The evaluation of treat and release attitudes of pre-hospital emergency healthcare professionals in case of hypoglycemia

According to the 2021 data of the International Diabetes Federation, 537 million adults worldwide live with diabetes and it is estimated that there will be 643 million people with diabetes by 2030 and 783 million adults will face that disease by 2045. It is observed that there are approximately 9 million diabetic patients in Turkey and this figure constitutes approximately 15% of the total adult population [1]. The most common acute complication of diabetes is hypoglycemia, which is defined as a sudden drop in blood glucose levels below normal values [2]. While patients who were diagnosed with Type 1 Diabetes usually have one to two mild attacks per week, they can have one severe attack per year, and a significant portion of these patients are the subject of pre-hospital emergency health services (PHEMS). “Treat and release” protocols are used in some of the hypoglycemia cases whose pre-hospital treatment is completed and in stable patients [3], [4], [5].

While it was stated that approximately 50% of patients with severe hypoglycemia required hospitalization [6], [7], [8], the low morbidity and mortality rates found in patients who were not transferred to the hospital [9], [10]. The more effective use of treat and release protocols in order to reduce the burden of the emergency department are a matter of debate. Although the treat and release criteria in hypoglycemia cases in PHEMS are clearly defined in the literature [11], [12], the lack of clear treat and release protocols in some PHEMS systems [13], [7] can differentiate the treat and release attitudes of PHEMS employees. Especially, reducing the burden of the emergency department and its decisiveness in the effective use of health resources make it an interesting subject to evaluate the knowledge and attitudes of PHEMS employees regarding the treat and release criteria in hypoglycemia cases. There is no study on this subject in the literature, so this study was planned as a descriptive study in order to evaluate the knowledge of PHEMS staff about the treat and release criteria and the attitudes of paramedics in the decision-making processes regarding the transfer to the hospital in cases with a change in consciousness due to hypoglycemia and whose hypoglycemia treatment was completed at the scene.

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