Masters: Clinical Reasoning by National Ambulance Service Paramedics and Advanced Paramedics in Ireland Focusing on Blood Glucometry

Andrew McRae
Centre for EMS Studies, University College Dublin, Ireland
September, 2016
Advanced Paramedic, National Ambulance Service, Ireland


Background: The National Ambulance Service within the Republic of Ireland has developed rapidly since the introduction of the Pre-Hospital Care Council in 2000. The skills of Emergency Medical Technicians, Paramedics and Advanced Paramedics have also evolved. With technology advancing arguments are now being made for more point of care testing to be available to prehospital emergency care practitioners.-

Aim: With the developing roles with in prehospital care the aim of this study is to investigate one aspect of clinical reasoning by prehospital care practitioners, by examining use of monitoring and point of care testing (POCT) devices (blood glucometer) which are available within the Irish National Ambulance Service in terms of whether an indication for such assessment was identified or not.

Method: A multi-methods approach was used to collect data for this study. Irish Ambulance Service Paramedics and Advanced Paramedics participated. The development and use of a call log, enabled the collection of information on patient’s presentation, the clinician’s working diagnosis and all measurements of vital signs, monitoring and adjunctive assessments, among which was blood sugar measurement. A questionnaire was designed to investigate practitioner’s views on routine use of monitoring devices

Results:---243 / 276 (88%) patients had a Blood Glucose check done a mean reading of

6.85 with the median result being 6.2 and a range of 1.6 – 30. 156/243 (64.2 %) had a Blood Glucose reading of between 4 and 7 mmol/L. A reading of between 7.1 and 19.9 mmol/L was obtained for 74/243 (30.5%) patients with 3.7% (n=9) having a level of below 4 mmol/L and 1.6% (n=4) having a Blood Glucose level (BGL) measured above 20 mmol/L.

135/276 (48.9%) of patients had indicators for Blood Glucometry with 141/276 (51.1%) not having indicators. 117/138 (84.7%) patients who did not have indicators had a BGL taken.

Reasoning for routinely taking of blood glucose measurements are not clear from the results of the questionnaire, with clinical presentation of patient, experience, training, CPGs, ED expectation and PCR completion all being classed as moderately influential on practitioner decision making. When focusing on blood glucose testing, practitioners felt that blood glucose levels are not needed on every patient but on average were unsure if they would miss something if a BGL was not done or if they did a test only when it was indicated.

Conclusion:- Blood glucose level testing is routinely performed on adult and paediatric patients by practitioners in the Irish National Ambulance Service. However practitioners do not feel that a blood glucose test is needed on every patient. By encouraging a more focused approach for the use of POCT devices within the National Ambulance Service patients who receive tests that are not indicated could be reduced.-