Pulse ox

pulse OX is not an Emt skill in the Emt scope in LACo
 
Without a medic supervising? That stupid sheet they gave me in the LACo class had me thinking that it wasn't this whole time? -___- I need to look this up.
 
Its a bls skill man. Now you got me wondering if the emt class you took teavhed you the right stuff.
 
Thats because LAcO medics can barely do pulse ox without base orders...
 
Corky said:
Thats because LAcO medics can barely do pulse ox without base orders...
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All i know os that i called county and asked if bls can use pulse ox and they said yes as long as their trained.
 
Blah, just had this "debate" at work. Makes me frustrated sometimes. They told me that it is not allowed, so I told them that in our protocols for Santa Clara County, under routine medical care - adult (S04), it defines "Baseline vital signs: pulse rate, blood pressure, respiratory rate, pulse oximetry", and then under BLS care, it uses the term "baseline vital signs". It does not exclude it from our Pulse Oximetry protocol (M04), but it does put emphasis that certain patients require "high flow" oxygen, and it also says this under each BLS protocols whether a patient should be administered oxygen or not meaning that pulse oximetry cannot be used to determine how much oxygen to adminsiter, but rather just a number we can document and report - if the protocols were followed word for word verbatim. I then also pointed out that under title 22 division 9 article 1 chapter 2 section 100063, it doesn't exclude pulse oximetry as a diagnostic sign that we could record. The class laughed at me "he said the section number, it must be true" (or something like that), and then I was told that "it is NOT in your scope of practice". The debate continued "we do it, it happens, but do not record that you did it, write down per RN".

I hate it that people tell you to learn your protocols and policies, yet whatever they say triumphs what it truly says, and even though they tell you to not put down inaccurate information or act outside of your scope of practice, it's okay with pulse oximetry to break the rules a little bit and then lie about it. They tell you MECHANISMS, MECHANISMS, MECHANISMS, understand physiology, yet they ignore it "that's not how it works in real life", and don't know or misunderstand the mechanism or physiology.

At this point with pulse oximetry, I've decided that I will refuse to do it, I will record what it is if reported to me by a nurse or if it's already hooked up to the patient making it clear that it is a number that I see, but do not understand, and I am simply recording it from observation, and if anyone ask, I will tell them that our laws, protocols, and policies do not clearly state whether it is or isn't allowed for EMTs to attach to their finger and to include it when making decisions based on sound clinical judgement.

At least on the 17th of April, I will be taking a short two hour class on Environmental Emergencies that will be taught by our county medical director. If I get the chance, I hope I can ask him about it along with some other things.

This debate made me a little mad. It reminded me at EMT school and at my previous EMT job when I'd say something, people laughed at me, didn't follow my instructions, told me I was wrong, but then tell me things like "how are you so smart?" or "you're smart." I just think "how dare you insult me by calling me smart when there are objective clues that you don't truly believe that - @#$% off". I wish I could say that to them nicely.
 
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I frequently used a cheap finger pulse ox when I did BLS.

-it was very accurate versus pulse ox devices carried by
RNs and medics.

-i made decisions based on all vitals, not just the pulse ox.
 
Aprz, we share medical directors. I read both SO4 and M04 and according to M04 not only are you allowed to use pulse oximetry it is required on certain subsets of patients. Dr. Rudnick is a very user friendly Medical Director. If a protocol says something is required that means it is to be done. All bls providers up here in NorcalEms are able to use oximetry as a vital sign. As long as treatment is not based on it alone, and in combination with other assessment VS findings. I highly doubt you folks in Santa Clara land are any different, unless the group has fouled up enough for him to pull it specifically from you protocols
 
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So apparently in LA county, EMTs are just cot lifters and ambulance drivers?

Seems amazing to me that they are trusted so little that they arent permitted to use a pulse oximeter. I guess thats life in the big city.

Where I live ALS is a good 45 minutes away when you call 911, so EMT basics and even first responders by necessity are given a little more leeway.
 
hogwiley said:
So apparently in LA county, EMTs are just cot lifters and ambulance drivers?

Seems amazing to me that they are trusted so little that they arent permitted to use a pulse oximeter. I guess thats life in the big city.

Where I live ALS is a good 45 minutes away when you call 911, so EMT basics and even first responders by necessity are given a little more leeway.
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We can use pulse ox its in our scope but county fire doesnt trust us unless you been running with them for a long time and they personally know you. But for the most part we are county fire slaves.
 
Gordoemt said:
We can use pulse ox its in our scope but county fire doesnt trust us unless you been running with them for a long time and they personally know you. But for the most part we are county fire slaves.
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Just like we don't usually trust the vitals Fire gives us here unless we are friends with them.

They aren't our slaves though.
 
NVRob said:
Just like we don't usually trust the vitals Fire gives us here unless we are friends with them.
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Just the other day fire gave me a pulse of 82... Yeah. It was 196. That's why you palpate a pulse and don't just use the number the pulse ox gives you :glare:
 
NVRob said:
Just like we don't usually trust the vitals Fire gives us here unless we are friends with them.

They aren't our slaves though.
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I beg to differ. I do belive that emts are fires slaves. They tell us what to do lol. We get minimal respect even amr for example some fire medics wont trust a medic working for amr to run the show or do the als stuff. La county has all als and bls around the neck with a belt.
 
Rather funny since they are the world wide joke of the EMS world.................
 
Gordoemt said:
I beg to differ. I do belive that emts are fires slaves. They tell us what to do lol. We get minimal respect even amr for example some fire medics wont trust a medic working for amr to run the show or do the als stuff. La county has all als and bls around the neck with a belt.
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Fire doesn't tell me anything about how to do my job unless their operations or my actions directly threaten me, my partner or our patient's safety.

We are the medical authority, so they do what we say, when we say it and how we say to do it. I have no problem telling a firefighter who also happens to have his paramedic card to stop what he's doing if myself or my partner don't agree with his/her actions and I'm an EMT still. Once we are on scene that patient is ours and the responsibility falls back on us, not the fire department. They are ILS we are ALS. They aren't our slaves, we work together as a team to accomplish a common goal. Do we but heads every now and again? Absolutely but who doesn't occasionally in any job?

I'm sorry that you see yourself as fire's slave. I don't care if you're a firefighter that doesn't give you the right to be rude and disrespectful to co-responders.
 
It's "nice" to see that Santa Clara has finally gotten to the point where they'll allow EMT personnel to use the pulse-ox. When I last worked there, it wasn't in the Protocols. I also figure that it's mostly going to remain essentially a "document only" and not base treatment decisions (in other words, do what you'd do without it) on the pulse-ox exclusively.
 
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