Contraindications to O2 Administration

MMiz

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As a trained lay rescuer, are there any contraindications to emergency O2 administration to the general public? I can't think of any.

Thanks!
 

Ridryder911

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Yes, it is a prescribed medication and to do without meeting the requirements for having or need to the use of oxygen is not following what you were taught, but I am sure your protocols specifically describes when and how to use oxygen, when you are deviating from them you are in violation. To distribute any medication (including oxygen) without orders (protocols) is practicing medicine without a license. That is why "oxygen bars" only can administer room air (21%) scented oxygen.

Second question is why would anyone want to ?

R/r 911
 
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MMiz

MMiz

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Yes, it is a prescribed medication and to do without meeting the requirements for having or need to the use of oxygen is not following what you were taught, but I am sure your protocols specifically describes when and how to use oxygen, when you are deviating from them you are in violation. To distribute any medication (including oxygen) without orders (protocols) is practicing medicine without a license. That is why "oxygen bars" only can administer room air (21%) scented oxygen.

Second question is why would anyone want to ?

R/r 911
Rid.

Tell me how you really feel :).

First, it would not be part of the standard school response, but would be administered by our on-site LPN or EMT.

Second, because we are not an EMS agency, we created our own guidelines based on a template (and being approved by EMS director and MD). We're waiting on the MD's RX, but the local EMS service actually was all for it.

I grew up in schools that had O2, and the O2 was used on numerous occasions. I can only remember it being used at large gatherings (in hot gyms) where someone passed out or was feeling dizzy. I can remember my principal using it during the student vs. staff basketball game my senior year. I just see it as another tool.

I can't find a single concrete contraindication for O2. By the time the COPD patient suffers we'll be out of O2. Use on infants and newborns is addressed.

My question is, do you think this would be detrimental to our emergency response plan? There is a fine line between a good plan and whackerdom. I don't want to cross that line.

Our school would love to advertise that we have one of the most progressive response plans/teams in the nation. I'd like to help them do that.
 

Ridryder911

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Although, personally I agree with there are probably no dangers in administration, many out there do not understand it is still considered a drug.. and hence if there was any questions, I would have a medical control to at least write a letter for orders of such for liability purposes.

R/r 911
 

ReebTop

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Wouldn't the administration of oxygen in a situation where the administering person acted in good faith in an attempt to help be protected by Good Samaritan laws or whatever local analogue may exist?
 

VentMedic

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ridryder 911, Agreed.

Most States already have rules in place. It is then up to the local schools to follow this rules as guidelines to create their own policy that benefits that particular school.

Believe me, it took some serious lobbying to get inhalers/epi-pens back into the hands of children that rely on them instead of waiting to the school nurse miles away or EMS to get to the child on the football field. Time is brain cells.

The same for dive boats....

Like the AED, the O2 should have a special place and be used by trained people only. It doesn't require a lot of training for oxygen. Look at the number of people in home care that rely on their loved ones to assist. I have about 15 minutes to teach them everything they need to know and walk away, hoping for the best. That is, after I get them to put down the cigarettes.

So yes, I feel very comfortable teaching teachers, students, and secretaries in a school system to administer oxygen in an emergency if their State allows. Education is the key.

examples:

http://www.dshs.state.tx.us/schoolhealth/pgtoc.shtm

http://www.nmschoolhealthmanual.org/shm_07.pdf

http://www.healthinschools.org/ejournal/2003/sept1.htm

Florida O2 for emergency use only
http://www.doh.state.fl.us/pharmacy/info-CompressedMedicalGas.html
 
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Chimpie

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Wouldn't the administration of oxygen in a situation where the administering person acted in good faith in an attempt to help be protected by Good Samaritan laws or whatever local analogue may exist?
Maybe if it was just John Q Citizen using it, but Matt is an EMT, and is the one overseeing the program (my guess). That alone would probably throw the Good Samaritan act out the window.
 

TKO

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There's really just two parts to Oxygen administration:
1) knowing HOW to use it, and
2) knowing WHEN to use it.

We don't give O2 to everyone just because we can. And a nasal canula is going to be beneficial to everyone because it only increases sats slightly. But if they are walking wounded, like a sprained ankle, I wouldn't bother. If sats are 98% and no pain complaints then I would likely withhold it too (depending on the C/C).

As for contraindications, some people don't like O2 (seen it) and flow rate will be a concern for pts with COPD (unless they are in resp. distress). Too low of a flow rate for pts that need higher could be considered a contraindication as well, ie: pt that has sats of 99% that was exposed to CO.
 

LIFEGUARDAVIDAS

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There are some basic courses for O2 providers. For example, many diving organizations which use similar training systems to the original one from PADI.

Between the Advanced Open Water Diver and the Rescue Diver certification levels, the student has to take the EFR (Emergency First Response). This course is from DAN which also offers BLS, O2 administration, etc. All of them are designed for people who are not in any medical emergencies related profession.

Since I had AHA BLS, ARC "CPRO" & NAEMT PHTLS before starting the rescue diver course I wasn't required to take the EFR. Though I can't tell you how those courses really are, for what I've seen they meet their purpose. Both PADI and DAN certifications are recognized world-wide, so the O2 provider course surely meets any Oxygen-administration-related law in the US.

Another option, a bit more advanced is a First Responder course available at some paramedic schools. Usually they meet the USDOT curriculum.

Both options meet the main two parts of Oxygen administration (as TKO said), "1) knowing HOW to use it, and 2) knowing WHEN to use it."

Good luck,

Guri
 

VentMedic

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If we're still talking O2 delivery for schools; there are relatively no contraindications for kids in emergency situations. (unless it is a neonate with uncorrected ductal dependent lesion in the heart) Kids are not small adults and have a different O2 consumption level. They may actually benefit from O2 without worrying about high SpO2. What you see on the pulse ox may not be what the tissues are seeing. Bacterial Meningitis is one disease that mimics the flu but wreaks havoc in a very short period of time. Tissure death starts almost immediately.

If kids need EMS at schools; soft tissue and bone injuries...other than that, if they are sick enough for EMS.... don't split hairs on O2 delivery. Kids can decompensate quickly.

Teachers and school staff should already be familiar with O2 with the increasing number of medical needs children now in our school system. If they are not familiar; time to get familiar. We're saving 22 weeks preemies now. They'll be in the school systems soon enough. This is the future.

http://www.medscape.com/viewarticle/425117
 
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TKO

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Kids are the only standing case where a cap refill exam is still effective.
 

Guardian

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Rid.

Tell me how you really feel :).

First, it would not be part of the standard school response, but would be administered by our on-site LPN or EMT.

Second, because we are not an EMS agency, we created our own guidelines based on a template (and being approved by EMS director and MD). We're waiting on the MD's RX, but the local EMS service actually was all for it.

I grew up in schools that had O2, and the O2 was used on numerous occasions. I can only remember it being used at large gatherings (in hot gyms) where someone passed out or was feeling dizzy. I can remember my principal using it during the student vs. staff basketball game my senior year. I just see it as another tool.

I can't find a single concrete contraindication for O2. By the time the COPD patient suffers we'll be out of O2. Use on infants and newborns is addressed.

My question is, do you think this would be detrimental to our emergency response plan? There is a fine line between a good plan and whackerdom. I don't want to cross that line.

Our school would love to advertise that we have one of the most progressive response plans/teams in the nation. I'd like to help them do that.


my gut says you stick with teaching and let me handle ems. Anotherwords, pick a profession. My gut could be way off on this as I admittedly don't have any experience with this kind of thing. Is O2 really that critical or can't you just wait for ems to show up. First aid, yea, know how to put a band aid on and of course know CPR. Anything beyond that, I don't see the point, unless you're hoping to be sued.
 
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Guardian

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Yes, it is a prescribed medication and to do without meeting the requirements for having or need to the use of oxygen is not following what you were taught, but I am sure your protocols specifically describes when and how to use oxygen, when you are deviating from them you are in violation. To distribute any medication (including oxygen) without orders (protocols) is practicing medicine without a license. That is why "oxygen bars" only can administer room air (21%) scented oxygen.

Second question is why would anyone want to ?

R/r 911
So o2 bars are really just air bars, what a crock, not that it would do anything at 100% but still.
 

VentMedic

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To think "EMS" providers are the only ones that can do O2 is arrogant at best.

For 25 years many States have been working on educating the educators on emergency procedures. Most States have established guidelines for the school system to work with. In my previous posts I gave links to such examples. We tell the people to go for a NRBM if not vomiting, NC if vomiting...Period.

And yes, oxygen is very important especially in children who have no reserve and have different O2 consumption requirements.

TRAINED first responders of any type; parents, teachers, secretaries, etc can safely administer some type of assistance, esp O2, until help arrives. AED training is also a must. We are lobbying for ALL teacher programs to include first aide and first responder training.

Athletic trainers and coaches (degreed) do have first responder trainer and beyond. If they have an exercise science degree...they are well advanced. Many teachers also have what many EMTs and Medics do not have; science (A&P) classes AND an understanding of children.

Probably the biggest advantage of having an educator participate in a first response program is comfort to the child having a familiar face there. Face it, alot of EMTs and Medics are not comfortable with children and it shows. The child can sense it.

There are too many children in our school systems who have some type of medical needs; asthma, diabetes, cardiac, BPD, too name a few. Gambling on that child's "quality of life" for the future.....

The sad thing is a lot of EMTs and Medics are never able to follow up on a child they bring into the hospital. If they get there with a heart beat...it's a save. In the hospital, if you ask later, all we can tell you is alive and stabe. We can not tell you for privacy reasons about the trach, peg and future at a pedi nursing home. You can also tell by the growning numbers of pedi nursing homes that there needs a change toward more education in all systems.

Sorry for the soapbox...lost a child in 1980 on a call to a school. The child's inhaler was locked up in a nurse's ofc who was "at lunch". I became a Respiratory Therapist later to be able to do more for kids. I have trained teachers and parents to administer whatever it takes to save the child (within the guidelines of State statutes).

So, check your State's guidelines and run with it to the fullest to provide the fastest and effective initial care.
 

Airwaygoddess

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Very well said and a great post!!:)
 

Stewart1990

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The only thing I can think of as a contraindication for O2 would be hypoxic drive. BTW, we are taught that everyone gets oxygen. If you don't put O2 on a patient, you fail. Its applied immediatly after c/c and the only exception is non-emerg. transports ( just what were taught, I'm not trying to set guidelines here)
 

HNcorpsman

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contraindications- COPD
 

Stewart1990

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contraindications- COPD
Very true- all you can really do is keep them in position of comfort, suction if neccesary......and maybe CPAP'em if the begin to decompensate
 
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