EMT or Paramedic Question

[ktgrok]

One of the characters in my current writing project is a firefighter/paramedic. (I think, lol)

Set up is he is at an outdoor wedding reception at a small inn type place.  Outside on the grounds, a way away from the main building, a  woman he is talking to faints/collapses/passes out from low blood sugar. He catches her. Would he then lay her down where they are, near the playground, and check her over? Or would he be more likely to carry her back to the inn itself and take her inside? Or?  (will have him call 911 either way)

He's going to find her medic alert bracelet and then find her emergency glucagon injection in her purse. 

Edited September 13, 2020 by Ktgrok

[ktgrok]

EMT or other would also be helpful - anyone who has experience 🙂

[Ottakee]

Not an emt but generally if the location is safe, you don't move a victim until you figure out what is going on.

[brehon]

If he’s a trained medic, he’d probably automatically look for a medical device. It’s just part and parcel of our assessment.  I guess he would look through her bag or whatever for her glucagon after he saw the medical alert device. And, even though  I’m sure people will jump in with the one time at band camp scenarios, most people don’t immediately go unconscious from low blood sugar, even brittle diabetics. There’s usually a period of decline as the BGL decreases which could be either quick or relatively slow.

Also, just to be picky, people who go unconscious from low blood sugar don’t faint or have a syncopal episode. Those by definition are transient conditions which are alleviated after the person lies down, i.e., the blood flow to the brain improves. Low blood sugar isn’t fixed by a postural change. Your medic would know that. 😉

 

[Jentrovert]

Here is what my Paramedic/Firefighter says, "Well, most people don't just collapse from low blood sugar and pass out. They get dizzy; they're still awake and conscious. For example, one time at a child's birthday party, woman was talking out of her head, dizzy, etc. I looked at her fingers and saw she had marks indicating she checked her blood sugar regularly. Then, it turned out someone knew she was diabetic. I rubbed cake icing on her gums. You could do something like this as long as they are awake and can maintain their airway. Be aware, though, that some newer medics feel you should not put anything in someone's mouth like that. They want to start an IV and push D50 (Dextrose 50%) on people. But all the old school use either glucotrol or some other oral sugar they can find. Again, this is if the person is awake. If you want the story to be dramatic, though, and she has completely passed out, you'd examine her right there. When you find the bracelet and the glucogon, you'd do that and then call 911. If the person is completely passed out, using glucogon will take some time to work (15-30 minutes at best)."

ETA: I did not check my spelling on anything, I just typed what it sounded like he said. I may have spelled something wrong.  

Edited September 13, 2020 by Jentrovert

[brehon]

21 minutes ago, Jentrovert said:

Here is what my Paramedic/Firefighter says, "Well, most people don't just collapse from low blood sugar and pass out. They get dizzy; they're still awake and conscious. For example, one time at a child's birthday party, woman was talking out of her head, dizzy, etc. I looked at her fingers and saw she had marks indicating she checked her blood sugar regularly. Then, it turned out someone knew she was diabetic. I rubbed cake icing on her gums. You could do something like this as long as they are awake and can maintain their airway. Be aware, though, that some newer medics feel you should not put anything in someone's mouth like that. They want to start an IV and push D50 (Dextrose 50%) on people. But all the old school use either glucotrol or some other oral sugar they can find. Again, this is if the person is awake. If you want the story to be dramatic, though, and she has completely passed out, you'd examine her right there. When you find the bracelet and the glucogon, you'd do that and then call 911. If the person is completely passed out, using glucogon will take some time to work (15-30 minutes at best)."

Tell your medic that this old school medic has been known to lightly smear oral glucose buccally while waiting for the glucagon to work, assuming I haven’t been able to establish an IV. And I thought most services changed to D10. D50 is so incredibly caustic on veins.

Katie, Jen’s source is correct. If the blood sugar level is so low that the patient is unconscious, her body is probably shunting pretty aggressively and the glucagon will take even longer than its normal onset of action. 

Edited September 13, 2020 by brehon

[Jentrovert]

16 minutes ago, brehon said:

Tell your hubby that this old school medic has been known to lightly smear oral glucose buccally while waiting for the glucagon to work, assuming I haven’t been able to establish an IV. And I thought most services changed to D10. D50 is so incredibly caustic on veins.

Katie, Jen’s dh is correct. If the blood sugar level is so low that the patient is unconscious, her body is probably shunting pretty aggressively and the glucagon will take even longer than its normal onset of action. 

 lol To the first: A big grin, "Oh, old school, all right."   ETA: "All right" as in, yay for old school. Just realized that reads differently than it sounded. 

And to the second: A long, pained sigh, "Yeah, I don't know why they haven't switched here; you've got to be careful with D50." I gather this is on the long list of things that should be changed around here.

Edited September 13, 2020 by Jentrovert

[ktgrok]

Thank you all! She's actually dizzy, then uncoordinated, then mumbling before falling...hopefully that's pretty accurate? Problem is that as she realizes what is happening she also realizes her purse is back at the pavilion. She just didn't make it all the way back over there in time. 

He's a guest, so doesn't have any equipment/meds with him, but he does send someone to grab her purse. 

I could have her woozy and not coherent rather than totally out, that would work. 

(and in the veterinary field we rub Karo syrup on their gums/inside the cheek as first aid, while getting IV started, etc. 🙂  So we are old school too 🙂

[Frances]

25 minutes ago, square_25 said:

This is totally off-topic, so I hope you don't mind, but I love this method of research! You can always be sure to find an expert in something on here... 

My husband has taking to saying to me, “Why don’t you ask about x on your homeschool board, surely someone there will know.” 

[ktgrok]

34 minutes ago, square_25 said:

This is totally off-topic, so I hope you don't mind, but I love this method of research! You can always be sure to find an expert in something on here... 

Yup! My backup plan was to contact the local fire department, but y'all are quicker 🙂

[klmama]

Katie, I love that you do some of your research here.  I always learn something new!

[katilac]

31 minutes ago, Ktgrok said:

Thank you all! She's actually dizzy, then uncoordinated, then mumbling before falling...hopefully that's pretty accurate? Problem is that as she realizes what is happening she also realizes her purse is back at the pavilion. She just didn't make it all the way back over there in time. 

He's a guest, so doesn't have any equipment/meds with him, but he does send someone to grab her purse. 

I could have her woozy and not coherent rather than totally out, that would work. 

  

I've observed several instances of dangerously low blood sugar, but they all played out differently than a quick fainting. The person in question would act oddly or off but that could last a while and no one ever did completely pass out. Most memorable example: Somebody came to fix the copier at work, and we thought he was talking a bit strangely when he came to tell us what was wrong, but, y'now, people are strange sometimes. Then it got more noticeable and he was moving slowly, and every single one of us thought he was stoned, lol. Fortunately, my boss called their office to complain, I can't believe this guy showed up stoned and they were immediately he's diabetic, he's diabetic! call 911! I'm pretty sure they had us give him juice or something, but not positive. When they arrived he had declined to pretty non-response and incoherent, but nominally conscious. They did whatever they did right there, didn't take him in or anything, just made sure he was alert and such. 

So, apparently very low blood sugar can represent as though you've had some really good weed, which could be helpful if you want another character to talk about her, lol. This workplace was a health-oriented non-profit, so while we didn't have direct knowledge of diabetes we were, as a group, more health savvy than most civilians. Low blood sugar or any other health crisis occurred to not a single one of us, we all thought the guy was stoned. 

[Katy]

Generally people with low blood sugar are going to act drunk and a bit crazy before they collapse. Even the breath of someone with severe hypoglycemia can smell like fruity alcohol.

Someone who is trained is unlikely to move someone who does collapse.  Unless they are somewhere soft like a bed and need to do CPR, in which case they'll move them to a firm surface or the ground.

Other random information that might help a scene like that:

They're going to yell at someone to go call 911 and come back and tell me what they said - mostly because doing so ensures they DO call 911 and don't just run away.  That's recommended in professional CPR classes because it greatly increases the percentage of people who DO respond.  You might also have someone who works at the inn or event center or whatever run out an AED (automated external defibrillator), and have him brush it off as not necessary because she's not having a heart attack if you need a way to increase the conflict. Most nurses/fire fighters and EMT's or Paramedics take the same AED CPR classes.  If you take it through the Heart Association rather than the Red Cross it's good for 3 years rather than 2.

If someone's diabetes is so brittle they carry around glucagon rather than just glucose tablets they might make sure everyone they spend much time with knows too, so you might have a friend shout, "she's not drunk, she's diabetic."  Or maybe he could find a continuous glucose monitoring system on her belt.   Maybe the alert is going off on her phone but she didn't hear it because of the loud music and she went far lower than usual because of the dancing, or skipping a meal because busy or interrupted repeatedly AFTER she injected insulin and before she ate.  Maybe he finds the alarming phone in her purse before he finds the monitoring unit.

It's probably far more typical for a paramedic or EMT to find a younger, thinner woman collapsing because of a drug overdose than because of poorly controlled diabetes.  If you couple that fact with a bit of judgment on his part that might also be a way to increase the conflict.  Maybe in the past couple months he's come across several pretty young women who died from overdoses, or who repeat overdosed and finally died. Maybe a woman he knew well (a sister, a friend) died from an overdose, leaving her baby in the lurch in foster care and he's trying to figure out how to care for the baby.

[Jean in Newcastle]

When I've had hypoglycemic episodes I stopped being able to think clearly.  I wouldn't have been able to remember where my purse was or what I had in it. 

[ktgrok]

8 hours ago, katilac said:

I've observed several instances of dangerously low blood sugar, but they all played out differently than a quick fainting. The person in question would act oddly or off but that could last a while and no one ever did completely pass out.

, apparently very low blood sugar can represent as though you've had some really good weed, which could be helpful if you want another character to talk about her, lol. 

 

7 hours ago, Katy said:

Generally people with low blood sugar are going to act drunk and a bit crazy before they collapse. Even the breath of someone with severe hypoglycemia can smell like fruity alcohol.

 

 

5 hours ago, Jean in Newcastle said:

When I've had hypoglycemic episodes I stopped being able to think clearly.  I wouldn't have been able to remember where my purse was or what I had in it. 

Yes! The idea is that people think she's drunk at first, then it gets worse and he realizes what is going on. 

I just haven't figured out if she's wearing a CGM and the low happened too fast for her to get to her purse after the alarm,, or if I have some reason for why she can't/isn't using one. Like, maybe her dress was such that she had no where to put it- although I know people often stick the receiver in a bra, etc....maybe her friend sees him fishing in her bra for it and yells at him, not realizing what is happening? Or her dress is such that she didn't wear a bra, so kept the receiver in her purse, which is back at her chair?

She also will have been dancing, had an alcoholic beverage, and not had time to eat because the bride is her good friend and she was helping out ,making sure things go smoothly. Hence the episode. 

Later, she will have a doctor's appt to discuss things, including that lately her sugars are harder to control. He tweaks her management but also mentions that regular exercise can sometimes help things be more stable (don't worry - I know Type 1 is not Type 2, but what I'm reading is it might help overall health, etc) and when she goes to the gym the personal trainer turns out to be the same medic who helped her at the wedding. (research says that personal trainer is a common side hustle for firefighters, etc)

She's also going to get a diabetes alert dog (I know they are not anywhere near 100 percent nor a replacement for monitoring, etc...just an extra layer of help. Plus the dog could be trained to fetch her purse if she has a low)

Edited September 13, 2020 by Ktgrok

9 hours ago, Ktgrok said:

Yup! My backup plan was to contact the local fire department, but y'all are quicker 🙂

 

OMG, that could be the plot of your next book -- romance writer doing research for her next book contacts hunky firefighter for background info and ... 🙂