Extended Roles (I)

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:

  1. • 40 years of age or over
  2. • 25 to 40 years of age with one or more of the following pre-disposing factors:
    1. o from a black or minority ethnic group
    2. o a history of diabetes in close family (mother, father, brothers and sisters)
    3. o overweight (BMI of 25-30 kg/m2 or above) with a sedentary lifestyle
    4. 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.

14 thoughts on “Extended Roles (I)”

  1. Well that sounds like a very good idea. An African friend of mine stumbled on to his diabetes when he used my wife's testing kit, she was being home monitored for pregnancy diabetes, and it came out at 7.2 about 3 hours after he had eaten breakfast! We tried it an hour after we had lunch and it came out at 10.5! That was 4 months ago and he is now telling everyone he know's from his home country about it!But I can see where this may get a little bit time consuming, and would you be expected to do this on anyone you treated who was drunk or in an altered state due to drugs? Not a totaly uncommon situation for you! I just wonder if the results obtained would be accurate. Should of paid more attention in Biology I guess.

  2. oh that sounds like fun.It's a good idea in principle, but could it not be done by GPs as part of an annual health check or something?

    Personally I refuse the finger-stabby. I don't mind needles anywhere else but I hate the finger-stabby. I have enough blood tests for other reasons that they include diabetes as a matter of course and I know I'm not diabetic, doing a finger-stabby will just make me panicky and…

    oh god. You're going to have to deal with no end of “I don't like needles” and panic attacks, aren't you?

  3. Extended roles is a Big Issue in Oz at the moment. Just came out of a rather bitter industrial dispute with this as the main platform. We were awarded an ALS allowance in the new agreement. However the services are trying to introduce more skills and responsibilty without compensation (but with press releases). Sometimes think I'm stuck on a merry go round.

  4. Yes. Yes he is. And I'm one of them. I was told by a paramedic that mine was the worst needle-phobia he'd ever seen, especially as it was only the finger-stabby and didn't even look like a needle. They took me to hospital. It took them three hours *not* to get blood out of me: they gave up in the end….

  5. So what are you supposed to do if one the tests comes out positive? Just send them to the doctor or start answering the million and one questions the patient will undoubtedly have? Try and persuade them to do something about it if they don't take it seriously?You'll end up with target treatment times as well as arrival times.

    It sounds like a good idea, but I'm not sure it's appropriate as part of an emergency service's remit.

  6. As someone who was diagnosed only a few days ago as diabetic and it was only by chance I went for a checkup … I think its an excellent idea!

  7. I go the other way… needles are fine, blood is fine, they're welcome to take a pint or more from the crook of my elbow, hell, give me a clean sharp knife and I'll even *cut* my own arm or leg.But finger-stabby snaps, hurts, and then with the amount of typing I did gets infected and throbs.

    Last time a paramedic wanted to do that to me, I calmly explained that I'd been recently tested, and it would only give me a panic attack on top of everything else. We agreed that I was giving an “informed refusal”.

  8. I would have thought it depends on the patient's symptoms, but reading the list again, I guess that's all stuff you could ascertain while doing an initial assessment.I just over think, and worry about a punter going “I've got [insert symptom], what's diabetes got to do with it? Maybe ambu staff could word it so the paitent knows its part of a new routine thing?

  9. Interesting… 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

    Someone out there's going to accuse the service of being racist, agist, and/or sizist. I like the idea of preventative health care, but I suspect this process is going to create more than a few headaches. Are they expecting you to take height and weight measurements in order to calculate BMIs (which are a less than brilliant tool anyway)? And given that many of the predisposing factors are only going to found out in conversation, what are you supposed to do with unconscious patients? I tend to take BSLs on a lot of unconscious patients anyway, so that will work in a lot of cases, but I can think of scenarios that wouldn't suggest to me that a BSL should be taken, and still leave you with a pt. that that can't tell if they have any predisposing factors.

    The BSL range you use is surprisingly narrow. In Victoria the ambulance services regard between 4.0 and 7.0 mmol/L as normal, and some health facillities have their own differences too. We'd regard 3.0 mmol as low, and conceivably requiring treatment, depending on the pt's symptoms and their normal range (if known).

  10. In Victoria the ambulance services regard between 4.0 and 7.0 mmol/L as normal, and some health facillities have their own differences too. We'd regard 3.0 mmol as low, and conceivably requiring treatment, depending on the pt's symptoms and their normal range (if known).I am glad you said that!! 3.0 sounded very low to me. I get all trembly if my blood glucose level dips to about 4.4 mmol.

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