Let's just take oxygen out of standing orders.

[Ridryder911]

Part of the problem of not only EMS but medicine... treat the patient NOT the protocols!!! How many times have we seen medics (all levels) categorize the patient to fit their local protocols in lieu of treating accordingly?

The new trend is less oxygen... even AHA is finally recognizing this. Again, treat the patient NOT the monitor.. numbers.... or protocols!!

Why knowing and understanding good, accurate patient assessment is so essential... no matter what level you are!

 

[Anonymous]

The problem is the second anything goes wrong and protocol was not followed (patient placed on high flow O2, or c-spine as in other threads) the provider is usually screwed. Fear of litigation has taken autonomy away from a lot of us. Also, would kind of be nice if basics were able to utilize the ever so invasive pulse ox.

 

[firecoins]

I put my patients on room air o2 if they aren't s.o.b.

 

[NYMedic828]

The problem is the second anything goes wrong and protocol was not followed (patient placed on high flow O2, or c-spine as in other threads) the provider is usually screwed. Fear of litigation has taken autonomy away from a lot of us. Also, would kind of be nice if basics were able to utilize the ever so invasive pulse ox.

Find me a documented case where a lawsuit was opened yet alone lost because oxygen was not administered when it wasn't indicated or a patient was not long boarded. (good luck)

Pulse-oximetry is a non invasive form of quantitative monitoring. Not all places have it for BLS. In NY it is optional for BLS mandatory for ALS.

Pulse-oximetry is also not a completey reliable vital sign. It is heavily affected by many outside factors from nail polish to movement. It is also at a delay from what is really going on in the body. But, it is absolute useful for establishing baselines and titrating/evaluating your treatment.

My favorite is when people assess SpO2 AFTER starting oxygen therapy. Sigh.

 

[Veneficus]

Part of the problem of not only EMS but medicine... treat the patient NOT the protocols!!! How many times have we seen medics (all levels) categorize the patient to fit their local protocols in lieu of treating accordingly?

The new trend is less oxygen... even AHA is finally recognizing this. Again, treat the patient NOT the monitor.. numbers.... or protocols!!

Why knowing and understanding good, accurate patient assessment is so essential... no matter what level you are!

It is very good to see you still hanging around.

Unfortunately, the trend more and more in EMS education I have noticed is to follow the protocols without deviation or thought.

Telling people to treat the patient, not the monitor or protocol is akin to telling me to use my judgement while wrenching on a Russian spacecraft. I just don't know how to do it to begin with.

 

[NYMedic828]

It is very good to see you still hanging around.

Unfortunately, the trend more and more in EMS education I have noticed is to follow the protocols without deviation or thought.

Telling people to treat the patient, not the monitor or protocol is akin to telling me to use my judgement while wrenching on a Russian spacecraft. I just don't know how to do it to begin with.

This factor probably plays one of the biggest roles in why EMS providers interested in providing real medical care often move on to a more progressive field. It is unfortunate as EMS does have potential for greatness but it will never be achieved in this country. Never. (hope one day I am proven wrong)

 

[Veneficus]

This factor probably plays one of the biggest roles in why EMS providers interested in providing real medical care often move on to a more progressive field. It is unfortunate as EMS does have potential for greatness but it will never be achieved in this country. Never. (hope one day I am proven wrong)

A couple of years ago I suggested nursing take it over. The idea was not well recieved despite being how it is done in several advanced systems around the world.

EMS follows the standard path of evolution, evolve or become a curio for archaeologists.

 

[mycrofft]

Vocab Nazi comment

There you go. Anyone with the educational level to order "administrate oxygen" ...sort of like "getting orientated" (oriented).

I teach for a company that also sells oxygen and I am required to teach them to start O2 no matter what. Fixed at six liters, nonetheless....

rennex showed me the citation for use of the word "adminstrate" being equivalent to "administer". Point taken, point granted, and the material seems sound, so I'll roll up my proofreading rug and steal away. (aweigh?)

However, it will now dwell alongside "irregardless" (double negative), "gone south"* (the original is "gone west"), "underway" (properly, "underweigh") and "oral exams" (not being done by a dentist, it means VERBAL exams) ; adopted by common usage, but still redheaded stepkids to me.

*If something "went South" from New Zealand, it would not have far to go before it would be going North again, right?

 

[DrParasite]

Can I hold them accountable for doing what they were told, by other incompetent people made instructor? No.

Can I hold them accountable for not self educating to understand what is truly right. Absolutely. And I do.

ACLS has been shown to not affect whether or not a cardiac arrest patient will walk out of the hospital. does that mean you are no longer going to follow the protocol on your next cardiac arrest patient?

Please don't think I think we should overoxygenate everyone, but for change to happen, it needs to start with the medical directors, ER doctors, EMT curriculum writers, and everyone who writes protocols. you can't fault an ignorant crew for following what they were taught and what their protocols say to do, regardless of if it's wrong or not.

The new trend is less oxygen... even AHA is finally recognizing this. Again, treat the patient NOT the monitor.. numbers.... or protocols!!

I have heard this before... so if I pick up grandma who is complaining of feeling sick, and has a pulse ox of 74, I shouldn't put her on supplemental oxygen?

You can't just treat the numbers, but use them to formulate a treatment plan.

Find me a documented case where a lawsuit was opened yet alone lost because oxygen was not administered when it wasn't indicated or a patient was not long boarded. (good luck)

According to current standards/protocols, oxygen is always indicated. until the standards and protocols are changed, failing to administer oxygen is failing to do your job according to current standards, which can be cause for termination. You might be right but until the governing body catches up, it's going to be an uphill battle winning that fight.

I do know of people who were disciplined for not C-spining people, and people who were not disciplined for over c-spining people.

 

[NYMedic828]

You are without a doubt the most irritating person on the forum to debate with...

AHA doesn't recommend oxygenation unless symptoms of respiratory distress are present and or an SpO2 of <94%. If grandmas sat is 74, she is administered o2, titrated to 94-100%.

ACLS is a standard utilized by ALL levels of medical provider in the country. Oxygenating every last patient is only done by EMS. Maybe there is a reason no one else does it? Does every arrest need 5mg of epi, no and it hasn't been proven to do anything at all but other aspects of ACLS do in fact work. ACLS in and of itself is an ongoing study of trials and error, as it is designed to be.

And my protocols in NYC have a section stating that "these protocols are guidelines not to be used in place of good clinical judgement." Basically, it is saying that the protocols exist as they do so that even the
most incompetent of providers can't do too much wrong.


And being "disciplined" for c-spine criteria at an agency level is FAR different from a lawsuit. Odds are the person doing the disciplining wasn't much more competent than the persons getting a talking to. If a provider is proficient in there abilities, being disciplined should not worry them unless they know they truly did wrong. Always be able to justify your actions and you will remain safe.

 

[mycrofft]

Reductio ad absurdum threads (take away oxygen, get rid of EMT's) invite wide-swinging arguments.

 

[Veneficus]

Reductio ad absurdum threads (take away oxygen, get rid of EMT's) invite wide-swinging arguments.

I actually have considerable reservations about eliminating tools from the box as a means of compensating for poor quality providers.

It has not worked in the past and I don't see anything that would suggest doing it now would have any different of an outcome.

 

[Aprz]

Find me a documented case where a lawsuit was opened yet alone lost because oxygen was not administered when it wasn't indicated or a patient was not long boarded. (good luck)

Pulse-oximetry is a non invasive form of quantitative monitoring. Not all places have it for BLS. In NY it is optional for BLS mandatory for ALS.

Pulse-oximetry is also not a completey reliable vital sign. It is heavily affected by many outside factors from nail polish to movement. It is also at a delay from what is really going on in the body. But, it is absolute useful for establishing baselines and titrating/evaluating your treatment.

My favorite is when people assess SpO2 AFTER starting oxygen therapy. Sigh.

I think he was being sarcastic about the pulse ox.

 

[Sandog]

Find me a documented case where a lawsuit was opened yet alone lost because oxygen was not administered when it wasn't indicated or a patient was not long boarded. (good luck)

.

Failure to C-spine

FANG v. UNITED STATES
UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
Nos. 96-56800 97-55028
March 31, 1998

Fang's mother, plaintiff Pearl Bei Fei Fang, brought this wrongful death action which, in part, alleged the negligent failure of National Park Service ("NPS") employees to (1) properly stabilize Fang's spine prior to treatment; (2) administer to Fang proper CPR; (3) carry all of the equipment necessary to Fang's treatment with them to the accident site.

 

[JPINFV]

Failure to C-spine

FANG v. UNITED STATES
UNITED STATES COURT OF APPEALS FOR THE NINTH CIRCUIT
Nos. 96-56800 97-55028
March 31, 1998

Fang's mother, plaintiff Pearl Bei Fei Fang, brought this wrongful death action which, in part, alleged the negligent failure of National Park Service ("NPS") employees to (1) properly stabilize Fang's spine prior to treatment; (2) administer to Fang proper CPR; (3) carry all of the equipment necessary to Fang's treatment with them to the accident site.

...and the only thing we know is that there was a case (granted, that was all that NYMedic asked for), not what the final decision in the case was.

 

[DrankTheKoolaid]

Just read that case summary.

Interesting read actually and not quite applicable as the equipment was not on hand at the time of the incident.

 

[JPINFV]

Just read that case summary.

Interesting read actually and not quite applicable as the equipment was not on hand at the time of the incident.

Plus the appeals court case dealt only with the argument that the government has immunity against the claims, not whether the claims were successful. That issue was sent back down to the trial court to be heard.

 

[mycrofft]

http://classweb.gmu.edu/erodger1/prls560/content/fang.htm

Description of incident:

After requesting additional medical personnel and supplies through dispatch, the two EMTs grabbed their emergency medical kits, a radio, and a partially full portable oxygen tank with delivery system and went down the hill. Upon finding Fang, the EMTs cleared her airway and administered oxygen without attempting to move her*. No immediate attempt was made to stabilize her spine. Approximately fifteen minutes after the accident, Fang stopped breathing. Cavanna and Boes, with the assistance of another of the car's passengers, then began to administer cardiopulmonary resuscitation* ("CPR").

After the arrival of additional medical support and equipment, Fang was placed in a cervical collar and strapped to a backboard. Then, using climbing ropes, the EMTs transported her up the mountain. This process took approximately fifty-five minutes, during which CPR was continuously administered.* Unfortunately, Fang was pronounced dead upon her arrival at the top of the hill. The cause of death was listed as "cervical fracture."
Basis of the claim:

"...wrongful death action which, in part, alleged the negligent failure of National Park Service ("NPS") employees to (1) properly stabilize Fang's spine prior to treatment; (2) administer to Fang proper CPR; (3) carry all of the equipment necessary to Fang's treatment with them to the accident site".


Plaintiff lost, then appealed. Findings of the appeals court:

"The appeals court, therefore, concluded that the Fang's equipment claim is precluded by the discretionary function exception. As a result, the appeals court affirmed the district court's dismissal of this claim.

Having found that Fang's spine stabilization and CPR claims against the United States were not precluded by the discretionary function exception, the appeals court reversed the summary judgment in favor of the United States and remanded (i.e., sent back) these two claims to the district court for further proceedings. In so doing, the appeals court expressed "no opinion on the facts underlying these claims or their outcome" at a future trial in the district court.

So it was the usual clustermug a multiple victim MVA in the middle of nowhere turns into, then they did CPR continuously while ascending a 45 deg angle hill for 210 feet (was that 210 vertical or linear?)/55 minutes. The final finding (I wonder if it is still going on?) was "no" to part, and "maybe, try again" to another part.

PS: MOI note: ejected from car during the accident. Other passengers ok enough to help.


* emphasis added by Mycrofft

 

[DrankTheKoolaid]

Family looking for a payout after the victims own negiligence caused the ejection in the first place (no seatbelt use). These cases really should not even make it into the court system, absolute shame.

 

[JPINFV]

Plaintiff lost, then appealed. Findings of the appeals court:

That's the rub. The case looks like it was dismissed erronously by the trial court. As such, it's hard to discuss the applicablity of this case because no actual ruling to the basis of the specific claim is discussed in the appeals court ruling. It looks like it was dismissed prior to going to trial.