EMTs Not Allowed to Administer Glucagon

2/22/18
FacebookTwitterEmail

Boston, MA — A hypoglycemic episode is caused by too much insulin or too little sugar in the body and if left untreated may lead to seizures, unconsciousness, loss of brain tissue and sometimes death. When a person with diabetes cannot take sugar orally to correct the low blood sugar, the emergency hormone medicine glucagon is administered to correct the blood sugar quickly. In extreme cases like these, time is of the essence.

Surprisingly though, a recent study published in the Annals of Internal Medicine found that if you call 911 due to a hypoglycemic episode, there is roughly a 3 in 4 chance the emergency medical responder will be unable to give you glucagon, the life-saving medication. The study was co-authored by Robert Gabbay, MD, PhD, and Chief Medical Officer at Joslin, Nicole E. Wagner, B.A. of Joslin, and Peter A. Kahn, MD, MPH, ThM, of Yale School of Medicine.

“What we couldn’t really ascertain was why this is the case. From a diabetologist point of view, it makes no sense,” says Gabbay, MD, PhD. “We hope by getting this out into literature to start a dialogue to understand this more and identify ways in which we can remedy this situation.”

While paramedics have specialized medical training that allows them to administer more types of emergency treatments such as glucagon, emergency medical technicians, or EMTs, do not. Paramedics are the only emergency responders currently allowed to carry and administer glucagon in most of the United States. There are nearly 200,000 EMTs versus only about 60,000 paramedics, meaning there might be a 75 percent chance a responder will be unable to give a potentially life-saving treatment.

While the process to administer the medicine does require you to dissolve a powder into a liquid before injecting it, the paper finds “these restrictions are even more surprising given that glucagon is routinely administered by family members.” Moreover, the side effects of glucagon are not serious and typically include nausea.

The study also uncovered that of all the diabetes-related calls they received, 911 dispatchers only told EMTs they would be responding to a diabetic emergency in 44 percent of cases. “[This] potentially increas[es] the likelihood of dispatching providers who cannot administer glucagon to patients suffering from hypoglycemia,” the paper says.

Currently, the laws around this vary state by state, which makes rolling out a unified protocol more challenging. This study may be used to influence policy makers though to create a national program that teaches all EMTs to administer glucagon.

“All emergency personnel should have access to glucagon along with training to safely administer glucagon to minimize unintended treatment accidents,” Dr. Gabbay and his fellow authors state. “Ensuring this access represents an important opportunity to reduce morbidity, mortality and healthcare costs. Diabetes specialists should work with emergency medical personnel to design curricula for the safe and effective use of glucagon nationwide.”