Pulse ox

Like I said, I plan to personally ask him on the 17th if he has the time to answer non environmental emergencies questions. I'm glad to see that you at least know his name; even Paramedics at my previous company didn't know his name. If my company told me not to do it because it is unclear whether we are allowed to do it or not, I understand, but they told me not to do it because it is not within our scope of practice and against the law. Since it is not in our minimum inventory (Policy 302).

Alulahawk, the protocols in Santa Clara County still specifies which patients should have oxygen or not, and that oxygen is not to be withheld based on pulse oximetry.

NOTE: Oxygen administration is not to be excluded based on a saturation value obtained
by pulse oximetry. Patients with conditions including, but not limited to: ischemic chest pain,
trauma, respiratory conditions (such as Asthma), congestive heart failure, etc. should
receive high flow oxygen regardless of saturation reading. Like other physiologic
parameters, pulse oximetry is used only as a guide in providing overall care to the patient.
Click to expand...
The non bold part after the bold part seems to contradict that bold part.

I will also see if I can sneak in a "why are we giving oxygen to suspected ischemic chest pain patients", but that may be too much to ask.

It doesn't clearly state under BLS for S04 and M04 (in fact, it doesn't say anything about BLS or EMTs in M04) that we can do it. It's only implied in S04 when it defined baseline vitals and uses the term base line vitals under BLS. You are right, it does say certain patients require pulse oximetry, but that is contradicted by our minimum inventory policy saying on a BLS transport unit, pulse oximetry is not required.

Anyhow, I straight up got laughed at in class and told (paraphrasing in quotes) "Do NOT write what they are satting at if you put it on their finger, it happens, but we are not suppose to do it, if the RN does it, write per RN." I could argue that the person teaching the class is from LA/OC area and is very unaware of our protocols and policies up here (as much as the rest of my class was). I was a sad panda yesterday.
 
Last edited by a moderator:
The minimum inventory is exactly that, MINIMUM inventory. Normally as an EMT, I won't even bother with getting a pulse-ox reading because regardless of the reading, those patients that are going to be most in need of oxygen are going to be getting as high concentration of O2 as we can provide because the protocols direct the EMT to do it.

In reviewing S04, they defined baseline vitals and direct that BLS providers can obtain them, therefore if you've been appropriately trained, you can do that. Given that the minimum inventory doesn't require BLS providers to have pulse-ox, it's going to be considered an optional item, and ambulance companies don't want to have spend money on stuff that's optional (unless it gives them an advantage), they won't get the pulse-ox units for their BLS ambulances.
 
Akulahawk said:
The minimum inventory is exactly that, MINIMUM inventory. Normally as an EMT, I won't even bother with getting a pulse-ox reading because regardless of the reading, those patients that are going to be most in need of oxygen are going to be getting as high concentration of O2 as we can provide because the protocols direct the EMT to do it.

In reviewing S04, they defined baseline vitals and direct that BLS providers can obtain them, therefore if you've been appropriately trained, you can do that. Given that the minimum inventory doesn't require BLS providers to have pulse-ox, it's going to be considered an optional item, and ambulance companies don't want to have spend money on stuff that's optional (unless it gives them an advantage), they won't get the pulse-ox units for their BLS ambulances.
Click to expand...
I understand that it is the minimum inventory, but saying that it contradicts saying that certain patients require pulse oximetry, but pulse oximetry isn't in the minimum inventory for BLS. How could it be required if you don't have it?

I am also not talking about the usefulness or clinical relevance of pulse oximetry, but trying to determine whether it is legitimately allowed or not.

Exactly, I mentioned they defined baseline vitals and use the term under BLS which is why it's implied (it doesn't say specifically pulse oximetry under BLS), but I am still being told [by the person in charge of training for my company] that only the first three apply, not pulse oximetry "because it's not in your scope of practice". I believe they are wrong, but I don't want to get in trouble [by my company] either.
 
Last edited by a moderator:
Aprz said:
Like I said, I plan to personally ask him on the 17th if he has the time to answer non environmental emergencies questions. I'm glad to see that you at least know his name; even Paramedics at my previous company didn't know his name. If my company told me not to do it because it is unclear whether we are allowed to do it or not, I understand, but they told me not to do it because it is not within our scope of practice and against the law. Since it is not in our minimum inventory (Policy 302).

Alulahawk, the protocols in Santa Clara County still specifies which patients should have oxygen or not, and that oxygen is not to be withheld based on pulse oximetry.


The non bold part after the bold part seems to contradict that bold part.

I will also see if I can sneak in a "why are we giving oxygen to suspected ischemic chest pain patients", but that may be too much to ask.

It doesn't clearly state under BLS for S04 and M04 (in fact, it doesn't say anything about BLS or EMTs in M04) that we can do it. It's only implied in S04 when it defined baseline vitals and uses the term base line vitals under BLS. You are right, it does say certain patients require pulse oximetry, but that is contradicted by our minimum inventory policy saying on a BLS transport unit, pulse oximetry is not required.

Anyhow, I straight up got laughed at in class and told (paraphrasing in quotes) "Do NOT write what they are satting at if you put it on their finger, it happens, but we are not suppose to do it, if the RN does it, write per RN." I could argue that the person teaching the class is from LA/OC area and is very unaware of our protocols and policies up here (as much as the rest of my class was). I was a sad panda yesterday.
Click to expand...

It's saying that a pulse ox is a guide, not an end all, to your o2 administration decision.

Like its saying if your pt is SOB and your pulse ox is still reading 94, throw them on oxygen.

It really isn't contradicting just further clarifying.
 
Sasha said:
It's saying that a pulse ox is a guide, not an end all, to your o2 administration decision.

Like its saying if your pt is SOB and your pulse ox is still reading 94, throw them on oxygen.

It really isn't contradicting just further clarifying.
Click to expand...

I use it to trend a patient, patient complains of SOB, I check a SaO2 and I'll put em on O2 regardless of the reading, then I'll record their SaO2 a few minutes later and how they're feeling.
 
Hunter said:
I use it to trend a patient, patient complains of SOB, I check a SaO2 and I'll put em on O2 regardless of the reading, then I'll record their SaO2 a few minutes later and how they're feeling.
Click to expand...

Y'all are allowed to check SaO2?! That's awesome!!

...
 
five is four and a half

If your employer or medical control or protocols say you can't use pulse ox and you go out and buy one...nuff said.

The 80- versus 196 comment earlier by Poetic Injustice is a breath of real-world air here. When the pt arrives at the ED and their vitals make yours look like boilerplate from Hallmark Cards, who will look worse, you or the machine? Those pulse ox's have a very good poker face.

I have seen a difference in the performance of machines kept in a nice warm immobile building (barring abuse by staff) with its own biomedical staff, versus those driving around in an ambulance, exposed to temperature differences (hence condensation), mechanical shocks, operating with low batteries, and no one certified to do repairs. This ignores the whole issue of cheap versus quality instruments.

If a hospital treated their biomedical instruments the way most ambulance companies/FD's undoubtedly tend to theirs, the hospitals would be in court a lot.

If you want to play table tennis about a medical diagnostic procedure you ought to be universally allowed to use, it is fingerstick glucometry (not to sidetrack the thread further into the "I can SO do that" sandbox).
 
La county told me i can use it and my employer said i could use a pulse ox..... nuff said.....
 
In oc its in your scope. I know it not to be in la's scope. I work in oc, la city and county. Me etsonally I use it for a baseline on every call but I never bill or record it. I take manual uses. Please if you do use your pulse ox ALWAYS take a manual! Cover your butt because if the hammer comes down and you say say "that's what the pulse ox said" you will get fired for being in doubt and not taking a manual. When you buy one make sure its for clinical use and not for just someone who likes to jog a lot. I got mine for 40a bucks and I love it but I want to d for the 100 one.

Plus on still alarms you will just love these. This was the first thing I dropped on a pt I found in the street before holding c spine :p in oc of course.
 
Aprz, enjoy his enviro talk. I listened to it a year ago and he a is great speaker. And yes I know his name well :o). We meet often as I am on the Medical Advisory Commitee for NorCalEms
 
Gordoemt said:
La county told me i can use it and my employer said i could use a pulse ox..... nuff said.....
Click to expand...

Then why come on here and ask?
 
Because i can.... And im curious as to what other bls crews in the nation can do as far as pulse ox.
 
Gordoemt said:
Because i can.... And im curious as to what other bls crews in the nation can do as far as pulse ox.
Click to expand...

That wasn't your question.
 
Aprz said:
I understand that it is the minimum inventory, but saying that it contradicts saying that certain patients require pulse oximetry, but pulse oximetry isn't in the minimum inventory for BLS. How could it be required if you don't have it?

I am also not talking about the usefulness or clinical relevance of pulse oximetry, but trying to determine whether it is legitimately allowed or not.

Exactly, I mentioned they defined baseline vitals and use the term under BLS which is why it's implied (it doesn't say specifically pulse oximetry under BLS), but I am still being told [by the person in charge of training for my company] that only the first three apply, not pulse oximetry "because it's not in your scope of practice". I believe they are wrong, but I don't want to get in trouble [by my company] either.
Click to expand...
It's part of baseline vitals because Paramedics can do BLS, have the tool available, and have it in their scope of practice,and are trained in how to use/interpret the readings. It's also in the EMT scope there as a "if you've been trained and your employer has it for you to use" but they're not required to have the tool. They're required to have a BP cuff and stethoscope as part of the minimum inventory.

A few years ago, the County had a combined BLS/ALS protocol book. Certain procedures were allowed to be performed by appropriately accredited providers only. Everything else was in the BLS scope. Theoretically, an EMT that was locally accredited to perform ETI could do it. Theoretically, an EMT that was locally accredited to administer NTG or ASA could do it. Paramedics were accredited for all the "advanced" procedures as part of their accreditation process.

In other words, as far as pulse-ox goes, yes, you can do it if you have been appropriately trained/educated, your company authorizes (and monitors your use of the procedure and ensures you're appropriately up-to-date), and you have a pulse-ox available for you to use. Being that it's not part of the minimum required equipment means to me that your employer has a choice about whether they can allow their crews to use the tool. For BLS, since you're not allowed to titrate O2 delivery to pulse-ox readings, it's basically a moot point. You do what protocol says, regardless of what the tool says.
 
Akulahawk said:
It's part of baseline vitals because Paramedics can do BLS, have the tool available, and have it in their scope of practice,and are trained in how to use/interpret the readings. It's also in the EMT scope there as a "if you've been trained and your employer has it for you to use" but they're not required to have the tool. They're required to have a BP cuff and stethoscope as part of the minimum inventory.

A few years ago, the County had a combined BLS/ALS protocol book. Certain procedures were allowed to be performed by appropriately accredited providers only. Everything else was in the BLS scope. Theoretically, an EMT that was locally accredited to perform ETI could do it. Theoretically, an EMT that was locally accredited to administer NTG or ASA could do it. Paramedics were accredited for all the "advanced" procedures as part of their accreditation process.

In other words, as far as pulse-ox goes, yes, you can do it if you have been appropriately trained/educated, your company authorizes (and monitors your use of the procedure and ensures you're appropriately up-to-date), and you have a pulse-ox available for you to use. Being that it's not part of the minimum required equipment means to me that your employer has a choice about whether they can allow their crews to use the tool. For BLS, since you're not allowed to titrate O2 delivery to pulse-ox readings, it's basically a moot point. You do what protocol says, regardless of what the tool says.
Click to expand...

Thank you.
 
Gordoemt said:
Thank you.
Click to expand...
Just for clarification, my post was specific for Santa Clara County. If your EMS Agency authorizes EMT use of the pulse-ox, then the above post could apply to you as well. Santa Clara EMS hasn't mandated the pulse-ox for use by BLS, but very much appears to allow it's use. Just look at BLS AED programs. There's some on-going training that must be done to ensure that BLS personnel continue to be competent in the procedure. I would imagine that a BLS company that wants to allow the pulse-ox to be used would have to institute a periodic skills check and have someone able to function as a skill coordinator to ensure consistency and competency.
 
OP Gordo, if they both say you can, then you can. As you said, 'nuff said, good job running it down.

Just don't be the one who has to take the hit if your employer alleges your machine isn't properly working and fires you or throws you under a bus.
 
mycrofft said:
OP Gordo, if they both say you can, then you can. As you said, 'nuff said, good job running it down.

Just don't be the one who has to take the hit if your employer alleges your machine isn't properly working and fires you or throws you under a bus.
Click to expand...

I have it im writing from my employer that i can use it and that they dont provide me eith one and that they dont have a problem with me using my own. Besides im not gonna go hard like a fng and code it to the er without als for a o2 sat thats 91 with out sob. Its the generialized picture.
 
Sounds reasonable.
 
You must log in or register to reply here.
Back
Top