National Night Out and diabetes awareness

Tuesday last was "National Night Out" -- a non-holiday in which localities, and local businesses, do their best to create a safe environment for those who work in, reside in, or pass through the town to sample what the town has to offer. Some cities offer free museum admission; some have local restaurants bring samples of their foods to a set location; many bring out the public-awareness arms of their municipal services. North Plainfield's "big thing" was hiring out a safe-document-disposal truck for the evening, showing off the local SWAT team and the county's Dive Rescue team, and putting out a table with a D.A.R.E. (Drug Abuse Resistance Education) display. The local Rescue Squad was on hand, as well as a few uniformed officers. The local Police Benevolent Association gave out free burgers, hot dogs, and beverages.

Based on some of the emergency-service-issue threads I've seen in TuDiabetes, Diabetes TALKfest, Diabetic Rockstar, and DiabeticConnect, I took the time to question some of these professionals specifically about the intersection of their jobs with the diabetic community. What I learned may be useful to you. At the very least, it may provide conversation for directions in diabetes advocacy/education.

New Jersey's medical-emergency first-responder model is based on local Rescue Squads, which are composed of volunteers with basic-EMT training, and paramedics, who are based out of local hospitals. This is a state-wide licensure model; other states and localities have other models. (New York City, for example, has a dedicated emergency medical service with a different level of training; Virginia Beach has a system of volunteer Rescue Squads whose members are a mix of basic-EMTs and responders who have Advanced Life Support (ALS) certification.

Warning: Please note that the information below is based on my interviews with local responders in my community; yours may differ.

Our Rescue Squad members go through Basic EMT training -- a 120-hour course that includes CPR, First Aid, use of Automated Electric Defibrillator (AED) devices, airway clearance, and patient transport. They are trained to look at the wrists, ankles, and shoe laces for medical-alert jewelry. They are aware of medic-alert tattoos, but have not seen any "in the flesh". Some are aware of medical-alert dogtags but may not have been specifically trained to look for the same. Their training regarding diabetes is based on patient- or caller-initiated information (I'm/my friend is running high/low/unresponsive). They cannot administer any sort of medication; however, if you have medication on hand, they can assist you in administering it to yourself. This suggests that if you are aware enough to test yourself or to draw up and administer an insulin shot, they may be able to help you steady your arm and read your monitor or syringe, but not much else. They are NOT familiar with insulin pumps -- what they look like, the specifics of how they work, etc. They do know of them, but apparently they are not common enough to be immediately recognizable. If you are not able to respond and cannot administer your own medication, your emergency needs to be escalated to the nearest (associated?) hospital, either by direct transport or through paramedic support.

Our local SWAT team includes a couple of medics who travel in a retired-but-stocked Mobile ICU (MICU) truck. They are trained as paramedics, with emphasis on the sort of injuries common to events involving SWAT teams (most frequently gunshot wounds and stab wounds; less frequently chemical exposure and explosions). We spoke a bit about diabetic and allergic emergencies which would/could be handled by paramedics. The MICU stocks epinephrine; they stock D50 (50% dextrose solution). They do stock glucagon, but their preferred method of treating an unresponsive low is to administer intravenous dextrose.

I also spent a few minutes at the D.A.R.E. display, manned by one of the local policemen. While some of the display's (simulated?) contents were familiar and obvious to anyone who has seen or participated in recreational marijuana use, other contents caused some concern: one of the pills marked "uppers" looked exactly like drugstore packaging of pseudoephedrine (Sudafed); syringes for heroin injection were of the same size used for insulin injection. I asked the officer about this. One of the current issues in illegal-drug seizure is that the drugs are packaged to look like normal over-the-counter or prescription drugs (identical shape/size/color/markings). Furthermore, he stated that it is the context in which the paraphernalia are found which determine the likelihood of illegal-drug use, as opposed to necessary medical therapy.

While I had the police officer's ear, I asked about traffic stops of persons with glycemic issues. He'd asked if I knew of specific issues within town or within the county. I noted that the issues I knew about were from all over the country -- not specifically local. I learned that the curriculum for my local and county police is determined at the county level, and if there were a specific piece of training I felt was lacking, I should pursue it at the county level.

Regarding the "appears drunk" traffic stops: the police are trained to understand that issues other than inebriation can cause erratic, "drunk-like" driving. If the driver states that he has diabetes and may be running low, the officer can stay with the driver until he consumes his emergency snack and is back to a level of being safe to drive, or he can call for medical assistance. A lot depends on the responsiveness of the driver. They cannot offer lifesavers or other quick-acting sugars for legal liability issues (e.g., if you choked on it). A negative breathalyzer test can puzzle police, but identifying yourself as someone with diabetes (or another medical issue that can cause similar disorientations) will explain the situation to the police. The individual officer I spoke with noted that -- presuming no personal or property damage -- you can fight a DUI citation if your breathalyzer was negative and you have a medical condition that could have temporarily caused the erratic driving in question.

Again, I need to emphasize that this is what I found out about my town; yours may differ. Your best bet is to find out as much as you can before an emergency hits -- before you are stopped for "drunk driving" -- before you are accused of illegal drug use. Not only is "forewarned, forearmed" -- but you might be able to improve local diabetes awareness and emergency response for yourself and others. Community safety is in all of our hands...