Glucagon use restrictions compromising prehospital hypoglycemia treatment in USA
medwireNews: The widespread bar on glucagon administration by basic providers of emergency medicine in the USA may prevent its use in three-quarters of cases in which it is needed, say researchers.
Peter Kahn (Yale School of Medicine, New Haven, Connecticut, USA) and colleagues found that, across all US states between 2013 and 2015, glucagon was administered to 89,263 patients in a prehospital setting.
They say that, in most states, only paramedics are allowed to administer glucagon, but in 2014 there were only 61,121 paramedics, compared with 198,200 basic emergency medicine providers, meaning that, potentially, responders would be unable to administer glucagon in the prehospital setting in three-quarters of cases. In seven states basic providers cannot even test blood glucose.
“These restrictions are even more surprising given that glucagon is routinely administered by family members and adverse effects were not serious and most typically included nausea,” the team writes in the Annals of Internal Medicine.
Adverse effects were recorded for 3944 of the total 89,263 cases in which glucagon was administered in a prehospital setting. The researchers note that appropriate prehospital use of glucagon “could reduce the number and severity of hypoglycemic episodes requiring emergency medical attention and hospitalization,” thus reducing the costs associated with this diabetes complication.
An additional problem was that only 44.67% of the emergency medicine callouts that led to glucagon administration had been correctly coded as a diabetes incident by the dispatchers, “potentially increasing the likelihood of dispatching providers who cannot administer this agent to patients with hypoglycemia.”
Coupled with an average response time exceeding 15 minutes, this “may increase patients’ risk for neurologic sequelae, death, or both,” say Kahn and team.
They conclude: “All emergency personnel should have access to glucagon along with training to safely administer this agent to minimize unintended treatment accidents.”
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