Let's just take oxygen out of standing orders.

Aidey

Community Leader Emeritus
4,800
11
38
Here is a case in which a patient was taken out of c-spine precautions at the hospital, and later became paralyzed. The court found in favor of the defendants and basically told the kid if he hadn't been a drunk obnoxious jackass then maybe everyone else could have done their job.
 

Aidey

Community Leader Emeritus
4,800
11
38
Here is a case in which the defendant was found 35% responsible for damages after a patient sustained neurological damage during a move in the hospital. The pt had a confirmed back injury the IFT company didn't know about, and they used sheet to slide him, resulting in injury. There was testimony that a back board would have been the only proper way to move him, however it all happened in 1976 and I think a couple good expert witnesses could have argued that the log roll to get him onto the back board would have been just as likely to cause the injury as the sheet slide.
 

mycrofft

Still crazy but elsewhere
11,322
48
48
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.

1. Driver is also negligent. At least in Calif.

2. That was immaterial to the basis of the suit. I threw it in because I thought it was ironic.

The lessons I got form it were not to claim you are doing adequate CPR while moving a subject up a steep incline, etc. Like I tell my cat, whem you take a dump on linoleum, acting like you are covering it up makes it no better.
 

mycrofft

Still crazy but elsewhere
11,322
48
48
Here is a case in which the defendant was found 35% responsible for damages after a patient sustained neurological damage during a move in the hospital. The pt had a confirmed back injury the IFT company didn't know about, and they used sheet to slide him, resulting in injury. There was testimony that a back board would have been the only proper way to move him, however it all happened in 1976 and I think a couple good expert witnesses could have argued that the log roll to get him onto the back board would have been just as likely to cause the injury as the sheet slide.

The lesson is when you transport, get an order about how. Spineboard is not actually something you do as an EMT during an IFT unless the pt fell there and was going to a hospital; it is not customary nor likely to have to re-spineboard someone for an IFT. I think the court got tangled up in the service and wanted to make sure SOMEONE paid the patient SOMETHING.
 

Aidey

Community Leader Emeritus
4,800
11
38
From what I could understand the company was found 35% at fault not really because the of the lack of backboard, but because they didn't get a good enough report and failed to know about the back injury.

Frankly the vast majority of the cases I found against EMS were patients that were placed in spinal motion restriction and were paralyzed anyway. Lots of suits claiming it wasn't done fast enough, or right or the patient was moved incorrectly after. And lots of judgements in favor of the defendants.
 

leoemt

Forum Captain
330
1
0
Regarding Oxygenation, they teach us to always oxygenate and in class it is always a 15lpm NRB.

Being new, I am probably guilty of over oxygenating my patients at times. My clinical skills aren't as developed as other providers and I am still learning. I do make a point to research conditions as much as possible so that I can better understand for future calls.

However, I disagree with minimizing oxygen delivery. In a pre-hospital setting it is unlikely that over oxygenation is going to cause any ill effects. Yes, Oxygen is a drug and should be treated as such. However, one of its benefits is it does provide a calming effect.

I am not allowed to withold oxygen. If they want it they get it. The problem with oxygen is many underlying conditions can affect its delivery. That is starting to get into diagnostic territory which is not my job.

Oxygen was one of the most confusing parts of my EMT class because there are no clear cut answers. When do you use an NC or an NRB? What about medium concentration vs high? CPAP? BiPap?

Even doctors screw this up. I treat my patients and I do my best to provide appropriate treatment and as my clinical skills develop, my oxygen use is going down. However, I err on the side of caution and they get O2 if they need it or if I am not sure.
 

Veneficus

Forum Chief
7,301
16
0
However, I disagree with minimizing oxygen delivery. In a pre-hospital setting it is unlikely that over oxygenation is going to cause any ill effects.

How do you know this?

That is starting to get into diagnostic territory which is not my job.

Do basics in your area give ntg? That is diagnostic
Do they use a glucometer? That is diagnostic
Pulse oximeter? Diagnostic
physical exam and history? Diagnostic

there are no clear cut answers. When do you use an NC or an NRB? What about medium concentration vs high? CPAP? BiPap?

Welcome to medicine :)

Even doctors screw this up. I treat my patients and I do my best to provide appropriate treatment and as my clinical skills develop, my oxygen use is going down. However, I err on the side of caution and they get O2 if they need it or if I am not sure.

Fair and reasonable.

I don't like it, but it is.
 

mycrofft

Still crazy but elsewhere
11,322
48
48
Jumping clear now. Have a good day.:cool:
 

JPINFV

Gadfly
12,681
197
63
However, I disagree with minimizing oxygen delivery. In a pre-hospital setting it is unlikely that over oxygenation is going to cause any ill effects. Yes, Oxygen is a drug and should be treated as such. However, one of its benefits is it does provide a calming effect.

So because something doesn't hurt in your time horizon, the risk shouldn't be considered? What ill effects are you looking for? If generating unneeded free radicals affects the final outcome, why would the patient need to immediately get worse with the administration of supplemental oxygen?
I am not allowed to withold oxygen. If they want it they get it. The problem with oxygen is many underlying conditions can affect its delivery. That is starting to get into diagnostic territory which is not my job.

I agree... EMS shouldn't withhold oxygen. That's a good way to kill patients.

Now withholding supplemental oxygen is a different issue altogether. Are you suggesting that EMTs are not trained or educated to determine when one of their primary interventions aren't needed? If I can't trust an EMT to provide good judgement on whether supplemental oxygen is needed, why should I trust them with any other judgement call?

Finally, if diagnostics isn't your job, why do a history and physical? I'm serious, if you aren't supposed to come to some sort of conclusion based off of your history and physical, and use that to guide your treatments, why even perform a history and physical?

However, I err on the side of caution and they get O2 if they need it or if I am not sure.
How is over treatment erring on the side of caution?
 

Sandog

Forum Asst. Chief
914
1
0
So how often are Reactive oxygen an issue, what condition? Does not the body have anti-oxidants to counter this. Just curious. I do know radical oxygen is making my skin age. :sad:

To put it another way, when would oxygen be contraindicated for worry of radicals?
 
Last edited by a moderator:

JPINFV

Gadfly
12,681
197
63
So how often are Reactive oxygen an issue, what condition? Does not the body have anti-oxidants to counter this. Just curious. I do know radical oxygen is making my skin age. :sad:

The body is set up to handle 21% oxygen, not 100% oxygen. Are there ways to handle reactive oxygen species? Sure. The problem is that sometimes those defenses are compromised, and even when they're not they're not designed to protect against 100% oxygen continuously.

To put it another way, when would oxygen be contraindicated for worry of radicals?

I think "contraindicated" is too strong of a word. There's very few times that oxygen is truly "contraindicated" in a patient who actually needs oxygen. The problem is that EMS more often administers oxygen to patients where oxygen isn't indicated outside of the indication of "ambulance."
 

leoemt

Forum Captain
330
1
0
So because something doesn't hurt in your time horizon, the risk shouldn't be considered? What ill effects are you looking for? If generating unneeded free radicals affects the final outcome, why would the patient need to immediately get worse with the administration of supplemental oxygen?


I agree... EMS shouldn't withhold oxygen. That's a good way to kill patients.

Now withholding supplemental oxygen is a different issue altogether. Are you suggesting that EMTs are not trained or educated to determine when one of their primary interventions aren't needed? If I can't trust an EMT to provide good judgement on whether supplemental oxygen is needed, why should I trust them with any other judgement call?

Finally, if diagnostics isn't your job, why do a history and physical? I'm serious, if you aren't supposed to come to some sort of conclusion based off of your history and physical, and use that to guide your treatments, why even perform a history and physical?


How is over treatment erring on the side of caution?

On the 911 side, I am with a patient for about 15 mins. Obviously some calls take longer than others, but we have a luxury of having hospitals close by.

As a Basic I cannot give NTG. I CAN assist a patient with it after obtaining Medical Control Authorization. In this state we are allowed to do glucometry (though some counties consider it an ALS skill). What is your point? How is that a Diagnosis? Hypoglycemia or Hyperglycemia is a symptom that I can address. However I don't diagnose the condition. Does Hypoglycemia automatically mean they are Diabetic? No it doesn't.

It takes initials after your name to make a clinical Diagnosis. I MAY know what is going wrong, I MAY know what their treatment will be but that doesn't mean it is definitive. Is every cancer patient going to receive Chemo? Does every Diabetic patient receive Insulin.

There is a big difference in making a diagnosis and having a reasonable suspicion as to what is wrong. If you are ever called to court for your treatment you better be able to articulate the two.

There is a lot I can do for a patient and even more a Paramedic can do. However we are not the definitive care.

Concerning over oxygenation not every person gets15lpm via NRB. Just because I give O2 doesn't mean they are getting the same level of O2. Room air is 21% oxygen. Depending on delivery methods, supplemental oxygen can be anywhere from 24% - 100%. Just because there is 100% O2 in the tank doesn't mean the patient is being saturated with 100%.

There are a lot of benefits to oxygen. I am not advocating giving oxygen to every patient, but in the pre-hospital setting the benefits far outweigh the risks. I have never seen a medic or a basic withhold supplemental o2.

Until my doctors change the protocols, I will continue to give O2 as necessary.

This is the article I have been reading, even before this thread was started. It is an interesting read. Even though it states the risks of over oxygenation, it typically takes around 72 hours for those risks to become apparent. That is LONG after we have turned them over to the ER. http://www.jems.com/behind-the-mask

As my clinical abilities improve I am less likely to jump to O2, and if I do I don't always do the 15lpm NRB. I think many people confuse the prehospital setting with long term oxygen use.

Again, education is key but don't be afraid of giving the O2. If in doubt there is always Medical control.
 
OP
OP
N

NYMedic828

Forum Deputy Chief
2,094
3
36
On the 911 side, I am with a patient for about 15 mins. Obviously some calls take longer than others, but we have a luxury of having hospitals close by.

As a Basic I cannot give NTG. I CAN assist a patient with it after obtaining Medical Control Authorization. In this state we are allowed to do glucometry (though some counties consider it an ALS skill). What is your point? How is that a Diagnosis? Hypoglycemia or Hyperglycemia is a symptom that I can address. However I don't diagnose the condition. Does Hypoglycemia automatically mean they are Diabetic? No it doesn't.

It takes initials after your name to make a clinical Diagnosis. I MAY know what is going wrong, I MAY know what their treatment will be but that doesn't mean it is definitive. Is every cancer patient going to receive Chemo? Does every Diabetic patient receive Insulin.

There is a big difference in making a diagnosis and having a reasonable suspicion as to what is wrong. If you are ever called to court for your treatment you better be able to articulate the two.

There is a lot I can do for a patient and even more a Paramedic can do. However we are not the definitive care.

Concerning over oxygenation not every person gets15lpm via NRB. Just because I give O2 doesn't mean they are getting the same level of O2. Room air is 21% oxygen. Depending on delivery methods, supplemental oxygen can be anywhere from 24% - 100%. Just because there is 100% O2 in the tank doesn't mean the patient is being saturated with 100%.

There are a lot of benefits to oxygen. I am not advocating giving oxygen to every patient, but in the pre-hospital setting the benefits far outweigh the risks. I have never seen a medic or a basic withhold supplemental o2.

Until my doctors change the protocols, I will continue to give O2 as necessary.

This is the article I have been reading, even before this thread was started. It is an interesting read. Even though it states the risks of over oxygenation, it typically takes around 72 hours for those risks to become apparent. That is LONG after we have turned them over to the ER. http://www.jems.com/behind-the-mask

As my clinical abilities improve I am less likely to jump to O2, and if I do I don't always do the 15lpm NRB. I think many people confuse the prehospital setting with long term oxygen use.

Again, education is key but don't be afraid of giving the O2. If in doubt there is always Medical control.

Without being at a computer it is difficult to properly address your entire post but right off the bat I can tell you 99% of the above could not be further from the truth.

Also, hypoglycemia IS a diagnosis secondary to a disease, diabetes. Altered mentation, diaphoresis, skin temperature/color changes are sings/symptoms.
 

Tigger

Dodges Pucks
Community Leader
7,843
2,794
113
Regarding Oxygenation, they teach us to always oxygenate and in class it is always a 15lpm NRB.

Being new, I am probably guilty of over oxygenating my patients at times. My clinical skills aren't as developed as other providers and I am still learning. I do make a point to research conditions as much as possible so that I can better understand for future calls.

Maybe I was just lucky with my class, but that was never really emphasized. If it is clinically indicated to give oxygen, provide in the proper manner. The key of course is to know when it is in fact clinically indicated...
However, I disagree with minimizing oxygen delivery. In a pre-hospital setting it is unlikely that over oxygenation is going to cause any ill effects. Yes, Oxygen is a drug and should be treated as such. However, one of its benefits is it does provide a calming effect.
Do you have any evidence beyond personal anecdote to back up oxygen's calming properties? I have not found much. It is not a mystery drug, it helps with respiratory distress and that's about it. Many patients of mine report that oxygen agitates them instead. I too might be a bit agitated too with plastic prongs jammed in my nose or mask pressed to my face blasting a very dry gas. An NRB makes talking and listening to your patient much more difficult as well.

I am not allowed to withold oxygen. If they want it they get it. The problem with oxygen is many underlying conditions can affect its delivery. That is starting to get into diagnostic territory which is not my job.

Oxygen was one of the most confusing parts of my EMT class because there are no clear cut answers. When do you use an NC or an NRB? What about medium concentration vs high? CPAP? BiPap?

You can certainly withhold oxygen to a patient if there is no clinical indication for its use. Now if my patient says that they would like some (COPD etc) then sure they can have some even if my assessment doesn't indicate it. But if the patient says they don't want it and it's not indicated, then you aren't withholding it.

If you aren't comfortable with "diagnosing" a patient that's fine, but realize that you need to base your treatments off of your clinical impression. Based upon such an impression you should have a lot better idea on how to administer oxygen.


I've said it once I'll say it a million times. We don't give everyone oral glucose, so why does everyone get oxygen?
 

Sandog

Forum Asst. Chief
914
1
0
On the 911 side, I am with a patient for about 15 mins. Obviously some calls take longer than others, but we have a luxury of having hospitals close by.

As a Basic I cannot give NTG. I CAN assist a patient with it after obtaining Medical Control Authorization. In this state we are allowed to do glucometry (though some counties consider it an ALS skill). What is your point? How is that a Diagnosis? Hypoglycemia or Hyperglycemia is a symptom that I can address. However I don't diagnose the condition. Does Hypoglycemia automatically mean they are Diabetic? No it doesn't.

Seriously? By definition: Diagnosis; a determining or analysis of the cause or nature of a problem or situation.

Using SAMPLE, one should be able to make a well educated diagnosis.


It takes initials after your name to make a clinical Diagnosis. I MAY know what is going wrong, I MAY know what their treatment will be but that doesn't mean it is definitive. Is every cancer patient going to receive Chemo? Does every Diabetic patient receive Insulin.

Your just being silly.


There is a big difference in making a diagnosis and having a reasonable suspicion as to what is wrong. If you are ever called to court for your treatment you better be able to articulate the two.

What do you think doctors do?


There is a lot I can do for a patient and even more a Paramedic can do. However we are not the definitive care.

It is your job to work within your scope and provide the best medical care possible based on your protocols.

Concerning over oxygenation not every person gets15lpm via NRB. Just because I give O2 doesn't mean they are getting the same level of O2. Room air is 21% oxygen. Depending on delivery methods, supplemental oxygen can be anywhere from 24% - 100%. Just because there is 100% O2 in the tank doesn't mean the patient is being saturated with 100%.

There are a lot of benefits to oxygen. I am not advocating giving oxygen to every patient, but in the pre-hospital setting the benefits far outweigh the risks. I have never seen a medic or a basic withhold supplemental o2.

Until my doctors change the protocols, I will continue to give O2 as necessary.

Fair enough.

This is the article I have been reading, even before this thread was started. It is an interesting read. Even though it states the risks of over oxygenation, it typically takes around 72 hours for those risks to become apparent. That is LONG after we have turned them over to the ER. http://www.jems.com/behind-the-mask

As my clinical abilities improve I am less likely to jump to O2, and if I do I don't always do the 15lpm NRB. I think many people confuse the prehospital setting with long term oxygen use.

Again, education is key but don't be afraid of giving the O2. If in doubt there is always Medical control.


Looks like I can't just respond in the quotes, so here is blah blah.
 
Last edited by a moderator:

JPINFV

Gadfly
12,681
197
63
On the 911 side, I am with a patient for about 15 mins. Obviously some calls take longer than others, but we have a luxury of having hospitals close by.

As a Basic I cannot give NTG. I CAN assist a patient with it after obtaining Medical Control Authorization. In this state we are allowed to do glucometry (though some counties consider it an ALS skill). What is your point? How is that a Diagnosis? Hypoglycemia or Hyperglycemia is a symptom that I can address. However I don't diagnose the condition. Does Hypoglycemia automatically mean they are Diabetic? No it doesn't.

Actually, hypoglycemia is very much a diagnosis.
2012 ICD-9-CM Diagnosis Code 251.2

Hypoglycemia, unspecified


  • syndrome of abnormally low blood glucose level; clinical hypoglycemia has diverse etiologies; severe hypoglycemia eventually lead to glucose deprivation of the central nervous system resulting in hunger, sweating, paresthesia, impaired mental function, seizures, coma, and even death.
  • Abnormally low blood sugar.
  • Abnormally low level of glucose in the blood.
  • Short description: Hypoglycemia NOS.
  • ICD-9-CM 251.2 is a billable medical code that can be used to specify a diagnosis on a reimbursement claim.

http://www.icd9data.com/2012/Volume1/240-279/249-259/251/251.2.htm

It's just like any other issue with blood concentrations, like hypo/hyper-calcemia, kalemia, natremia. Just because it's often caused by diabetes and can be caused by other diseases doesn't mean that it, itself, is not a diagnosis.
It takes initials after your name to make a clinical Diagnosis. I MAY know what is going wrong, I MAY know what their treatment will be but that doesn't mean it is definitive. Is every cancer patient going to receive Chemo? Does every Diabetic patient receive Insulin.

As someone over halfway to getting those magical initials, there's nothing special about making a diagnosis. I swear, we don't get a decoder ring, or some sort of special hand shake, or even a cape (thankfully)
There is a big difference in making a diagnosis and having a reasonable suspicion as to what is wrong. If you are ever called to court for your treatment you better be able to articulate the two.

You mean like the difference between a working diagnosis, a differential diagnosis, and a discharge diagnosis? Yep, there's a difference between them. Wanna guess what the common theme is between them?

There is a lot I can do for a patient and even more a Paramedic can do. However we are not the definitive care.

Cool beans. No one is saying you are definitive care. Wanna know a little secret? When the emergency physician admits a patient to the internal medicine team or surgery or some other specialty, they aren't definitive care either. Do you think that emergency physicians don't diagnose? Do you think that the admission diagnosis always matches the discharge diagnosis, especially in anything that isn't completely textbook?
Concerning over oxygenation not every person gets15lpm via NRB. Just because I give O2 doesn't mean they are getting the same level of O2. Room air is 21% oxygen. Depending on delivery methods, supplemental oxygen can be anywhere from 24% - 100%. Just because there is 100% O2 in the tank doesn't mean the patient is being saturated with 100%.

There are a lot of benefits to oxygen. I am not advocating giving oxygen to every patient, but in the pre-hospital setting the benefits far outweigh the risks. I have never seen a medic or a basic withhold supplemental o2.

What benefits are there for oxygen in patients who are eupneic with a normal SpO2? "Look, we did something"?
Until my doctors change the protocols, I will continue to give O2 as necessary.

I guess I'm just lucky that the strictest protocols for oxygen use I've ever worked under as an EMT used the words, "as clinically indicated." Not indicated, not given.
This is the article I have been reading, even before this thread was started. It is an interesting read. Even though it states the risks of over oxygenation, it typically takes around 72 hours for those risks to become apparent. That is LONG after we have turned them over to the ER. http://www.jems.com/behind-the-mask

Um, that 72 hours related directly to mortality in animals administered 100% oxygen, not the other complications like damage from reactive oxygen species. Additionally, just because there's a latent period between removing the insult and the onset of complications doesn't mean that the insult doesn't cause the complications.

As my clinical abilities improve I am less likely to jump to O2, and if I do I don't always do the 15lpm NRB. I think many people confuse the prehospital setting with long term oxygen use.

I think many people in EMS, including unfortunately many educators, think that oxygen is some sort of wonder drug. It isn't Paracetamoxyfrusebendroneomycin.
 

Sandog

Forum Asst. Chief
914
1
0
I think many people in EMS, including unfortunately many educators, think that oxygen is some sort of wonder drug. It isn't Paracetamoxyfrusebendroneomycin.

Don't use words you can't pronounce. :p
 

Sandog

Forum Asst. Chief
914
1
0
The body is set up to handle 21% oxygen, not 100% oxygen. Are there ways to handle reactive oxygen species? Sure. The problem is that sometimes those defenses are compromised, and even when they're not they're not designed to protect against 100% oxygen continuously.



I think "contraindicated" is too strong of a word. There's very few times that oxygen is truly "contraindicated" in a patient who actually needs oxygen. The problem is that EMS more often administers oxygen to patients where oxygen isn't indicated outside of the indication of "ambulance."

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.
 

Veneficus

Forum Chief
7,301
16
0
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.
 
Last edited by a moderator:

Veneficus

Forum Chief
7,301
16
0
correction of error

Circulating neutrophils increase 100%.

I meant to say they double and for some reason typed 50%.

Sorry.

My fault.
 
Top