Hypoglycemia Patients and Transport by EMS in Alameda County, 2013–15

Abstract

Objective To estimate the rate, characteristics and dispositions of hypoglycemia events among persons who received care from Alameda County, California, Emergency Medical Services (EMS). Methods This study was based on data for 601,077 Alameda County EMS encounters during 2013–2015. Subjects were defined as having hypoglycemia if EMS personnel recorded a primary impression of hypoglycemia or low blood glucose (<60 mg/dl or “unspecified low”). The outcome of interest was patient transport or non-transport to an emergency department or other care setting; we excluded 33,177 (6%) encounters which lacked clear disposition outcomes. Results Among 567,900 eligible encounters, 8,332 (1.47%) were attributed to hypoglycemia, of which 1,125 (13.5%) were not transported. Non-transport was more likely among males, adult patients age <60, initial blood glucose >60 mg/dl or EMS arrival time 18:00 – 6:00. Conclusions Without an understanding of EMS encounters and non-transport rates, surveillance based solely on emergency department and hospital data will significantly underestimate rates of severe hypoglycemia. Additionally, given that hypoglycemia is often safely and effectively treated by non-physicians, EMS protocols should provide guidance for non-transport of hypoglycemic patients whose blood glucose levels have normalized.

Hypoglycemic Patient Transported by EMS inMakkah Region, 2017

“…In Makkah region during2017, 1 in 4 (27%) EMS encounters for hypoglycemia did not result in transport to ED.We took the data from the Saudi red crescent authority.Compared to some previous research we found the same result that non-transported was more likely among male patient or age from (40-59) 7,14,16,17 or patients for encounters during midnight to 6 AM. 7,17,9 The differentiation was in use dextrose 10% 7 which is more likely used in Saudi Arabia, maybe because EMS is more familiar with it but in the end it dependson condition of the patient.We ran out of time, and there isa shortage of data on types of diabetes, 11 pickup locations, destination, a repeated call from the same patient, 4 follow up the patient in the hospital and the improvement of the patient status.…”

“…7,17,9 The differentiation was in use dextrose 10% 7 which is more likely used in Saudi Arabia, maybe because EMS is more familiar with it but in the end it dependson condition of the patient.We ran out of time, and there isa shortage of data on types of diabetes, 11 pickup locations, destination, a repeated call from the same patient, 4 follow up the patient in the hospital and the improvement of the patient status. 8 The Patient who refused transport in some cases preferred alternative transport mode or EMS deeming transfer unnecessary.…”

Accuracy of a composite event definition for hypoglycemia

“…This would have greatly increased the data collection burden and created additional challenges with regards to control sampling. Even with the selection of controls, it would have been difficult to estimate the sensitivity of the definition with accuracy, since many hypoglycemia events that occur in the community setting are not captured in medical records, although we included an outpatient definition to capture more events . For the outpatient events that are based on laboratory glucose measurements, spuriously low glucose values may occur due to glycolysis if the blood samples are untreated and there is any delay in testing.…”

“…Experts recommend considering the risk of hypoglycemia when evaluating diabetes treatment effectiveness . However, assessing the occurrence of hypoglycemia events accurately on a population level is challenging because many events are not captured through health care encounters . There is agreement among providers and researchers that any hypoglycemia event requiring hospitalization or emergency care is a severe event.…”

“…7 However, assessing the occurrence of hypoglycemia events accurately on a population level is challenging because many events are not captured through health care encounters. 8,9 There is agreement among providers and researchers that any hypoglycemia event requiring hospitalization or emergency care is a severe event. Nonetheless, a low glucose measurement at any time can be clinically meaningful due to its potential physiologic effects, even when the patient reports no symptoms.…”