So… What is the new and expanded role of the ambulance service? It’s actually one of the better ideas, but why it can’t be done by the hospitals mystifies me. I’ll let the memo tell you. (PRF= Patient Report Form)
Routine screening for early diagnosis of diabetes
There are over two million people in the UK who have been diagnosed as diabetic. Because of modern diet, lifestyle and the way populations are changing diabetes has become one of the UK’s fastest growing diseases – the number of diabetics is likely to double over the next five years (it is already estimated that there are about one million undiagnosed diabetics in the UK).
The majority of people with diabetes have Type 2 diabetes, which usually occurs in people over the age of 40. The older a person is, the greater their risk of developing Type 2 diabetes. Due to a complex range of factors including genetics, cultural and lifestyle differences, people from a black or minority ethnic group are at increased risk over the age of 25 and are four to five times more likely to develop Type 2 diabetes than people from white ethnic groups.
The longer diagnosis is delayed, the more chance there is that people with diabetes will go on to develop serious and life-threatening complications – kidney failure, blindness, lower limb amputation and increased risk of coronary artery disease and stroke are all potential results from undiagnosed, and therefore untreated, diabetes. Once diagnosed, diabetes is a manageable condition, and diabetics who manage their condition are better able to lead full, healthy lives.
In view of the above facts, the Department of Health’s National Service Framework for Diabetes sets out a vision for ‘fewer people developing [Type 2] diabetes.’ Part of the approach for realising this vision includes increasing the number of people who are screened for diabetes, particularly those who are more at risk.
To contribute towards this goal, whilst continuing to test the blood-glucose of patients who are known diabetics, EMTs, paramedics and ECPs should routinely test the blood-glucose levels of all patients who are:
- • 40 years of age or over
- • 25 to 40 years of age with one or more of the following pre-disposing factors:
- o from a black or minority ethnic group
- o a history of diabetes in close family (mother, father, brothers and sisters)
- o overweight (BMI of 25-30 kg/m2 or above) with a sedentary lifestyle
- o ischaemic heart disease, cerebro-vascular disease, other circulatory problems or hypertension
Where blood-glucose testing would not normally form part of their assessment and treatment, the patient’s consent should be sought before the test is carried out, explaining why the test is being done.
If a patient declines to consent to the test this should be recorded on the PRF. The results of the test should be recorded in the usual way on the PRF.
If the blood glucose reading is outside normal limits (above 5.6 mmol/l or below 3.0 mmol/l) in a non-diabetic patient, this information should also be passed to the receiving staff upon handover at the receiving hospital unit.
If the patient isn’t conveyed, the pink copy of the PRF should be left with them, and they should be advised to see their GP to discuss the test results. Generally, the hospital or GP will diagnose diabetes when two separate blood tests reveal blood glucose levels above 7.8 mmol/l before eating or above 10.0 mmol/l after eating.
The screening for diabetes should not take priority over assessment and treatment pertinent to the patient’s presenting condition, nor should it contribute to unnecessarily extended times on scene.
So, during our roaming around we are to check the blood sugar of pretty much all out patients to screen for diabetes. Got a twisted ankle? Get a free trip to hospital with added diabetes check.
It’s not a bad idea to be honest, if we can detect diabetes earlier, then we can better treat it. But, I’m betting that we aren’t getting any extra money for this new role… Also, given the make up of Newhams population, I’m going to be checking the blood sugar of pretty much everyone over the age of 25 I go to. I wonder if this is why we currently have a shortage of the blood sampling needles?
As for the person who suggested that we are about to be asked to work twelve hours without a break – we already are expected to do this, we get £7.10 paid to us because we don’t get any breaks.
Later I’ll tell you about another role that we seem to have taken upon ourselves.