1. Sierra – Sacramento Valley EMS Agency
EMT Finger Stick Blood Glucose Testing Expanded Scope
(Updated 06/2017)

2. In order for EMT personnel to perform finger stick blood glucose testing utilizing a glucometer, they must:
Be part of the organized EMS system, functioning under the oversight of an S-SV EMS approved BLS provider
Be authorized by the approved BLS provider to perform finger stick blood glucose testing utilizing a glucometer
Have received adequate training on finger stick blood glucose testing utilizing a glucometer

3. Finger Stick Blood Glucose Testing By EMT Personnel
Education/Training Purpose
Provide a review of diabetes and diabetic emergencies
Provide education/training to EMT personnel on performing finger stick blood glucose testing using a glucometer
Provide instruction on what to do with the blood glucose testing results

4. Finger Stick Blood Glucose Testing By EMT Personnel
Education/Training Objectives
Review diabetes and diabetic emergencies
Describe finger stick blood glucose testing indications
Describe finger stick blood glucose testing procedure
Describe proper disposal of sharps/contaminates
Describe what to do with the blood glucose testing results
Treatment
Informing other appropriate personnel
Documentation

5. Review of Diabetes and Diabetic Emergencies Finger Stick Blood Glucose Testing Indications

6. Finger Stick Blood Glucose Testing By EMT Personnel
Diabetes Mellitus
Type 1 Diabetes
The body stops producing insulin or produces too little insulin to regulate blood glucose levels
Type 2 Diabetes
The pancreas secretes insulin, but the body is partially or completely unable to use the insulin (insulin resistance)

7. Finger Stick Blood Glucose Testing By EMT Personnel
Type 1 Diabetes
10% of diabetic patients
Early onset (childhood/adolescence)
No known prevention
All patients insulin dependent
Increased risk of infections, kidney disease, ocular disease, nerve injury, hypertension, coronary artery disease and stroke

8. Finger Stick Blood Glucose Testing By EMT Personnel
Type 2 Diabetes
90% of diabetic patients
Associated with:
Older age
Obesity
Family history of diabetes
History of gestational diabetes
Impaired glucose metabolism
Physical inactivity
Race/ethnicity (more prevalent among Hispanics, Native Americans, African Americans and Asians)

9. Finger Stick Blood Glucose Testing By EMT Personnel
Type 2 Diabetes (cont.)
Increased risk of infections, kidney disease, ocular disease, nerve injury, hypertension, coronary artery disease and stroke
Can be controlled with diet, exercise, weight loss
Patients frequently take oral medications and/or insulin

10. Finger Stick Blood Glucose Testing By EMT Personnel
Finger Stick Blood Glucose Testing Indications
Altered level of consciousness (ALOC)
Unresponsive
Seizure/post-seizure
Suspected diabetic emergency
Suspected stroke, including the following:
Weakness, facial droop, slurred speech
Aphasia (inability to speak), dysarthria (difficulty pronouncing words), hemiparesis (one-sided weakness), or hemiplegia (inability to move one side of the body)

11. Finger Stick Blood Glucose Testing By EMT Personnel
What Are We Measuring
Amount of glucose in the blood (serum glucose level)
Normal serum glucose level
100 mg/dl
Fluctuates between 70 – 150 mg/dl

12. Finger Stick Blood Glucose Testing By EMT Personnel
Blood Glucose Level
Untreated diabetes results in high blood glucose levels

13. Finger Stick Blood Glucose Testing By EMT Personnel
Hyperglycemia and Hypoglycemia
Both can lead to diabetic emergencies
Hyperglycemia – blood glucose is above normal
Lack of insulin
Results in Diabetic Ketoacidosis (DKA) if untreated
Hypoglycemia – blood glucose is below normal
Results in unresponsiveness/hypoglycemic crisis/diabetic coma if untreated

14. Finger Stick Blood Glucose Testing By EMT Personnel

15. Glucometer Blood Glucose Measuring Devices

16. Finger Stick Blood Glucose Testing By EMT Personnel
Glucometer Blood Glucose Measuring Devices
Samples of glucometers used to check blood glucose levels

17. Finger Stick Blood Glucose Testing By EMT Personnel
Glucometer Use
Equipment needed:
Exam gloves
Glucometer
Test strip
Alcohol prep pad
Gauze pad
Band-Aid
Lancet
Sharps Container

18. Finger Stick Blood Glucose Testing By EMT Personnel
Glucometer Device Variations
Some glucometers turn on automatically when the test strip is inserted – be familiar with the instructions of the specific device your organization utilizes

19. Finger Stick Blood Glucose Testing By EMT Personnel
Glucometer Utilization and Care
Follow manufacturers specific utilization instructions, which may include:
Verification of proper test strip batch number
Calibration
Routine control testing
Handle with care
Do not expose to excessive heat, humidity, cold, dust, or dirt
Store device in manufacturer provided case
Clean per manufacturer instructions

20. Finger Stick Blood Glucose Testing By EMT Personnel
Causes of Glucometer Device Errors
Improper calibration
Lack of cleaning/ maintenance
Battery failure
Test strip failure
Codes on test strips and glucometer do not match

21. Finger Stick Procedure

22. Finger Stick Blood Glucose Testing By EMT Personnel
Choose Appropriate Site
Best locations are the 3rd and 4th fingers on the non- dominant hand
Avoid the 2nd and 5th fingers if possible
Perform the stick off to the side of the center of the finger
Never use the tip or center of the finger

23. Finger Stick Blood Glucose Testing By EMT Personnel
Massage or Warm Site
Avoid fingers that are cold, cyanotic, swollen, scarred, or covered with a rash
Massage to warm the finger and increase blood flow by gently squeezing from palm to fingertip 5 – 6 times

24. Finger Stick Blood Glucose Testing By EMT Personnel
Clean and Dry Site
Cleanse fingertip with alcohol prep
Caution: alcohol can falsely elevate or lower blood glucose levels
Wipe dry with clean gauze or allow to air dry

25. Finger Stick Blood Glucose Testing By EMT Personnel
Using a sterile lancet, make a skin puncture just off the center of the finger pad
Wipe away the first drop of blood (which tends to contain excess tissue fluid)

26. Finger Stick Blood Glucose Testing By EMT Personnel
Finger Stick (cont.)
If necessary, apply light pressure to surrounding tissue until another drop of blood appears
Avoid “milking” – do not squeeze or apply strong repetitive pressure to site – this may result in hemolysis or increase tissue fluid in the blood causing incorrect testing results

27. Finger Stick Blood Glucose Testing By EMT Personnel
Finger Stick (cont.)
Free flowing blood is necessary to obtain reliable results
Increased pressure beyond what is necessary to hold the finger can result in inaccurate results
The drop of blood must be big enough to fill the strip completely

28. Finger Stick Blood Glucose Testing By EMT Personnel
Finger Stick (cont.)
Properly discard the lancet into an approved sharps container and discard any bloody dressings into an appropriate bio-hazard waste container
Apply Band-Aid to puncture site

29. What To Do With The Results

30. Finger Stick Blood Glucose Testing By EMT Personnel
Treatment
If blood glucose results are ≤ 60 mg/dL (or slightly above 60 mg/dL and patient history and clinical picture fits hypoglycemia):
Administer pre-packaged glucose solution/gel or 2 – 3 tablespoons of sugar in water/juice ONLY if patient is conscious and able to swallow

31. Finger Stick Blood Glucose Testing By EMT Personnel
Treatment (cont.)
If blood glucose results are > 60 mg/dL (and patient history and clinical picture does not fit hypoglycemia):
Monitor & reassess
Provide appropriate treatment based on patient condition

32. Finger Stick Blood Glucose Testing By EMT Personnel
Other Responsibilities
Inform other appropriate EMS providers and/or the receiving hospital of the blood glucose testing results
Adequately document the blood glucose testing results