate triage.
authors.affiliation: Division of Emergency Medicine, University of Washington Medical Center, Seattle 98195, USA. strote@u.washington.edu
authors.forename: Jared
authors.initials: J
authors.lastname: Strote
authors.forename: Donald
authors.initials: D
authors.lastname: Cloyd
authors.forename: Thomas
authors.initials: T
authors.lastname: Rea
authors.forename: Mickey
authors.initials: M
authors.lastname: Eisenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003657:Decision Making; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods*; D004634:Emergency Medical Technicians / Q000145:classification / Q000193:education; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014861:Washington
chemical_list: D001786:Blood Glucose