Oxygen Myth?

[JPINFV]

I wanted to respond to the rest of this, but needed to go get lunch first after clarifying the "cult" quote.

Can a stroke patient not have respiratory issues? ACS- I addressed that. It depends how the body responds, arrhythmias, existing conditions, other system involvement and the oxygen delivery ability within the body. Who is to say sepsis does not have a role in some of these events?

Maybe I'm giving EMS too much credit than is due, but I firmly hope and believe that most providers at any EMT level (B through P) understands that more than one condition can be present at any one time and that conditions can present in multiple ways that may change the appropriate treatment. Essentially we're down to the education and job requirements question.

If EMS is to be simplified down to a "give every patient a NRB at 15 LPM, c-spine any trauma to the body, head, or neck and for any mechanism that could cause injury to those regions, splint any limb that hurts due to trauma, and transport ASAP to nearest ED with lights and sirens" then we can train EMTs in about 5-10 hours since the only thing needed is motor skills and we can cover all of the "what ifs?" under the current scope of practice for basics.

The alternative is that EMS providers need to be educated to the point where they can make proper assessments, can design an appropriate treatment plan, can justify that treatment plan, and are empowered to implement their treatment plan. Until that time we're currently either drastically over educating or drastically under educating current prehospital providers. Otherwise EMS treatment (especially basic level treatment) is going to be contingent on cute sayings (treatment ABC (lights and sirens, NRB for all patients, c-spine for all patients, and a few others) doesn't hurt anyone, so why would you consider withholding it?) and what I've come to call "first mover education" (i.e. the first person, regardless of level, to talk to a new provider about a disease process or treatment plan that wasn't covered in class. Generally when a provider justifies a plan by saying "Well EMT/Paramedic/Nurse/Doctor John Doe once told me to do this and he's really smart and knows his stuff!").

The adult studies without O2 are also being researched from other countries that don't have O2 available but again special considerations to the limitations of the studies must be made for living condtions, overall health of the population and environment.

Sometimes those are the only places where studies can be done. How hard would it be to get IRB approval for a study that basically says, "We want to study something that has always been done, is expected to be done, and by most accounts is a logical treatment."

How many examples and examples within examples do you want me to give you? Every disease processs in the body can bring about another response or complication. One could argue O2 is not required for trauma but then if pulmonary hypertension or an embolus is present, do you still make the same blanket statement? It would be wonderful if the only complications and diseases processes that a patient can have are just those covered in the EMT(P) book but it doesn't work that way. The human body is just too complex. All I did was point out many situations where high concentrations are still needed and all of them can occur in the situations Bledsoe mentioned.

I understand the concept of comorbidity and hope most other EMS providers understand the concept as well. Maybe I'm a little too hopeful, but it's a known character flaw of mine.

Edited March 12, 2009 by JPINFV