I think we mostly agree on all the principles, we are just not communicating in an optimal way.
Oh well, we'll disagree about something one day, mate. We just have to keep trying 
I was not speaking about the use of O2 in this case at all.
I will admit that I am a bit zealous about doing things based on "wrote protocol."
This comes not from just my US experience, but my world wide medical experience of watching patient slip through the cracks of guidline based medicine.
Fair point. I suppose I'm coming from the opposite position (and considerably less experience all round it has to be said). I see many aspects to our system, both EMS and local healthcare in general, that would be greatly improved by an increased focus on guidelines. Mostly to overcome the basic fact that not everyone can be experts in everything but also to tackle to ridiculous inefficiencies, mostly logistical and communication related, that could easily be fixed if the stakeholders sat down and agreed on how things should be done.
I think it originates from a flawed thinkng. That idea is that if you are following the rules you must be doing the right thing for the patient regardless of the need or outcome.
Now while that kind of thinking is not unique to US EMS, because of US EMS history and integration with the US fire service, which is very strongly paramilitary, it becomes very difficult to change that style of thinking. The most effective means is to consistently and adamantely take issue with it.
I agree this is definately the case. But I am not sure it makes it wrong.
There are multiple podcasts and blogs by various experts on a variety of EMS and critical care issues that advocate their points and do not readily accept counter points and in some notable cases do not even acknowledge them.
On the specific matter of O2, I would say there is very appreciable evidence when you look at all of the different medical specialties that have dealt with this topic showing that emergent use of high flow O2 is not a reasonable treatment.
I would offer yet again, the Emergency Medicine community asa world-wide whole, no matter the specialty involved focuses only on all or nothing studies that are only done in the emergency environment.
I strongly feel this is a deletorious approach, not one demonstrating of expertise. Many emergency treatments and patients cannot be studies. A hyperbolic example is CPR. We cannot have a control group of those who will not have CPR performed on them. But in more reasonable research, it is aways difficult for a variety of reasons. That limits the very ability to gather research. To then turn around and say there isn't "a lot," or "definitive" evidence while failing to acknowledge or extrapolate studies and evidence from other specialties is not simply disingenious, it is entirely self serving.
Again a good argument. I strongly agree with seeking and considering evidence from outside your speciality. I'm often asked why I read a lot of surgical and general practice/primary care literature. "How is that relevant?", they ask. How will I know unless I read it", I reply.
I doubt they did that too. But I do not think it is outrageous to think that sat around and said "these decisions are too complex to put in the hands of EMS providers so we will create our guideline on the side of administering treatment as opposed to withholding it."
Well they aren't EMS specific. Just emergency specific. But you could make the same point for nurses of junior doctors who manage these pts initially.
While I agree with this, and personally defer to guidelines when I am not in the know, I have also been burned by following those guidelines in certain cases to the detriment of the patient.
The question then becomes not "should we follow the guidelines" but "how do we interpret and integrate these guidlines in practice?"
Truth.
