Just in case someone isn't reading the comments.
I think one of the big problems is that EMS, especially EMS education, tends to treat oxygen as some sort of miracle drug that gives EMS providers a chance to save everyone from a stubbed toe to a CVA to a cardiac arrest. Why else is failure to give high concentration of oxygen (at least they aren't calling it "high flow") a critical failure for, of all things, a medical assessment? Shouldn't the assessment be driving the treatment? If not, why even do an assessment in the first place. It's like saying, "Assessment tools be damned, if you're a paramedic treating a patient with an ALOC, it's D50 and narcan. Assessment (including point of care lab values like blood glucose levels) and patient history (including HPI) be damned."
Medic Marshall asks, "Are there only certain conditions under which oxygen should be administered?"
Why not? What other intervention is given to all patient regardless of assessment? We don't transport lights and sirens for all patients (I'd argue that the decision to use emergency transport over regular transport is as much an intervention as anything else). More and more trauma patients aren't being put through spinal immobilization for no better reason than they suffered a traumatic insult regardless of how minor it was. Why should we continue with the "Well, ambulance transport means a NRB" attitude?
While working as an EMT-B, I used a NRB once on a patient that fell into the "Well, I can't do anything else, so maybe...." column. The nurse receiving the patient asked innocently why the patient was on a NRB and the only thing I could think of was "protocol." In my time as an EMT, I have never felt more dirty or a failure than after I uttered those words, including all of the times I've made mistakes or missteps because we, as a supposed profession, should always be able to justify our treatment interventions based on our education, training, and assessment and a "I couldn't think of anything else and it's 'benign" is a failure. I vowed never to make that mistake again.
Of course my attitude of using assessment based treatment clashes with another JEMS columnists views that the only true source of education is the initial training (unfortunatly, my comments on that column was lost in the transfer to the new web design).
http://www.jems.com/article/training/use-these-tips-ems-professor
Sincerely,
Joe P. MS, NREMT-B, OMS-II (only including these since they're relevant to this comment).
