EMS Corner: Diabetic Emergencies

What Is the Difference Between Insulin Shock vs. Diabetic Coma?

Diabetic emergencies are common calls for first aid providers and industrial response teams.  Although the symptoms may seem similar, there are vastly different reasons for various diabetic conditions.

Insulin Reaction (or Insulin Shock) is a condition that occurs when there is TOO MUCH INSULIN in the body. This condition rapidly reduces the level of sugar in the blood and brain cells suffer. Insulin reaction can be caused by taking too much medication, by failing to eat, by heavy exercise and by emotional factors. Signs and symptoms of Insulin Shock include; fast breathing, fast pulse, dizziness, weakness, change in the level of consciousness, vision difficulties, sweating, headache, numb hands or feet, hunger.

Diabetic Coma is a condition that occurs when there is TOO MUCH SUGAR and too little INSULIN in the blood and body cells do not get enough nourishment. Diabetic coma can be caused by eating too much sugar, by not taking prescribed medications, by stress and by infection. Diabetic coma develops slowly, sometimes over days, with signs and symptoms including; drowsiness, confusion, deep and fast breathing, thirst, dehydration, fever, a change in the level of consciousness and a peculiar sweet or fruity-smelling breath.

If the patient is conscious, you can ask two very important questions which will help determine the nature of the problem:

– Ask “HAVE YOU EATEN TODAY?” – Someone who has eaten, but has not taken prescribed medication may be in a diabetic coma.

– Ask “HAVE YOU TAKEN YOUR MEDICATION TODAY?” – Someone who has not eaten, but did take their medication, may be having an Insulin reaction.

NOTE: Distinguishing between the two types of diabetic emergencies can be difficult

A person in Insulin Shock needs sugar quickly. If the person is conscious, give sugar in any form such as juice, candy, or a soft drink. If the person is suffering from Diabetic Coma, the sugar is not required but will not cause them harm.

Safety Compliance Services provides National Safety Council First Aid in which diabetic emergencies are covered.  This can be an important skill to help a friend, family member or coworker.

Mixing and Matching Fall Protection: Can I do that?

Can I mix Fall Protection Equipment from different manufacturers?

Although many published documents from manufacturers contain statements such as “Brand X harnesses are designed for use with Brand X components.  Substitution or replacement with non-approved components combinations or subsystems or both may affect or interfere with the safe function of each other and endanger the compatibility within the system”, it does NOT violate OSHA or ANSI to utilize components from different manufacturers in a fall protection system. Mixing manufacturer’s equipment is less about regulations or safety and more about potential litigation should equipment fail. Manufacturers know that mixed brand fall protection systems are used every day with no harmful outcome. However, these same groups must state that this practice is ill-advised due to legal liability.

Using components from different manufacturers in assembling a fall protection system is safe and acceptable to OSHA and ANSI provided the components are “compatible” as determined by a competent person. ANSI defines compatible as; “Capable of orderly, efficient integration and operation with other elements or components in a system, without the need of special modification or conversion, such that connection will not fail when used in the manner intended”. OSHA 1926, Subpart M, Appendix C states; “Ideally, a personal fall arrest system is designed, tested, and supplied as a complete system. However, it is common practice for lanyards, connectors, lifelines, deceleration devices, body belts and body harnesses to be interchanged since some components wear out before others. The employer and employee should realize that not all components are interchangeable. For instance, … . Any substitution or change to a personal fall arrest system should be fully evaluated or tested by a competent person to determine that it meets the standard, before the modified system is put in use”.

Bottom line is you should strive to purchase your fall protection equipment from the same manufacturer, but when inheriting a mix of equipment already present at your site, changing over to a new brand, or needing specific equipment not available from your “preferred” manufacturer, you can safely, and in full compliance with OSHA, assemble personal fall protection systems with components from differing manufacturers provided all equipment is compatible with each other for their intended uses.

EMS Corner: CPR Training and Re Training

Following training in CPR, how long is the ability to perform effective CPR retained?

Although skill retention from any learned competency varies by individual, the Advisory Council of First Aid and Aquatics Safety and Preparedness (ACFASP) conducted a scientific review in 2009 of 40 different studies on CPR skill retention. Based on their review of these studies, the ACFASP concluded;

– The data indicated substantial CPR skill degradation within 10 weeks after training

– The majority of skills deterioration seemed to occur in the first year

– There was no published evidence indicating adequate retention of CPR skills at 2 years (the typical duration of CPR certifications)

– Several studies reported improved retention when a brief refresher is conducted every 6-12 months

The ACFASP cited numerous limitations associated with their Scientific Review, including  the lack of any study with actual patient outcomes. (All studies used a CPR manikin as a surrogate for human patients) An additional limitation was the lack of a standard to evaluate satisfactory or unsatisfactory skill performance.

Bottom line according to the ACFASP Review – The majority of studies reviewed indicated substantial skill degradation within the first year of training while several studies suggested improved retention associated with brief (30 minute) refresher training.

It is for this reason that, for those clients SCS provides FA/CPR training for, we advocate scheduling FA and CPR training on alternating years allowing for brief CPR skills refresher training during the First Aid training on years between re-certifying CPR training