# Pulse ox



## Gordoemt (Mar 6, 2012)

Can an emt in los angeles county use a cheapo pocket pulse ox on a bls rig?


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## DesertMedic66 (Mar 6, 2012)

If pulse ox is in your scope of practice. If its not in your scope then no.


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## tnoye1337 (Mar 6, 2012)

In our rigs we have a moniter that does BP, HR, o2 sat, and a bunch of other things. In NY we're allowed to do o2 sats as basics.


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## JPINFV (Mar 6, 2012)

There's 2 different questions here. 

1. Can an EMT in LA gather and interpret pulse oxymetry?

2. Can an EMT use their own cheap finger probe to do so?

For 1, I would argue yes. Given what is listed on the LA LEMSA website regarding scope of practice, they largely appear to copy the state scope of practice, which includes the following line, "C. Obtain diagnostic signs to include, *but not limited to*, the assessment of temperature,blood pressure, pulse and respiration rates, level of consciousness, and pupil status."

Emphasis added. 
- http://ems.dhs.lacounty.gov/policies/Ref800/802.pdf

So how far can you legitimately stretch the "but not limited to" clause? Does it not make sense to give EMTs access to non-invasive monitoring for one of the interventions that they can provide (i.e. supplemental oxygen)?


2. If you supply your own equipment, you're responsible to ensure that it is properly maintained and calibrated. I don't know if I would want to, day in and day out, rely on a 30 dollar drug store pulse ox to make medical decisions.


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## Melclin (Mar 6, 2012)

You can't ask a clinical manager or medical director these questions?


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## rwik123 (Mar 6, 2012)

To me pulse ox is just another vital sign that all basics should be able to assess. It's one of the first thing I slap on the patient when coming on scene. It takes half a second and gives me a baseline. What's the reasoning for not allowing it in some basic scopes?


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## NomadicMedic (Mar 6, 2012)

Sounds like somebody wants to buy a new toy. 

If its supplied on your rig, you most likely don't need it. Contrary to what many think, even a pulse ox requires a biomed calibration every year (or more frequently). 

If you want to spend money, take classes.


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## JPINFV (Mar 6, 2012)

rwik123 said:


> What's the reasoning for not allowing it in some basic scopes?




...because people would rather use stupid outdated cliches like "everyone needs oxygen" or "treat the patient not the machine" than teach clinical reasoning and trouble shooting.


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## Melclin (Mar 6, 2012)

rwik123 said:


> To me pulse ox is just another vital sign that all basics should be able to assess. It's one of the first thing I slap on the patient when coming on scene. It takes half a second and gives me a baseline. What's the reasoning for not allowing it in some basic scopes?



It can give people a false sense of security. A SpO2 of 98% does not a healthy respiratory pt make. Similarly, 78% doesn't mean you're sick. It might just mean you have nail polish on, or that the sensor isn't seated properly. I've been to quite a few nursing homes where a nurse has popped the pulse ox on a pt for daily obs and found it to be 94 after looking at it for only a few moments. We get called for a "desat" and you get there to find a pt on 3LPM via a non re-breather. 

It can be dangerous to collect information if you don't really understand what that information means. 

That said, as part of a 911 ambulance service, I think SpO2 is quite important. If people don't know how to use then, they need to be taught.


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## rwik123 (Mar 6, 2012)

Melclin said:


> It can give people a false sense of security. A SpO2 of 98% does not a healthy respiratory pt make. Similarly, 78% doesn't mean you're sick. It might just mean you have nail polish on, or that the sensor isn't seated properly. I've been to quite a few nursing homes where a nurse has popped the pulse ox on a pt for daily obs and found it to be 94 after looking at it for only a few moments. We get called for a "desat" and you get there to find a pt on 3LPM via a non re-breather.
> 
> It can be dangerous to collect information if you don't really understand what that information means.
> 
> That said, as part of a 911 ambulance service, I think SpO2 is quite important. If people don't know how to use then, they need to be taught.



Agreed. Generally from my experience spo2 has been generally accurate 99% of the time. Of course you need to weigh your clinical judgment in turn with the readout and not use cookbook medecine by not treating the number. Another thing to keep in mind are CO patients. They may read like they are sating normal but are not in reality.


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## Melclin (Mar 6, 2012)

rwik123 said:


> Agreed. Generally from my experience spo2 has been generally accurate 99% of the time. Of course you need to weigh your clinical judgment in turn with the readout and not use cookbook medecine by not treating the number. Another thing to keep in mind are CO patients. They may read like they are sating normal but are not in reality.



Yup. Not saying an EMT can't do that. I'm sure they can and they should be taught how. I agree with you. SpO2 is basically a vital sign nowadays. 

But I think trouble starts when an EMT goes to walmart and buys a $29 pulse ox with the lose understanding that lower numbers are bad and then proceeds to ignore more important signs of respiratory status while they fiddle with their new toy, which is sort of what the OP seemed to be suggesting.


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## jjesusfreak01 (Mar 8, 2012)

I carry a $60 pulseox identical to the ones my company provides (and does not calibrate). It doesn't really make sense that you could limit the use of a non-invasive diagnostic tool. I pretty much just use it on my respiratory patients to make sure they maintain well during transport. Obviously their general appearance, other vitals, and breath sounds are equally important to their sat values.


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## BearChicago (Mar 16, 2012)

Our Chicago SMOs say to use pulse ox "if available" in certain situations. Most privates in town refuse sink money into them at the BLS level, and I'm not buying my own. Seems kind of stupid, because most EDs want a SPO2 on room air and on O2.


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## Akulahawk (Mar 16, 2012)

If you can show/document that you were properly in-serviced/educated in the use of the SpO2 devices, including troubleshooting them and factors that can confound them, _and_ use of that tool is authorized (or at least excluded from) as part of your scope of practice for your level, then yes, you should be able to use the SpO2. Whether or not you also want to take on any additional liability for maintaining them, that's up to you.

Now since your employer may be at least _somewhat_ responsible for your clinical actions, they _may_ also have a say in what you can use while you're "on the clock."


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## jjesusfreak01 (Mar 16, 2012)

Akulahawk said:


> If you can show/document that you were properly in-serviced/educated in the use of the SpO2 devices, including troubleshooting them and factors that can confound them, _and_ use of that tool is authorized (or at least excluded from) as part of your scope of practice for your level, then yes, you should be able to use the SpO2. Whether or not you also want to take on any additional liability for maintaining them, that's up to you.
> 
> Now since your employer may be at least _somewhat_ responsible for your clinical actions, they _may_ also have a say in what you can use while you're "on the clock."



It would seem the alternative though is to either just make clinical decisions without pulse oximetry or to make no decisions at all and put everyone on 15lpm NRB. In the end, without a means to determine sats, every respiratory, cardiac, overheated, or generally sick looking person is going to get 15 lpm, and we know that actually causes harm when it isn't indicated. I suppose I agree with you, its just annoying.


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## Akulahawk (Mar 16, 2012)

I used to make clinical decisions about O2 all the time... without the "benefit" of the SpO2. I still make them that way, actually. I use the SpO2 to (more or less) confirm what I'm seeing and as a tool to quantify response to tx.

Oh, yeah, it's _very_ annoying to me that sometimes we're required to put a patient on 15LPM because protocol says so... and there's no room for exercising clinical judgment. (Just one small example.)


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## mycrofft (Mar 17, 2012)

Using your own instrumentation is foolish. If something goes wrong, the company washes their hands of you. And you will not have the certified maintenance needed, or want to replace the >$100 leads that the real one seem to demand.

*Exactly* WHAT does a pulse-ox do except make reassuring or alarming beeping sounds? And how does putting one on a pt make sure they are in good shape? (I know the practical answers, but have heard many magical explanations over the years, want a few more).

PS: I remember a few years a go here that everyone swore by them; now, not so much.


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## hogwiley (Mar 18, 2012)

Regardless of the usual high and mighty your just a silly little EMT who cant possibly be trusted to understand that a pulse ox reading isnt always reliable, I think they are useful tools and dont see any point in denying someone the ability to use one. I work in a hospital and I use them on patients constantly all shift long. Can they be wrong? Once in a blue moon youll get a reading that doesnt seem right, but its rare. More often you simply wont be able to get any reading due to poor circulation, or the previously mentioned nail polish. 

Now getting a skewed reading on a Temporal thermometer is far more common, but thats another story.


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## Christopher (Mar 18, 2012)

Basically, with a good waveform you can trust SpO2%. Without a good waveform, you cannot trust SpO2%.

So, if your device will not show you the waveform associated (or doesn't have some index or meter to display the quality of the flow it is reading) then you cannot trust the numbers.


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## DrParasite (Mar 18, 2012)

Was on the ambulance a few weeks ago, with me, a new guy, and a 10 year veteran/past captain of the organization, and asked the new guy to get vitals.  the past captain told the new guy to just throw the patient on the pulse ox to get a pulse rate.  and finding that it was missing, the new guy was unsure how to proceed.

I told him if I ever ask him to get to get vitals, and he reaches for the pulse ox, I am going to hit him in the head with the metal clip board.

Now if someone wants to get manual vitals, and use the pulse ox to monitor pulse rates and PO2 during the transport, fine.

then again, I think those would always complain about using technology for assessments (autocuffs for BP, cardiac monitor and pulse ox for RR) but think it's ok that the ERs and hospitals (and even some paramedics) do this all the time are major hypocrites.


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## SoCal911 (Mar 18, 2012)

pulse OX is not an Emt skill in the Emt scope in LACo


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## Gordoemt (Mar 18, 2012)

Yes it is. You need to call county buddy.


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## SoCal911 (Mar 18, 2012)

Without a medic supervising? That stupid sheet they gave me in the LACo class had me thinking that it wasn't  this whole time? -___- I need to look this up.


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## Gordoemt (Mar 18, 2012)

I called county and they told me yes. Call em.


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## Gordoemt (Mar 18, 2012)

Its a bls skill man. Now you got me wondering if the emt class you took teavhed you the right stuff.


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## DrankTheKoolaid (Mar 18, 2012)

Thats because LAcO medics can barely do pulse ox without base orders...


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## Gordoemt (Mar 18, 2012)

Corky said:


> Thats because LAcO medics can barely do pulse ox without base orders...



All i know os that i called county and asked if bls can use pulse ox and they said yes as long as their trained.


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## SoCal911 (Mar 18, 2012)

Sounds sketchy.


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## Gordoemt (Mar 18, 2012)

SoCal911 said:


> Sounds sketchy.



Sounds like you need to call county buddy.


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## Aprz (Mar 18, 2012)

Blah, just had this "debate" at work. Makes me frustrated sometimes. They told me that it is not allowed, so I told them that in our protocols for Santa Clara County, under routine medical care - adult (S04), it defines "Baseline vital signs: pulse rate, blood pressure, respiratory rate, pulse oximetry", and then under BLS care, it uses the term "baseline vital signs". It does not exclude it from our Pulse Oximetry protocol (M04), but it does put emphasis that certain patients require "high flow" oxygen, and it also says this under each BLS protocols whether a patient should be administered oxygen or not meaning that pulse oximetry cannot be used to determine how much oxygen to adminsiter, but rather just a number we can document and report - if the protocols were followed word for word verbatim. I then also pointed out that under title 22 division 9 article 1 chapter 2 section 100063, it doesn't exclude pulse oximetry as a diagnostic sign that we could record. The class laughed at me "he said the section number, it must be true" (or something like that), and then I was told that "it is NOT in your scope of practice". The debate continued "we do it, it happens, but do not record that you did it, write down per RN".

I hate it that people tell you to learn your protocols and policies, yet whatever they say triumphs what it truly says, and even though they tell you to not put down inaccurate information or act outside of your scope of practice, it's okay with pulse oximetry to break the rules a little bit and then lie about it. They tell you MECHANISMS, MECHANISMS, MECHANISMS, understand physiology, yet they ignore it "that's not how it works in real life", and don't know or misunderstand the mechanism or physiology.

At this point with pulse oximetry, I've decided that I will refuse to do it, I will record what it is if reported to me by a nurse or if it's already hooked up to the patient making it clear that it is a number that I see, but do not understand, and I am simply recording it from observation, and if anyone ask, I will tell them that our laws, protocols, and policies do not clearly state whether it is or isn't allowed for EMTs to attach to their finger and to include it when making decisions based on sound clinical judgement.

At least on the 17th of April, I will be taking a short two hour class on Environmental Emergencies that will be taught by our county medical director. If I get the chance, I hope I can ask him about it along with some other things.

This debate made me a little mad. It reminded me at EMT school and at my previous EMT job when I'd say something, people laughed at me, didn't follow my instructions, told me I was wrong, but then tell me things like "how are you so smart?" or "you're smart." I just think "how dare you insult me by calling me smart when there are objective clues that you don't truly believe that - @#$% off". I wish I could say that to them nicely.


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## firecoins (Mar 18, 2012)

I frequently used a cheap finger pulse ox when I did BLS.

-it was very accurate versus pulse ox devices carried by 
RNs and medics.

-i made decisions based on all vitals, not just the pulse ox.


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## DrankTheKoolaid (Mar 18, 2012)

Aprz, we share medical directors.  I read both SO4 and M04 and according to M04 not only are you allowed to use pulse oximetry it is required on certain subsets of patients. Dr. Rudnick is a very user friendly Medical Director.  If a protocol says something is required that means it is to be done.  All bls providers up here in NorcalEms are able to use oximetry as a vital sign.  As long as treatment is not based on it alone, and in combination with other assessment VS findings.  I highly doubt you folks in Santa Clara land are any different, unless the group has fouled up enough for him to pull it specifically from you protocols


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## hogwiley (Mar 18, 2012)

So apparently in LA county, EMTs are just cot lifters and ambulance drivers? 

Seems amazing to me that they are trusted so little that they arent permitted to use a pulse oximeter. I guess thats life in the big city. 

Where I live ALS is a good 45 minutes away when you call 911, so EMT basics and even first responders by necessity are given a little more leeway.


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## Gordoemt (Mar 18, 2012)

hogwiley said:


> So apparently in LA county, EMTs are just cot lifters and ambulance drivers?
> 
> Seems amazing to me that they are trusted so little that they arent permitted to use a pulse oximeter. I guess thats life in the big city.
> 
> Where I live ALS is a good 45 minutes away when you call 911, so EMT basics and even first responders by necessity are given a little more leeway.



We can use pulse ox its in our scope but county fire doesnt trust us unless you been running with them for a long time and they personally know you. But for the most part we are county fire slaves.


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## Handsome Robb (Mar 18, 2012)

Gordoemt said:


> We can use pulse ox its in our scope but county fire doesnt trust us unless you been running with them for a long time and they personally know you. But for the most part we are county fire slaves.



Just like we don't usually trust the vitals Fire gives us here unless we are friends with them. 

They aren't our slaves though.


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## STXmedic (Mar 18, 2012)

NVRob said:


> Just like we don't usually trust the vitals Fire gives us here unless we are friends with them.



Just the other day fire gave me a pulse of 82... Yeah. It was 196. That's why you palpate a pulse and don't just use the number the pulse ox gives you :glare:


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## Gordoemt (Mar 18, 2012)

NVRob said:


> Just like we don't usually trust the vitals Fire gives us here unless we are friends with them.
> 
> They aren't our slaves though.



I beg to differ. I do belive that emts are fires slaves. They tell us what to do lol. We get minimal respect even amr for example some fire medics wont trust a medic working for amr to run the show or do the als stuff. La county has all als and bls around the neck with a belt.


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## DrankTheKoolaid (Mar 18, 2012)

Rather funny since they are the world wide joke of the EMS world.................


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## Handsome Robb (Mar 18, 2012)

Gordoemt said:


> I beg to differ. I do belive that emts are fires slaves. They tell us what to do lol. We get minimal respect even amr for example some fire medics wont trust a medic working for amr to run the show or do the als stuff. La county has all als and bls around the neck with a belt.



Fire doesn't tell me anything about how to do my job unless their operations or my actions directly threaten me, my partner or our patient's safety.

We are the medical authority, so they do what we say, when we say it and how we say to do it. I have no problem telling a firefighter who also happens to have his paramedic card to stop what he's doing if myself or my partner don't agree with his/her actions and I'm an EMT still. Once we are on scene that patient is ours and the responsibility falls back on us, not the fire department. They are ILS we are ALS. They aren't our slaves, we work together as a team to accomplish a common goal. Do we but heads every now and again? Absolutely but who doesn't occasionally in any job?

I'm sorry that you see yourself as fire's slave. I don't care if you're a firefighter that doesn't give you the right to be rude and disrespectful to co-responders.


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## Akulahawk (Mar 18, 2012)

It's "nice" to see that Santa Clara has finally gotten to the point where they'll allow EMT personnel to use the pulse-ox. When I last worked there, it wasn't in the Protocols. I also figure that it's mostly going to remain essentially a "document only" and not base treatment decisions (in other words, do what you'd do without it) on the pulse-ox exclusively.


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## Aprz (Mar 19, 2012)

Like I said, I plan to personally ask him on the 17th if he has the time to answer non environmental emergencies questions. I'm glad to see that you at least know his name; even Paramedics at my previous company didn't know his name. If my company told me not to do it because it is unclear whether we are allowed to do it or not, I understand, but they told me not to do it because it is not within our scope of practice and against the law. Since it is not in our minimum inventory (Policy 302).

Alulahawk, the protocols in Santa Clara County still specifies which patients should have oxygen or not, and that oxygen is not to be withheld based on pulse oximetry. 



> NOTE: Oxygen administration is not to be excluded based on a saturation value obtained
> by pulse oximetry. Patients with conditions including, but not limited to: ischemic chest pain,
> trauma, respiratory conditions (such as Asthma), congestive heart failure, etc. *should
> receive high flow oxygen regardless of saturation reading.* Like other physiologic
> parameters, pulse oximetry is used only as a guide in providing overall care to the patient.


The non bold part after the bold part seems to contradict that bold part.

I will also see if I can sneak in a "why are we giving oxygen to suspected ischemic chest pain patients", but that may be too much to ask.

It doesn't clearly state under BLS for S04 and M04 (in fact, it doesn't say anything about BLS or EMTs in M04) that we can do it. It's only implied in S04 when it defined baseline vitals and uses the term base line vitals under BLS. You are right, it does say certain patients require pulse oximetry, but that is contradicted by our minimum inventory policy saying on a BLS transport unit, pulse oximetry is not required.

Anyhow, I straight up got laughed at in class and told (paraphrasing in quotes) "Do NOT write what they are satting at if you put it on their finger, it happens, but we are not suppose to do it, if the RN does it, write per RN." I could argue that the person teaching the class is from LA/OC area and is very unaware of our protocols and policies up here (as much as the rest of my class was). I was a sad panda yesterday.


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## Akulahawk (Mar 19, 2012)

The minimum inventory is exactly that, MINIMUM inventory. Normally as an EMT, I won't even bother with getting a pulse-ox reading because regardless of the reading, those patients that are going to be most in need of oxygen are going to be getting as high concentration of O2 as we can provide because the protocols direct the EMT to do it.

In reviewing S04, they defined baseline vitals and direct that BLS providers can obtain them, therefore if you've been appropriately trained, you can do that. Given that the minimum inventory doesn't require BLS providers to have pulse-ox, it's going to be considered an optional item, and ambulance companies don't want to have spend money on stuff that's optional (unless it gives them an advantage), they won't get the pulse-ox units for their BLS ambulances.


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## Aprz (Mar 19, 2012)

Akulahawk said:


> The minimum inventory is exactly that, MINIMUM inventory. Normally as an EMT, I won't even bother with getting a pulse-ox reading because regardless of the reading, those patients that are going to be most in need of oxygen are going to be getting as high concentration of O2 as we can provide because the protocols direct the EMT to do it.
> 
> In reviewing S04, they defined baseline vitals and direct that BLS providers can obtain them, therefore if you've been appropriately trained, you can do that. Given that the minimum inventory doesn't require BLS providers to have pulse-ox, it's going to be considered an optional item, and ambulance companies don't want to have spend money on stuff that's optional (unless it gives them an advantage), they won't get the pulse-ox units for their BLS ambulances.


I understand that it is the minimum inventory, but saying that it contradicts saying that certain patients require pulse oximetry, but pulse oximetry isn't in the minimum inventory for BLS. How could it be required if you don't have it?

I am also not talking about the usefulness or clinical relevance of pulse oximetry, but trying to determine whether it is legitimately allowed or not.

Exactly, I mentioned they defined baseline vitals and use the term under BLS which is why it's implied (it doesn't say specifically pulse oximetry under BLS), but I am still being told [by the person in charge of training for my company] that only the first three apply, not pulse oximetry "because it's not in your scope of practice". I believe they are wrong, but I don't want to get in trouble [by my company] either.


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## Sasha (Mar 19, 2012)

Aprz said:


> Like I said, I plan to personally ask him on the 17th if he has the time to answer non environmental emergencies questions. I'm glad to see that you at least know his name; even Paramedics at my previous company didn't know his name. If my company told me not to do it because it is unclear whether we are allowed to do it or not, I understand, but they told me not to do it because it is not within our scope of practice and against the law. Since it is not in our minimum inventory (Policy 302).
> 
> Alulahawk, the protocols in Santa Clara County still specifies which patients should have oxygen or not, and that oxygen is not to be withheld based on pulse oximetry.
> 
> ...



It's saying that a pulse ox is a guide, not an end all, to your o2 administration decision.  

Like its saying if your pt is SOB and your pulse ox is still reading 94, throw them on oxygen. 

It really isn't contradicting just further clarifying.


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## Hunter (Mar 19, 2012)

Sasha said:


> It's saying that a pulse ox is a guide, not an end all, to your o2 administration decision.
> 
> Like its saying if your pt is SOB and your pulse ox is still reading 94, throw them on oxygen.
> 
> It really isn't contradicting just further clarifying.



I use it to trend a patient, patient complains of SOB, I check a SaO2 and I'll put em on O2 regardless of the reading, then I'll record their SaO2 a few minutes later and how they're feeling.


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## STXmedic (Mar 19, 2012)

Hunter said:


> I use it to trend a patient, patient complains of SOB, I check a SaO2 and I'll put em on O2 regardless of the reading, then I'll record their SaO2 a few minutes later and how they're feeling.



Y'all are allowed to check SaO2?! That's awesome!!

...


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## mycrofft (Mar 19, 2012)

*five is four and a half*

If your employer or medical control or protocols say you can't use pulse ox and you go out and buy one...nuff said.

The 80- versus 196 comment earlier by Poetic Injustice is a breath of real-world air here. When the pt arrives at the ED and their vitals make yours look like boilerplate from Hallmark Cards, who will look worse, you or the machine? Those pulse ox's have a very good poker face.

I have seen a difference in the performance of machines kept in a nice warm immobile building (barring abuse by staff) with its own biomedical staff, versus those driving around in an ambulance, exposed to temperature differences (hence condensation), mechanical shocks, operating with low batteries, and no one certified to do repairs. This ignores the whole issue of cheap versus quality instruments.

 If a hospital treated their biomedical instruments the way most  ambulance companies/FD's  undoubtedly tend to theirs, the hospitals would be in court a lot.

If you want to play table tennis about a medical diagnostic procedure you ought to be universally allowed to use, it is fingerstick glucometry (not to sidetrack the thread further into the "I can SO do that" sandbox).


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## Gordoemt (Mar 19, 2012)

La county told me i can use it and my employer said i could use a pulse ox.....  nuff said.....


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## MRSA (Mar 19, 2012)

In oc its in your scope. I know it not to be in la's scope. I work in oc, la city and county. Me etsonally I use it for a baseline on every call but I never bill or record it. I take manual uses. Please if you do use your pulse ox ALWAYS take a manual! Cover your butt because if the hammer comes down and you say say "that's what the pulse ox said" you will get fired for being in doubt and not taking a manual. When you buy one make sure its for clinical use and not for just someone who likes to jog a lot. I got mine for 40a bucks and I love it but I want to d for the 100 one.

Plus on still alarms you will just love these. This was the first thing I dropped on a pt I found in the street before holding c spine  in oc of course.


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## DrankTheKoolaid (Mar 19, 2012)

Aprz, enjoy his enviro talk.  I listened to it a year ago and he a is great speaker.  And yes I know his name well ).  We meet often as I am on the Medical Advisory Commitee for NorCalEms


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## STXmedic (Mar 19, 2012)

Gordoemt said:


> La county told me i can use it and my employer said i could use a pulse ox.....  nuff said.....



Then why come on here and ask?


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## Gordoemt (Mar 19, 2012)

Because i can.... And im curious as to what other bls crews in the nation can do as far as pulse ox.


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## Sasha (Mar 19, 2012)

Gordoemt said:


> Because i can.... And im curious as to what other bls crews in the nation can do as far as pulse ox.



That wasn't your question.


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## Hunter (Mar 19, 2012)

Sasha said:


> That wasn't your question.



This ^


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## Akulahawk (Mar 19, 2012)

Aprz said:


> I understand that it is the minimum inventory, but saying that it contradicts saying that certain patients require pulse oximetry, but pulse oximetry isn't in the minimum inventory for BLS. *How could it be required if you don't have it?*
> 
> I am also not talking about the usefulness or clinical relevance of pulse oximetry, but trying to determine whether it is legitimately allowed or not.
> 
> Exactly, I mentioned they defined baseline vitals and use the term under BLS which is why it's implied (it doesn't say specifically pulse oximetry under BLS), but I am still being told [by the person in charge of training for my company] that only the first three apply, not pulse oximetry "because it's not in your scope of practice". I believe they are wrong, but I don't want to get in trouble [by my company] either.


It's part of baseline vitals because Paramedics can do BLS, have the tool available, and have it in their scope of practice,and are trained in how to use/interpret the readings. It's also in the EMT scope there as a "if you've been trained and your employer has it for you to use" but they're not required to have the tool. They're required to have a BP cuff and stethoscope as part of the minimum inventory. 

A few years ago, the County had a combined BLS/ALS protocol book. Certain procedures were allowed to be performed by appropriately accredited providers only. Everything else was in the BLS scope. Theoretically, an EMT that was locally accredited to perform ETI could do it. Theoretically, an EMT that was locally accredited to administer NTG or ASA could do it. Paramedics were accredited for all the "advanced" procedures as part of their accreditation process. 

In other words, as far as pulse-ox goes, yes, you can do it _if_ you have been appropriately trained/educated, your company authorizes (and monitors your use of the procedure and ensures you're appropriately up-to-date), and you have a pulse-ox available for you to use. Being that it's not part of the minimum required equipment means to me that your employer has a choice about whether they can allow their crews to use the tool. For BLS, since you're not allowed to titrate O2 delivery to pulse-ox readings, it's basically a moot point. You do what protocol says, regardless of what the tool says.


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## Gordoemt (Mar 19, 2012)

Akulahawk said:


> It's part of baseline vitals because Paramedics can do BLS, have the tool available, and have it in their scope of practice,and are trained in how to use/interpret the readings. It's also in the EMT scope there as a "if you've been trained and your employer has it for you to use" but they're not required to have the tool. They're required to have a BP cuff and stethoscope as part of the minimum inventory.
> 
> A few years ago, the County had a combined BLS/ALS protocol book. Certain procedures were allowed to be performed by appropriately accredited providers only. Everything else was in the BLS scope. Theoretically, an EMT that was locally accredited to perform ETI could do it. Theoretically, an EMT that was locally accredited to administer NTG or ASA could do it. Paramedics were accredited for all the "advanced" procedures as part of their accreditation process.
> 
> In other words, as far as pulse-ox goes, yes, you can do it _if_ you have been appropriately trained/educated, your company authorizes (and monitors your use of the procedure and ensures you're appropriately up-to-date), and you have a pulse-ox available for you to use. Being that it's not part of the minimum required equipment means to me that your employer has a choice about whether they can allow their crews to use the tool. For BLS, since you're not allowed to titrate O2 delivery to pulse-ox readings, it's basically a moot point. You do what protocol says, regardless of what the tool says.



Thank you.


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## Akulahawk (Mar 19, 2012)

Gordoemt said:


> Thank you.


Just for clarification, my post was specific for Santa Clara County. If your EMS Agency authorizes EMT use of the pulse-ox, then the above post could apply to you as well. Santa Clara EMS hasn't mandated the pulse-ox for use by BLS, but very much appears to allow it's use. Just look at BLS AED programs. There's some on-going training that must be done to ensure that BLS personnel continue to be competent in the procedure. I would imagine that a BLS company that wants to allow the pulse-ox to be used would have to institute a periodic skills check and have someone able to function as a skill coordinator to ensure consistency and competency.


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## mycrofft (Mar 19, 2012)

OP Gordo, if they both say you can, then you can. As you said, 'nuff said, good job running it down.

Just don't be the one who has to take the hit if your employer alleges your machine isn't properly working and fires you or throws you under a bus.


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## Gordoemt (Mar 19, 2012)

mycrofft said:


> OP Gordo, if they both say you can, then you can. As you said, 'nuff said, good job running it down.
> 
> Just don't be the one who has to take the hit if your employer alleges your machine isn't properly working and fires you or throws you under a bus.



I have it im writing from my employer that i can use it and that they dont provide me eith one and that they dont have a problem with me using my own. Besides im not gonna go hard like a fng and code it to the er without als for a o2 sat thats 91 with out sob. Its the generialized picture.


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## mycrofft (Mar 19, 2012)

Sounds reasonable.


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## Aprz (Mar 21, 2012)

Bummer. I just got to policy 808 in our protocols in Santa Clara County. Pulse Oximetry is not within the scope of practice of an EMT. Well, that's the end of that. If I had only read this part of the policies and protocol last week before we had that discussion at work.

http://www.sccgov.org/SCC/docs/Emer...P)/attachments/9.1.11 SNF Handbook 090111.pdf


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## Akulahawk (Mar 21, 2012)

That document was last updated in 9/11. It's certainly possible that the scope of practice has been slightly updated since then. Generally speaking though, that document is a pretty good summary of the scope of practice for SCC EMS since I first saw it about 10 years ago.

There is a possible conflict between that document and the other one in the protocols that defines what the basic vital signs are... so that may have to be clarified somehow.


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## Aprz (Mar 22, 2012)

True that, there are a couple of mistakes I've found in the protocols e.g. they mispelled Lucile Packard Children's Hospital as Louise Packard Children Hospital in policy 101 provider codes, in policy 501 hospital ring down under trauma they say refer to 606, which is transfer of care, for the list of mechanisms for activating trauma, but likely meant policy 605 prehospital trauma triage. They have little mistakes like in policy 600 field pronouncement of death they list criterias as II and Action as II, skip III, and go to IV. It makes me wonder they tell us not to make mistakes like this on our PCRs and to follow protocols, but there are mistakes like this all over the place.

I also considered that in that policy, 808, it says the scope is the same for 911, and EMTs are trained to place electrodes and pulse ox for the paramedics and do it so perhaps this is intended to say they cannot interpret is value unless our exclusive operating agency (EOA) that does 9-1-1 has an approve class to expand the scope of practice for EMTs to do that (cause I'm sure they have to take a class within the agency), and I mean this is an approve class by the medical director, not just a class like my company is suppose to make sure are on the same page if you know what I mean.


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