# Pulse ox & aeds, shouldnt bls units have?



## VOODOO MEDIC (Dec 10, 2013)

The company i work for doesn't allow bls to carry a pulse ox or even a AED, something seems really wrong about this considering they do back up the 911 system contracts, plus do general transports across state...


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## VA Transport EMT (Dec 10, 2013)

if it's so important to you (Pulse Ox) buy your own from Wal-Mart. You wouldn't be the first.

Also, AED's are required by every state to operate as an ambulance regardless of 911 or not.

It's not my place to say but as a medic you should know this.


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## VOODOO MEDIC (Dec 10, 2013)

Well when i was working bls it would have been nice as a tool in the bag as a option. i asked management why they didnt have them they stated that its really not needed. but if we have a whole box of them laying around why not it helps.   the whole AED thing is under "management review" aka bs


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## DrankTheKoolaid (Dec 10, 2013)

You would think that they would have AEDs for sure.

 Pulse Oximetry for what? If the patient is short of breath it is treated with oxygen at the BLS level and you don't need a oximetry for that. If the patient is not showing any signs of dyspnea then why would they administer medication? Sure you could argue for a baseline saturation but treatment is priority number #1. I have watched on scenes patients go untreated while people struggled to get saturations when it was obvious that the patient was struggling.


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## VOODOO MEDIC (Dec 10, 2013)

I just thought since they have them why not allow BLS to use em.  In one of our contracted cities i know they throw a fit if we do not put everyone on ETCO2, among things they like to :censored::censored::censored::censored::censored: about. 

I know several people have brought up the AED issue and seem to get pushed under the rug. Maybe its a Rural metro thing.


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## triemal04 (Dec 10, 2013)

VOODOO MEDIC said:


> I just thought since they have them why not allow BLS to use em.


Stop with that line of thinking right now.  The line of "it's there so why don't we do it" or "I have it so I'm going to use it" leads to multiple problems, many of which you'll see in EMS today.  

It's not about what we have, could have, or could do, but what the patient actually needs that matters.

And this applies to ALS as well as BLS providers.


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## Tigger (Dec 10, 2013)

VA Transport EMT said:


> if it's so important to you (Pulse Ox) buy your own from Wal-Mart. You wouldn't be the first.
> 
> Also, AED's are required by every state to operate as an ambulance regardless of 911 or not.
> 
> It's not my place to say but as a medic you should know this.



It was my impression that AEDs were not required on ambulances in parts of California (shocking).


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## DesertMedic66 (Dec 10, 2013)

VA Transport EMT said:


> if it's so important to you (Pulse Ox) buy your own from Wal-Mart. You wouldn't be the first.
> 
> Also, AED's are required by every state to operate as an ambulance regardless of 911 or not.
> 
> It's not my place to say but as a medic you should know this.



Negative. In some areas it is up to the county or medical director on what equipment is carried. For the first year that I worked BLS we did not have AEDs on our units until the county made it a mandatory item. 

If monitoring a pulse ox is not in the EMTs scope for that area going out and buying one is a good way to get you fired and your card pulled.


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## DesertMedic66 (Dec 10, 2013)

Tigger said:


> It was my impression that AEDs were not required on ambulances in parts of California (shocking).



This is true


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## jrm818 (Dec 10, 2013)

Good lord...I can't imagine any unit with the possibility of doing 911 calls without an AED....in plenty of places even the cops have them....

just another reason "transport" and  "ambulette" should be separated from "ambulance" and "emergency"....


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## NomadicMedic (Dec 10, 2013)

Tigger said:


> It was my impression that AEDs were not required on ambulances in parts of California (shocking).



Or NOT shocking, as the case may be.


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## CentralCalEMT (Dec 10, 2013)

Actually, until recently there were parts of CA where not only was an AED not required on a BLS unit, but they were not allowed to have them in the first place. As backward as this seems seeing as Walmart, the gym, airport, and malls all have them but an ambulances can not??? From what I hear that has changed and they are allowed to carry them.


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## Carlos Danger (Dec 10, 2013)

DEmedic said:


> Or NOT shocking, as the case may be.



Well, I find it revolting.


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## VA Transport EMT (Dec 10, 2013)

DesertEMT66 said:


> If monitoring a pulse ox is not in the EMTs scope for that area going out and buying one is a good way to get you fired and your card pulled.


In my area it was allowed by Scope and protocols but we're not allowed to take BGA.


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## mycrofft (Dec 10, 2013)

Pulse ox is seemingly simple to use and needs some gaining and experience to know what it all really means. It would need to be integrated into protocols to be useful use of time and money.

AED can't be used in a moving vehicle.


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## NomadicMedic (Dec 10, 2013)

Halothane said:


> Well, I find it revolting.



I was being punny. See, they don't have AEDs... "Not shocking..." Get it? 

:/


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## DesertMedic66 (Dec 10, 2013)

Halothane said:


> Well, I find it revolting.





DEmedic said:


> I was being punny. See, they don't have AEDs... "Not shocking..." Get it?
> 
> :/



Re*Volt*ing 

Does that help


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## Carlos Danger (Dec 10, 2013)

DEmedic said:


> I was being punny. See, they don't have AEDs... "Not shocking..." Get it?
> 
> :/



So was I


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## Wheel (Dec 10, 2013)

DEmedic said:


> I was being punny. See, they don't have AEDs... "Not shocking..." Get it?
> 
> :/



Whoosh!


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## patzyboi (Dec 10, 2013)

I thought that every ambulance were required to have two things: Oxygen and an AED.


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## NomadicMedic (Dec 10, 2013)

Yikes. Felling like an ***. 

Hahah. Thanks guys. :/


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## johnrsemt (Dec 10, 2013)

We had Pulse Ox most of the time that I was BLS,  but I seldom used it;   if they were symptomatic and were working to breathe they got oxygen,   otherwise?    we were allowed to give the patient the O2 that they needed or didn't,   no just high flow everyone


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## EpiEMS (Dec 10, 2013)

Here's a thought: make it a Medicare requirement -- if your BLS "ambulance" doing IFT dialysis runs doesn't have an AED (or pulse ox, or whatever you deem necessary), then Medicare shouldn't (wouldn't) reimburse.


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## TheLocalMedic (Dec 11, 2013)

DesertEMT66 said:


> Re*Volt*ing
> 
> Does that help



That does help.


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## toxik153 (Dec 17, 2013)

I do not understand why BLS units don't have a pulse ox or an AED either. And regarding the guy who said having your own pulse ox is an easy way to get your card pulled.....really. That doesn't make sense to me. 

I have my own pulse ox, its a good reference tool that goes along with my patient assessment.


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## ksquire222 (Dec 17, 2013)

toxik153 said:


> I do not understand why BLS units don't have a pulse ox or an AED either. And regarding the guy who said having your own pulse ox is an easy way to get your card pulled.....really. That doesn't make sense to me.
> 
> I have my own pulse ox, its a good reference tool that goes along with my patient assessment.



Doesn't matter if it is not in your protocols. While pulse ox may be easy to use (and let's be honest, a monkey could figure out to put it on a finger), if you go outside of your regions scope of practice, you're essentially breaking the law.

With that said, I even feel the same about a glucometer.


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## DesertMedic66 (Dec 17, 2013)

toxik153 said:


> I do not understand why BLS units don't have a pulse ox or an AED either. And regarding the guy who said having your own pulse ox is an easy way to get your card pulled.....really. That doesn't make sense to me.
> 
> I have my own pulse ox, its a good reference tool that goes along with my patient assessment.





ksquire222 said:


> Doesn't matter if it is not in your protocols. While pulse ox may be easy to use (and let's be honest, a monkey could figure out to put it on a finger), if you go outside of your regions scope of practice, you're essentially breaking the law.
> 
> With that said, I even feel the same about a glucometer.



A good way to get fired and get your card pulled is to operate outside of your scope. SpO2 monitoring is not in every EMT scope.


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## DrBeat (Dec 17, 2013)

toxik153 said:


> I do not understand why BLS units don't have a pulse ox or an AED either. And regarding the guy who said having your own pulse ox is an easy way to get your card pulled.....really. That doesn't make sense to me.
> 
> I have my own pulse ox, its a good reference tool that goes along with my patient assessment.



Here all ambulances (BLS/ALS) are equipped with the same pieces, regardless of their tasks (emergency and non-emergency duties). AED+Emergency Backpack with PulseOx, glucometer, sphygmomanometer, etc - it's mandatory. 

If the ambulance is not provided with the aforementioned equipments, it is simply not allowed to perform any sort of medical service.


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## Handsome Robb (Dec 17, 2013)

You'd be surprised how often I get false numbers from first responders when it comes to pulse oximetry. 

Sure any monkey can put it on the patient's finger but without a good pleth wave the number it spits back at you doesn't mean anything. At all.


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## DesertMedic66 (Dec 17, 2013)

Robb said:


> You'd be surprised how often I get false numbers from first responders when it comes to pulse oximetry.
> 
> Sure any monkey can put it on the patient's finger but without a good pleth wave the number it spits back at you doesn't mean anything. At all.



But the number has to be 100% on all patients right?!


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## exodus (Dec 17, 2013)

Robb said:


> You'd be surprised how often I get false numbers from first responders when it comes to pulse oximetry.
> 
> Sure any monkey can put it on the patient's finger but without a good pleth wave the number it spits back at you doesn't mean anything. At all.



Which is why I can't wait for our new monitors and hope SPO2 is integrated so we can get an actual visual waveform.  We can even visually see if PVC's are non-perfusing or perfusing!


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## DesertMedic66 (Dec 17, 2013)

exodus said:


> Which is why I can't wait for our new monitors and hope SPO2 is integrated so we can get an actual visual waveform.  We can even visually see if PVC's are non-perfusing or perfusing!



You mean the LP15s or Zolls we were supposed to get over a year ago? Lol


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## exodus (Dec 17, 2013)

DesertEMT66 said:


> You mean the LP15s or Zolls we were supposed to get over a year ago? Lol



Yuppppp. As much as I've started to like the 15's. I want the zolls as that's what everyone out here uses.


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## xrsm002 (Dec 17, 2013)

They are required in Texas on BLS or at least on our BLS truck at my service they are


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## unleashedfury (Dec 18, 2013)

Pa requires an AED and Pulse Oximiters on all BLS units as of 2004 I believe it was. 

We used to be optional and alot of larger companies Like your private fleets the cost of purchasing 30 AEDs and Pulse Oximeters  was a little much so they held off until they had to

Pulse Oximeters tend to make EMT's lazy though, they see the numbers spit out and go with it, 

The more automation we use, the more our manual skills weaken, I know everyone hates that monkier but its true relying on machines to do your job make you more prone to mistakes, Reference threads about Auto BP Cuffs. you'll see what i mean


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## jwk (Dec 18, 2013)

DesertEMT66 said:


> A good way to get fired and get your card pulled is to operate outside of your scope. SpO2 monitoring is not in every EMT scope.



Kinda stupid.  We'd consider it as part of routine vital signs.



Robb said:


> You'd be surprised how often I get false numbers from first responders when it comes to pulse oximetry.
> 
> Sure any monkey can put it on the patient's finger but without a good pleth wave the number it spits back at you doesn't mean anything. At all.



Lots of hospital respiratory therapy departments use the little finger-only pulse ox devices - no waveform - and they make clinical decisions based on the number that comes up.  If you have a monitor that shows the waveform, and the waveform is crappy, then I agree with you, the number is pretty worthless.   Also remember most have at least a 12-second delay before meaningful numbers come up.


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## phideux (Dec 19, 2013)

I'm pretty sure our state DHEC requires an AED on all BLS units.


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## CodeBru1984 (Dec 19, 2013)

VOODOO MEDIC said:


> I know several people have brought up the AED issue and seem to get pushed under the rug. Maybe its a Rural metro thing.




It must be a regional thing because my division has AED's on all of our BLS units.


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## NomadicMedic (Dec 19, 2013)

Every BLS ambulance here has a decal that says "AED equipped".


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