Prehospital hypoglycemia: the safety of not transporting treated patients.

OBJECTIVES

Emergency medical services (EMS) personnel frequently encounter patients who refuse transport after being treated for a hypoglycemic episode. The outcomes of most of these patients are unknown. The purpose of this study was to determine the outcomes of patients treated and not transported for hypoglycemia and identify criteria that could be used to identify patients who did not require transport to hospital.

METHODS

This was a prospective, observational study involving all adult (>15 years) hypoglycemic patients (blood glucose less than 4 mmol/L by glucometer) attended to by the EMS system in the Halifax Metropolitan area in the province of Nova Scotia during a ten-month interval.

RESULTS

There were 220 calls for adult patients with hypoglycemia. Of the 75 calls that resulted in transport, there were 17 further hypoglycemic episodes requiring a repeat call for an ambulance (22.7%) and three recurrences (4%). Of the 145 calls that did not result in transport, 40 further episodes of hypoglycemia (27.6%) and three recurrences (2%) were reported. These differences were not statistically significant (p=0.43 and 0.33, respectively). There was also no statistically significant difference in the intervals between hypoglycemic episodes for patients transported (51.1 days +/-65) compared with patients not transported for their previous hypogylcemic episode (40.7 days +/-53.5) (p=0.6). Of the 47 calls entered in the study, there were seven repeat calls for hypoglycemia (15%) and one recurrence (2.1%). The majority of patients did not follow up with their physician.

CONCLUSIONS

Repeat episodes of hypoglycemia are common; however, recurrences within 48 hours are not. Admission to hospital is rarely required. There appears to be no difference in the incidence of recurrences and repeat episodes of hypoglycemia between transported and nontransported insulin-dependent patients, regardless of age. Given the high incidence of repeat episodes, paramedics and physicians need to emphasize the importance of follow-up.