# LACo EMT Scope: Pulse Oximetry Added



## NPO (Dec 12, 2013)

I just reviews my scope of practice and it now included pulse oximitry for emt basics. 

Ive never seen it on there before and the policy revision date is 12-01-13. 

I have to say, I'm glad its finally in our scope. It made a rather silent entry unless it was added before and I wasnt aware.


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## exodus (Dec 12, 2013)

NPO said:


> I just reviews my scope of practice and it now included pulse oximitry for emt basics.
> 
> Ive never seen it on there before and the policy revision date is 12-01-13.
> 
> I have to say, I'm glad its finally in our scope. It made a rather silent entry unless it was added before and I wasnt aware.



It's there, but if it's not a required equipment then you won't be seeing it on the units.


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## wanderingmedic (Dec 12, 2013)

Kind of a ridiculous thing to have to add....especially if you are administering O2.


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## NPO (Dec 12, 2013)

azemtb255 said:


> Kind of a ridiculous thing to have to add....especially if you are administering O2.



Maybe next year we can work on getting blood glucose testing. :wacko:

But I agree, which is why I am glad to finally see it.


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## NomadicMedic (Dec 12, 2013)

Welcome to 1992.


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## Jim37F (Dec 12, 2013)

Shoot I'd be happy if they'd just add AEDs to the required inventory. 

(Although how many of the MaxxTransLifeCareAidPro services would actually be able to afford them?)


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## NPO (Dec 12, 2013)

Jim37F said:


> Shoot I'd be happy if they'd just add AEDs to the required inventory.
> 
> (Although how many of the MaxxTransLifeCareAidPro services would actually be able to afford them?)



Two birds one stone, my friend.


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## Chris07 (Dec 13, 2013)

Hmmm after taking a look at the LA County EMT Scope of practice document I think they snuck another addition in there...



> G. Administer the following over the counter medications:
> 1. Oral glucose or sugar
> 2. *Aspirin – for adults with suspected myocardial chest pain *


Looks like they added Aspirin...unless I missed the memo the first time around.

http://ems.dhs.lacounty.gov/policies/Ref800/802.pdf (Page 4)


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## DesertMedic66 (Dec 13, 2013)

Jim37F said:


> Shoot I'd be happy if they'd just add AEDs to the required inventory.
> 
> (Although how many of the MaxxTransLifeCareAidPro services would actually be able to afford them?)





NPO said:


> Two birds one stone, my friend.



This. 

If they become required the services will find a way to afford them.


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## Chris07 (Dec 13, 2013)

DesertEMT66 said:


> This.
> 
> If they become required the services will find a way to afford them.



Ebay!


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## smhee (May 2, 2014)

My company could afford them but our owner is too cheep to buy them what company you guys at? Assuming you are all laco that is


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## mycrofft (May 2, 2014)

You can tell the ambulance with the AED. It stops every two minutes.


OK, now they have to train and document knowledge of users of the pulse ox. WHEN to use it is pretty easy (any time you want), but acting on the readings is another thing. "We were all staring at the pulse ox and didn't see the pt's eye roll up and lips turn blue…". Clip it on yourself, take a few deep breaths, an tell me why the pulse changes and the ox reading can actually dip for a bit.

And are they going to keep you stocked in disposable probes, or replace them as they get dirty or damaged?

PS: hope they're locked into the vehicles, very pilfer able .


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## CentralCalEMT (May 4, 2014)

All those small LA County companies will be able to afford AEDs. It just means the owner does not get his 2nd boat, private jet, or a 3rd BMW for another year or so.


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## NPO (May 4, 2014)

BMW? Try Merc.


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## JPINFV (May 4, 2014)

Chris07 said:


> Ebay!


[YOUTUBE]http://www.youtube.com/watch?v=YKtlK7sn0JQ[/YOUTUBE]


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## dmawhorter (May 4, 2014)

Was this added in the revision that was done? From what I understood the revision was only Medics.


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## NPO (May 4, 2014)

dmawhorter said:


> Was this added in the revision that was done? From what I understood the revision was only Medics.



As of Dec 1, 2013 the EMT scope was updated to include pulse ox, CPAP (under approved providers) and Aspirin administration (not assistance). However the policy does not specify when, how, dosage or anything like that for anything that was added. It literally just says "asprin - for suspected mi"


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## dmawhorter (May 4, 2014)

NPO said:


> As of Dec 1, 2013 the EMT scope was updated to include pulse ox, CPAP (under approved providers) and Aspirin administration (not assistance). However the policy does not specify when, how, dosage or anything like that for anything that was added. It literally just says "asprin - for suspected mi"



Thanks!!


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## ITBITB13 (May 4, 2014)

Jim37F said:


> Shoot I'd be happy if they'd just add AEDs to the required inventory.
> 
> (Although how many of the MaxxTransLifeCareAidPro services would actually be able to afford them?)



Or you can just go work for an laco provider who sticks them in every rig, by choice.^_^


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## Christopher (May 5, 2014)

Jim37F said:


> Shoot I'd be happy if they'd just add AEDs to the required inventory.
> 
> (Although how many of the MaxxTransLifeCareAidPro services would actually be able to afford them?)



Wait...an AED is not required on an ambulance? You must be joking or referring to wheelchair vans or something...if not yikes.

If it weren't for the "unfunded mandate", EMT level ambulances would be required to carry 12-Lead capable monitors in NC! Right now it is optional, and grants were available in the last few years to equip every 911 unit with one.


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## ITBITB13 (May 5, 2014)

Christopher said:


> Wait...an AED is not required on an ambulance? You must be joking or referring to wheelchair vans or something...if not yikes.
> 
> If it weren't for the "unfunded mandate", EMT level ambulances would be required to carry 12-Lead capable monitors in NC! Right now it is optional, and grants were available in the last few years to equip every 911 unit with one.



Dang, must be nice! Correct me if I'm wrong, but in SoCal, aeds are completely optional. The only ambulances that have them are approved 911 providers. And that's by choice.


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## Christopher (May 5, 2014)

Ivan_13 said:


> Dang, must be nice! Correct me if I'm wrong, but in SoCal, aeds are completely optional. The only ambulances that have them are approved 911 providers. And that's by choice.



That is _insane_. AED's are required for all levels of ambulances, whether IFT/convalescence or 911.


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## NPO (May 5, 2014)

Ivan_13 said:


> Dang, must be nice! Correct me if I'm wrong, but in SoCal, aeds are completely optional. The only ambulances that have them are approved 911 providers. And that's by choice.



Thats correct. In fact, CA has it regulated to a point where it becomes difficult and excessively expensive to maintain AEDs on all ambulances. 

Gyms are required to have them. But not an ambulance... <_<


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## MedicalSlick (Aug 10, 2014)

Although great that SPO2 (PulseOx) was added to your certain scope, remember to not be the person to put the pt. on 15LPM via mask when the pulse ox says %70 but pt. provides no symptoms (Dyspnea, cyanosis, etc..), because then you just look like a jackwagon.


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## JPINFV (Aug 10, 2014)

MedicalSlick said:


> Although great that SPO2 (PulseOx) was added to your certain scope, remember to not be the person to put the pt. on 15LPM via mask when the pulse ox says %70 but pt. provides no symptoms (Dyspnea, cyanosis, etc..), because then you just look like a jackwagon.




So you're saying not to treat the acutely hypoxic person because of a lack of immediate symptomatology and no reason to suspect that the pulseox reading is wrong (i.e. pulse not correlating, terrible waveform, etc)?


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## Chris07 (Aug 10, 2014)

..remember that old classic and favorite saying...."treat the patient not the monitor"


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## Jim37F (Aug 11, 2014)

Hmmm....if my monitor showed 70% but the patient showed no other signs of needing O2.....I'd probably take it off the patient, give it a quick sani-cloth wipe and put in my finger to see what it says (we're supposed to check ours during shift check out each morning). If it then showed my normal ~95% and the patient still at 70%, I'd probably put them on a NC and see what it says and make sure I alert the hospital to the fact that our patient is now showing a significantly reduced Spo2 than what they were on scene but no other changes and see what they say


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## JPINFV (Aug 11, 2014)

Chris07 said:


> ..remember that old classic and favorite saying...."treat the patient not the monitor"



I'm treating the fact that a tool I'm using (which I have presumably troubleshot to ensure that the reading is accurate... correlating pulses, good waveform, etc) that measures an aspect of the patient that I can't directly measure is giving me a critical value. It's like saying that you aren't going to treat hyperkalemia (yes, I know that EMS generally doesn't have access to lab value) simply because there's no EKG changes (yet). It's not "go crazy and upgrade code 3," but to say, "do nothing" is more than a bit mindbogglingly. More so when the moral of the "treat the patient not the monitor" fairy tail is "Don't ignore a normal pulseox because your patient is compensating with a rate of 40."


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## Akulahawk (Aug 11, 2014)

I would tend to agree... if the tool I've got is giving me some good numbers, I'm quite likely to begin treating based on those numbers. In the case of the pulse oximeter giving a 70% reading and I _know_ it's giving me good readings, you'd better believe I'm going to put the patient on at least _some_ oxygen. While the patient may be compensating well for now, just bringing the SpO2 up to a more normal reading may somewhat resolve some issues... like perhaps the reason you were called out to begin with... like perhaps my all-time _favorite_ chief complaint from many a SNF: "Weakness and Lethargy."

It's kind of funny when you show up and assess your patient and you realize that they're just a little bit hypoxic. Then you give just a little oxygen and they suddenly perk up... 

What's less funny is when I get the report for such a patient and I'm told they put the patient "all the way up to 3 LPM" and when I get to the patient, they're still profoundly hypoxic and they start to perk up a bit when I put them on a much higher concentration. Oh, the glares I got from some of the nurses when I did that...


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## Chewy20 (Aug 12, 2014)

DEmedic said:


> Welcome to 1992.


 
Lol seriously time  for yall to get out of that state.


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