NPA or OPA

lightsandsirens5

Forum Deputy Chief
3,970
19
38
Almost every thread about oxygenation and ventilation and airway turns into

Oxygen bad or good.

Whether or not oxygen is good or bad. Or an npa is used or an opa is used. It doesnt matter what is right or what you believe. Its just what your protocols say. If your protocols say no one with a skull fracture gets an npa then no one with a skull fracture gets an npa.

One of those threads were mine and I still didn't get the answer I was looking for lol. Because it turned into o2 vs no o2.

I'll tell you what the problem is...(in my opinion at least)

Underneath it is not a case of O2 good or O2 bad. It is more of a case of all or nothing. Not every pt needs O2. But some do. Not every head trauma pt is an absolute contra for an NPA, but some are. Not every MVA pt needs c-spine, but some do. The problem arises here. If some pts need these interventions (or don't need them as the case may be), then either all or none of them will have the procedure in question done (or not done) to them. Why? Because those of us in EMS have become content with the trained monkey occupation. Where some people need to be c-spined, so all of them are cause us monkeys cant tell the difference. Where every freaking pt gets O2, 15 Liters a minute via a non-re-breather mask, because some might need it.

Do you see the problem? It is not the protocols. They are the absolute best we can have with the system we currently have. The problem is we are a bunch of trained chimps, the best of whom are (to steal a term from firetender) flesh mechanics. "Hmmmm...belt is squeaking? Check the books....ok, replace tensioner. Well, that didn't work. Lets clean the pulleys. Oh wait.....that didn't work either......"

Ok, bad analogy, I know, but I think you all get the point. Maybe if we were actually trained to recognize problems and treat them we would start to actually treat patients. We might possibly improve patient outcome. Maybe we would improve some of those statistics that have improved a whopping 0.01% since 1973.

/end rant.

Sorry to spout off like that. But I really need to scream at someone (for other reasons than this....lol....) and this kind of got me excited.

I don't think that was too off topic considering this thread has already seemed to have drifted off course somewhat. :p
 

MrBrown

Forum Deputy Chief
3,957
23
38
....We might possibly improve patient outcome. Maybe we would improve some of those statistics that have improved a whopping 0.01% since 1973.

What would you possibly know about 1973 apart from what your read in a history book? :D
 

Anjel

Forum Angel
4,548
302
83
I'll tell you what the problem is...(in my opinion at least)

Underneath it is not a case of O2 good or O2 bad. It is more of a case of all or nothing. Not every pt needs O2. But some do. Not every head trauma pt is an absolute contra for an NPA, but some are. Not every MVA pt needs c-spine, but some do. The problem arises here. If some pts need these interventions (or don't need them as the case may be), then either all or none of them will have the procedure in question done (or not done) to them. Why? Because those of us in EMS have become content with the trained monkey occupation. Where some people need to be c-spined, so all of them are cause us monkeys cant tell the difference. Where every freaking pt gets O2, 15 Liters a minute via a non-re-breather mask, because some might need it.

Do you see the problem? It is not the protocols. They are the absolute best we can have with the system we currently have. The problem is we are a bunch of trained chimps, the best of whom are (to steal a term from firetender) flesh mechanics. "Hmmmm...belt is squeaking? Check the books....ok, replace tensioner. Well, that didn't work. Lets clean the pulleys. Oh wait.....that didn't work either......"

Ok, bad analogy, I know, but I think you all get the point. Maybe if we were actually trained to recognize problems and treat them we would start to actually treat patients. We might possibly improve patient outcome. Maybe we would improve some of those statistics that have improved a whopping 0.01% since 1973.

/end rant.

Sorry to spout off like that. But I really need to scream at someone (for other reasons than this....lol....) and this kind of got me excited.

I don't think that was too off topic considering this thread has already seemed to have drifted off course somewhat. :p

Haha I enjoyed reading this. You ranted about every frustration I have regarding the EMS system. Well not every one but most. :p

I just finished EMT-B and have already figured this out. Whoever started this whole training thing decided we weren't able to decide what's best for our patient. So they laid out steps for us to follow. But humans are all different. The one guy having a heart attack is different from the one next store having a heart attack. In fact I remember my practicals. If you did not place the heart attack patient on a NRB 15 lpm it was an autofail. Failure to place pt on high flow O2 was what the sheet said.

I wish we could have more decision making abilities. I don't like being programmed a certain way but then I look at the kids that passed my class and I wouldn't trust them to make decisions to save my pet rock. So I guess it goes both ways.
 

FrostbiteMedic

Forum Lieutenant
218
2
18
Haha I enjoyed reading this. You ranted about every frustration I have regarding the EMS system. Well not every one but most. :p

I just finished EMT-B and have already figured this out. Whoever started this whole training thing decided we weren't able to decide what's best for our patient. So they laid out steps for us to follow. But humans are all different. The one guy having a heart attack is different from the one next store having a heart attack. In fact I remember my practicals. If you did not place the heart attack patient on a NRB 15 lpm it was an autofail. Failure to place pt on high flow O2 was what the sheet said.

I wish we could have more decision making abilities. I don't like being programmed a certain way but then I look at the kids that passed my class and I wouldn't trust them to make decisions to save my pet rock. So I guess it goes both ways.

That is exactly the point many have made in the past. We don't bring the textbook with us on the ambulance (protocol manual is there, but that is moot point) because everyone presents differently. A good EMT or Medic remembers that and applies their knowledge to the patient's care, rather than just performing their skill set. That is the problem that I have with the way that some of our testing and evaluation- you may effectively manage the patient within your scope of care, but because that effectiveness was not "by the book" so to speak, you 'must' have done something wrong. It leaves no room for the application of lessons learned.

*gets off the soapbox*
 
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