Blood Glucometry and Nebulized Albuterol for EMS agencies

Bureau of EMS Policy Statement
Policy Statement # 09-13
Date December 28, 2009
Subject Re: Blood Glucometry and Nebulized Albuterol for EMS agencies
Supercedes/Updates 05-04

Background

The New York State Emergency Medical Advisory Committee (SEMAC) has approved the use of glucometers and nebulized albuterol by Emergency Medical Technicians (EMT) who are employees/volunteers of an EMS agency (i.e. ambulance service, ALS-FR, BLS-FR). The SEMAC approval was granted with the specific condition that the EMS agency wishing to use a glucometer or nebulized albuterol, be granted approval by the Regional Emergency Medical Advisory Committee (REMAC), that each EMT from that EMS agency complete a REMAC approved training program, and that the EMS agency be granted a Limited Laboratory Registration (for blood glucometry only).

The purpose of this policy is to explain the approval process for EMS agencies wishing to implement a nebulized albuterol and/or blood glucometry program.

  • Prehospital blood sugar evaluation is intended to assist in the recognition of hypoglycemia and improve the speed with which proper treatment is received.
  • Nebulized albuterol, when administered under the Statewide BLS Adult and Pediatric Treatment Protocols has been shown to decrease respiratory distress in patients between one and sixty-five years of age who are experiencing an exacerbation of their previously diagnosed asthma.

AUTHORIZATION FOR BLOOD GLUCOMETRY AND/OR NEBULIZED ALBUTEROL

Each REMAC will adopt protocols which will allow an EMT to obtain a blood sample, using a lancet device or equivalent, and test the blood sample in a commercially manufactured electronic glucometer. The REMAC will determine the type and level of record keeping and quality assurance required for both blood glucometry and/or nebulized albuterol. Please note that a protocol for nebulized albuterol has been approved by SEMAC and is included in the Statewide BLS Adult and Pediatric Treatment Protocols for EMT-B and AEMT.

To be authorized to use an electronic glucometer or nebulized albuterol, the EMS agency must make written request to the appropriate REMAC. The request must include, but not necessarily be limited to, the following items:

  • A letter from the EMS agency physician medical director supporting the request and indicating an understanding of their role in the Clinical Laboratory requirements (blood glucometry only) and quality assurance process
  • A completed NYS Department of Health Clinical Laboratory Limited Laboratory Registration Application (DOH-4081) for blood testing licensure (blood glucometry only)
  • Written policies and procedures for the operation of the glucometer and storage and maintenance of nebulized albuterol that are consistent with applicable Regional and State protocols. These policies and procedures shall include, but not necessarily be limited to the following:
    • didactic and psychomotor objectives for training of authorized users including who will be authorized to conduct this training;
    • documentation and attendance records of the training of authorized users;
    • a defined quality assurance program, including appropriateness review by the EMS agency physician medical director;
    • documentation of control testing process (blood glucometry only);
    • written policies and procedures for storage of the glucometer and/or nebulized albuterol, and proper disposal of sharps devices (blood glucometry only);
    • notice to the EMS agency physician medical director of the use of the glucometer and/or nebulized albuterol, and;
    • requirements for documentation when the glucometer and/or nebulized albuterol is used for patient care.

LIMITED LABORATORY REGISTRATION FOR BLOOD GLUCOMETRY

New York State Public Health Law requires that any EMS agency testing blood glucose, whether by electronic glucometer or chemstrip, be required to possess a Limited Laboratory Registration. In order to obtain the Registration, EMS agencies must complete and submit the following documents:

  • Limited Service Laboratory Registration (DOH-4081)
  • Disclosure of Ownership and Controlling Interest Statement (DOH-3486)

The information and appropriate application paperwork is available at http://www.wadsworth.org/labcert/clep/Administrative/ChangeForms.htm. No EMS agency may engage in the testing of blood glucose without a registration permit.

Notification

Once the EMS agency has received written approval for blood glucometry and/or nebulized albuterol from the REMAC, the EMS agency must provide BEMS with an updated and signed Medical Director Verification Form (DOH-4362), indicating the Limited Laboratory Registration permit number (if applicable) and authorization by the EMS agency physician medical director.

Issued and authorized by Bureau of EMS