Emergency medical servicesrequirements for als course sponsors granting advanced standing

No. 12-01
Date: January 10, 2012
Bureau of Emergency Medical Services
Re: Blood Glucometry
and Nebulized Albuterol
POLICY STATEMENT
for EMS Agencies
Supersedes/Updates: 09-13 Page 1 of 2
BACKGROUND
The New York State Emergency Medical Advisory Committee (SEMAC) has approved the use
of glucometers and nebulized albuterol by Emergency Medical Technicians (EMT) who are
employees/volunteers of an EMS agency (i.e. ambulance service, ALS-FR, BLS-FR). The
SEMAC approval was granted with the specific condition that the EMS agency wishing to use
a glucometer or nebulized albuterol, be granted approval by the Regional Emergency Medical
Advisory Committee (REMAC), that each EMT from that EMS agency complete a REMAC
approved training program, and that the EMS agency be granted a Limited Service Laboratory
Registration (for blood glucometry only).

The purpose of this policy is to explain the approval process for EMS agencies wishing to
implement a nebulized albuterol and/or blood glucometry program.
Prehospital blood sugar evaluation is intended to assist in the recognition of hypoglycemia and improve the speed with which proper treatment is received. Nebulized albuterol, when administered under the Statewide BLS Adult and Pediatric Treatment Protocols has been shown to decrease respiratory distress in patients between one and sixty-five years of age who are experiencing an exacerbation of their previously diagnosed asthma.
AUTHORIZATION FOR BLOOD GLUCOMETRY AND/OR NEBULIZED ALBUTEROL
Each REMAC will adopt protocols which will allow an EMT to obtain a blood sample, using a
lancet device or equivalent, and test the blood sample in a commercially manufactured
electronic glucometer. The REMAC will determine the type and level of record keeping and
quality assurance required for both blood glucometry and/or nebulized albuterol. Please note
that a protocol for nebulized albuterol has been approved by SEMAC and is included in the
Statewide BLS Adult and Pediatric Treatment Protocols for EMT-B and AEMT.
To be authorized to use an electronic glucometer or nebulized albuterol, the EMS agency must
make written request to the appropriate REMAC. The request must include, but not
necessarily be limited to, the following items:
 A letter from the EMS agency physician medical director supporting the request and
indicating an understanding of their role in the Clinical Laboratory requirements (blood glucometry only) and quality assurance process. 12-01 Blood Glucometry and Nebulized Albuterol for EMS Agencies  A completed NYS Department of Health Clinical Laboratory Evaluation Program Limited Service Laboratory Registration Application (form DOH-4081) for blood testing licensure (blood glucometry only).  Written policies and procedures for the operation of the glucometer and storage and maintenance of nebulized albuterol that are consistent with applicable Regional and State protocols. These policies and procedures shall include, but not necessarily be limited to the following:  didactic and psychomotor objectives for training of authorized users including who will be  documentation and attendance records of the training of authorized users;  a defined quality assurance program, including appropriateness review by the EMS agency  documentation of control testing process (blood glucometry only);  written policies and procedures for storage of the glucometer and/or nebulized albuterol, and proper disposal of sharps devices (blood glucometry only);  notice to the EMS agency physician medical director of the use of the glucometer and/or  requirements for documentation when the glucometer and/or nebulized albuterol is used for LIMITED LABORATORY REGISTRATION FOR BLOOD GLUCOMETRY
New York State Public Health Law requires that any EMS agency testing blood glucose,
whether by electronic glucometer or chemstrip, be required to possess a Limited Service
Laboratory Registration. In order to obtain the Registration, EMS agencies must complete
and submit the following document:

 Limited Service Laboratory Registration Application (form DOH-4081)
Information and application materials are available at: http://www.wadsworth.org/labcert/limited/index.htm No EMS agency may engage in the testing of
blood glucose without a Limited Service Laboratory Registration Certificate.
NOTIFICATION
Once the EMS agency has received written approval for blood glucometry and/or nebulized
albuterol from the REMAC, the EMS agency must provide BEMS with an updated and signed
Medical Director Verification Form (form DOH-4362), indicating the Limited Laboratory
Registration permit number (if applicable) and authorization by the EMS agency physician
medical director.
Issued and authorized by the Bureau of EMS Acting Director
12-01 Blood Glucometry and Nebulized Albuterol for EMS Agencies

Source: http://www.sthcs.org/sthcs/images/stories/DOH_12-01_Blood_Glucometry_and_Nebulized_Albuterol.pdf