Based on what you say, I would think the best we can do is understand airway management, base our findings on current level of training, use visual indicators such as difficulty in breathing, perhaps vitals for further diagnostics, even pinch the nail for perfusion. Use the tools we have been given, and then follow our protocols. I think the protocols are pretty clear as to when O2 is indicated. I am unclear as to what you mean "when not indicated". Surely the protocols do not indicate O2 for a broken arm, but they do indicate for shortness of breath and blue lips.
Not trying to be a wise guy, rather, seek enlightenment.
I think this is where the misconception is.
This is an obsolete view of airway management. It is from an era when it was assumed they could all be grouped into 1 simple task and if it wasn't working it was was for greater minds to figure out.
It is not possible to deflect lack of knowledge or "just following orders" and claim professionalism or demend respect from others in the healthcare community as a healthcare team member.
Ventilation, oxygenation and respiration are all seperate processes. The pathologies that result from them cannot always be treated simply by giving oxygen.
Take for one example hemorrhage, with loss of both blood volume, and heme, you have lost 2 of the 3 parts of oxygen delivery. Adding more oxygen isn't going to really matter.
Think of it like a train, oxygen delivery requires intact vascular volume (tracks) Heme (train cars) and cardiac output (the engine) Oxygen is the cargo.
No tracks, no cars, and you can add all the cargo in the world and go nowhere with it. But sooner or later it will break somebody's back.
Sure somebody might argue that by raising the Po2, then you maintain heme saturation, but the problem isn't that there is not enough to saturatate, the problem is similar to anemia, there isn't enough blood to carry that oxygen.
As JP said, when you over oxygenate, you cause harm. Perhaps not perceptable by you in your short time. But it is like lighting dynamite and running away, you might not see the destruction, but you certainly caused it.
That leaves the people you drop the patient off at to clean up your mess. (At least try to)
You might even take years off of the end of life and not this acute event.
You can induce pulmonary damage, which may form scar. You can induce renal damage, which may not heal, you can even induce liver damage. (did you know lliver damage from tylenol OD is actually from free radical formation?) Which means Your oxygen might ultimately make things worse.
Now let's say you lose 1% of your lung function forever and/or 0.5% renal function from a short event of 100% o2 by NRB. It probably won't show up clinically or even on a lab. But then what if you do this to a person 5 times throughout their life. Plus the loss of function from the normal process of aging, plus any other acute or chronic pathology you add?
That 0.5 or 1% might be the difference between quality of life or total life down the road for that person.
How do you look at a patient and say "I might take a few years of your life away from you , but it makes me comfortable to take the risk and do this to you today."
What if your patient is truly critical? O2- (superoxide) is one of the things your immune cells use to protect you, it is also what your body uses to kill some of its own cells. It works like a bomb, it doesn't matter what it hits.
So lets say your patient has neutrophils getting filtered in the lung, because they get filtered by in the lung and kidneys .(Everytime epinepherine is released into your system, your circulating neutrophils increase by 50%) some of these will degranulate and cause damage most likely in the lung and kidney. (with superoxide) Now you come along and add more oxygen to it. Amplifying the damage. 2 days later the patient is in the ICU with ARDS. Did you make it worse? Did you incite it? Truthfully we will not ever know. But we do know you did what can incite it or make it worse.
So much for "do no harm."
Now the argument becomes "why was it written into protocol?" Because it was written by people who had no idea of this stuff at the time or simply didn't care because they thought just like you do. "As long as they don't die here, then we didn't kill them."
Today's standards of care take far more evidence to change than they did to implement. (I know cause I try to change them all the time.) If anyone will even let you gather the evidence or change them even in the face of overwhelming evidence.
I don't think it is reasonable for an EMT-B to know and understand this level of pathophysiology while drinking coffee at starbucks, but I think it is very reasonable to demand that the same EMT-B understand that not every patient they see should be given high doses of a drug because it might harm in the long term.
I will never give professional acknowledgement or respect to any individual who hides behind "just following orders" to make up for lack of knowledge or deflect responsibility.
That is not the behavior of a professional.
Accepting responsibility, educating oneself, and promoting change based on new information are things professionals do.
You can no longer claim ignorance. I just explained it to you...
For free.
Considerably more than your EMT instructor probably ever told you.
