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

Prehosp Emerg Care. 2017 Nov-Dec;21(6):767-772. doi: 10.1080/10903127.2017.1321707. Epub 2017 Jun 22.

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 2013-15. 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.

Keywords: blood glucose; diabetes mellitus; emergency medical services; hypoglycemia; public health surveillance; transportation of patients.

MeSH terms

  • Adult
  • Aged
  • Blood Glucose
  • California
  • Emergency Medical Services*
  • Emergency Service, Hospital
  • Female
  • Humans
  • Hypoglycemia / diagnosis*
  • Hypoglycemia / epidemiology
  • Hypoglycemia / therapy
  • Male
  • Middle Aged
  • Retrospective Studies

Substances

  • Blood Glucose