My job

[mrsbull]

Well I could not think of a better title lol. This post is about my job. For those who dont know I work as an EMT on the top of a pretty busy mountain.

I was recently asked to read/sign a few "standards" that some emts at my job have not either been aware of or things that they do not do.

This is one of the "standards" as written (capitals and all)

**Patients only need oxygen if they are BELOW 70% or if they are cyanotic (blue in the lips or nail beds). If patient is around 60% try to coach them up with out oxygen first. Have them sit down, drink water, and focus on deep breathing (in through nose and out through mouth with a small pause in between inhalation and expiration).

** NRBs should ONLY be used for EXTREME cases such as: Potential Heart Attack Patients, patients with severe head trauma, patients severe altitude sickenss and a nasal canula is not enough.

What do you think of this??

I treat according to S/S. Not just the monitor. I also work at 14,110 feet. O2 is limited up there (supply) they want us to "conserve" O2. I understand that. It is difficult getting decent supplies up there. Let alone a pulse ox I can trust (another reason I treat the pt not monitor) I have no way of cardiac monitoring, we ran out of lancets yesterday. No IV supplies at ALL. No ALS for around an hour (less if flight is needed). However UP TOP we have to call in the Army for a Shinook due to altitude. We have to head down with a ranger to meet FFL if PT is not TOO Critical but needing flight. We also would have to clear a LZ of up to several hundred cars on top of the mtn depending on traffic that day. No idea on the time that could take. No LZ is kept free from visitors. STUPID I know!! I have to call a ranger to pick up (only 1 EMT normally) to transport an pt to ALS. So I have to wait for a ranger to get to the top, meanwhile I get als rolling. I get in with the ranger and pt. Head down a mtn (with lots of switchbacks). L/S depending usually lights tho... 2 days ago I was transporting (no seat belt on me) I have to sit sideways in the vehicle to be able to properly attend to my pt. The breaks locked up on the vehicle ON a switchback. If my pt was not already having an MI he just started :0.

Also there is sometimes ONLY 1 emt up there alone and thusly we are not "allowed" to leave to transport.

Thoughts???

It is scary up there with the lack of supplies/communication etc. I am not used to working in such a rural area. Any advice is appreciated.

NOTE: We are also a free service up there. All "tips" are for our EMS fund.

[fiznat]

Are these standards coming from a medical control physician or the company you work for? It seems a little ridiculous to me that you would withhold O2 from someone with a SPO2 in the 70's and 80's, but then again maybe things are different up there in the cold and high altitude. I don't have any experience with that. How high up are we talking here?

In either case, the direction (or magnitude) of your treatment should never hang on a stupid oxygen saturation value. That's what nursing home CNA's do.

[Richard B the EMT]

NY State standards is, 8-12 LPM via NRB if O2 is going to be administered. Cannula @ 2-5 LPM IF THE PATIENT CANNOT TOLERATE the NRB.

[mrsbull]

Are these standards coming from a medical control physician or the company you work for? It seems a little ridiculous to me that you would withhold O2 from someone with a SPO2 in the 70's and 80's, but then again maybe things are different up there in the cold and high altitude. I don't have any experience with that. How high up are we talking here?

In either case, the direction (or magnitude) of your treatment should never hang on a stupid oxygen saturation value. That's what nursing home CNA's do.

They are (mostly) I think coming from the Company I work for. However I was told Med Control approved the "standards". On a side note I am 84 up there. We are talking 14,110 feet. Oxygen in the air is thinner and less of it. I do not know the %. Even in the city I live in is 92 is acceptable.

As posted above I DO NOT treat from the monitor I treat from the pts appearance and vitals etc...

[chbare]

Call me crazy; however, I thought we already had this altitude sickness, saturation discussion. I remember explaining things in terms of the CaO2 equation.

Take care,

chbare.

[FSU-EMT]

I work in florida so there is NO elevation, we are always at sea level. But for us, basically everyone gets O2. It cant really hurt right?

[mrsbull]

Call me crazy; however, I thought we already had this altitude sickness, saturation discussion. I remember explaining things in terms of the CaO2 equation.

Take care,

chbare.

Thaw was discussed. I have been there now for a bit however the lack of being able to take care of a pt better. For example not having the supplies needed. Not that not having lancets or fluids wouldnt be beneficial but it would help to access and establish care up there a bit better. I hope that comment makes sense. I know what I cam trying to say it is just not forming in my mind well enough to type out.