BLS WITH OUT PULSE OX AND OR AED. SHOULDNT THEY HAVE ONE ?

[Just Plain Ruff]

Again, I would go back to the state requirements for all ambulances and look to see if there is an AED Required for BLS rigs. If there is then this service is in clear violation of those requirements and should be reported to the State because it is putting every patient that gets into that ambulance at risk.

It can be an anonymous complaint, you can probably even send an email to the state and let them know.

Honestly, It's the right thing to do if you ask me.

[uglyEMT]

As for the "treat the patient, not the machine," mantra, that is just used by people who don't understand how to use the machine properly. If the machine didn't serve a purpose, it wouldn't be created.

I hear you ERDoc. I understand the benefits to using the technology and learning how to use it properly. Its just a personal preference in my book following the mantra. Its not that I don't know how to use it, I just prefer not to. I don't need a machine to tell me if my patient is oxygenating well if I am doing my job correctly (please don't think I am being snarky with that sentence, I mean it with respect) I have seen a few providers rely on tech to do the work for them and they get too comfortable and miss things they otherwise may have picked up. The CO patient was a big eye opener for me that the tech can sometimes take over.

[MikeEMT]

AEDs should be standard equipment on all ambulances that carry patients. Their benefits have been proven over and over. They may not be used often but they are one of the few things that actually will make a difference.

As for the "treat the patient, not the machine," mantra, that is just used by people who don't understand how to use the machine properly. If the machine didn't serve a purpose, it wouldn't be created.

I will take issue with you on this. I know how to use a pulse ox properly and I understand its meaning. I pride myself on doing proper patient assessments and that includes looking at patient presentation. I don't need a machine to tell me that a patient isn't getting enough oxygen.

As for your argument "if the machine didn't serve a purpose, it wouldn't be created" there are plenty of devices in EMS that have been created that are not useful. The most prominent right now being the backboard. Just because something is there doesn't mean it is the end all. I have seen pulse ox be wrong on numerous occassions and I have seen nurses and doctors stymied when they can't figure out why it is wrong or what to do now.

I once went into an ER and got chewed out by an RN and a doc because the triage pulse ox said the patient was sating in the low 80's and had a very high pulse rate and I didn't have the patient on Oxygen. I told both of them that those vitals were wrong and the patient wasn't that bad. While the doctor was chewing my butt the RN got a different vital tree and it was discovered that the original vital tree was broken and I was spot on with my assessment.

Pulse ox, AED's and other devices have their place but only if users understand how to properly use them and understand what to do if they fail. I would like to have a pulse ox on board just because it would be a little easier, but I don't miss it and I am not going to be affected without it. Just like an AED isn't going to change the fact that I do CPR. If I have an AED with me, great I will deploy it, if not then its compressions until ALS gets on scene. An AED, however, isn't appropriate in every case of Cardiac Arrest.

The bottom line is this; an EMT or Paramedic needs to be patient focused, not machine focused. Machines are useful and do have their place in EMS but the provider needs to look at the whole picture not just what the machine says.

[chbare]

n=1 experiences may not be representative of the world in general...

[Just Plain Ruff]

I will take issue with you on this. I know how to use a pulse ox properly and I understand its meaning. I pride myself on doing proper patient assessments and that includes looking at patient presentation. I don't need a machine to tell me that a patient isn't getting enough oxygen.

As for your argument "if the machine didn't serve a purpose, it wouldn't be created" there are plenty of devices in EMS that have been created that are not useful. The most prominent right now being the backboard. Just because something is there doesn't mean it is the end all. I have seen pulse ox be wrong on numerous occassions and I have seen nurses and doctors stymied when they can't figure out why it is wrong or what to do now.

I once went into an ER and got chewed out by an RN and a doc because the triage pulse ox said the patient was sating in the low 80's and had a very high pulse rate and I didn't have the patient on Oxygen. I told both of them that those vitals were wrong and the patient wasn't that bad. While the doctor was chewing my butt the RN got a different vital tree and it was discovered that the original vital tree was broken and I was spot on with my assessment.

Pulse ox, AED's and other devices have their place but only if users understand how to properly use them and understand what to do if they fail. I would like to have a pulse ox on board just because it would be a little easier, but I don't miss it and I am not going to be affected without it. Just like an AED isn't going to change the fact that I do CPR. If I have an AED with me, great I will deploy it, if not then its compressions until ALS gets on scene. An AED, however, isn't appropriate in every case of Cardiac Arrest.

The bottom line is this; an EMT or Paramedic needs to be patient focused, not machine focused. Machines are useful and do have their place in EMS but the provider needs to look at the whole picture not just what the machine says.

But Mike, that's you, you pride yourself on being a good emt and I have no cause to not believe you but we have tons of lazy providers who do not take pride in their care of the patient. To them it's you call we haul and I am sure you work with at least one of them.

The machines are designed at least to me, to be an adjunct to the patient care continuum and to help those lazy providers to do what they should be doing all along, which is look at the patient. If the machine shows a pulse ox of 72% then the provider is prompted to gasp, look at the patient and hopefully make a thorough assessment of the patient as to whether they are truly at 72% or if the machine is off.

Your experiences are anecdotal and valid in your situation, I'm not discounting that, but the manufacturers of these devices I am sure have put a lot more research and development cost and time into producing these machines than you or I have in hours on the street.

Edited December 11, 2013 by Captain ToHellWithItAll

[ERDoc]

You can't use the argument of the CO poisoning against the use of the technology, it is an argument against the abilities of the provider. Any provider who has access to a pulse ox should know that you can get falsely high readings. Without a pulse ox, how do you titrate your oxygen to your chest pain or stroke pts? A good exam can only tell you so much. How do you determine if the pt is not getting enough oxygen?

EDIT: Saying an AED "has it's place" sounds a bit naive to me. An AED may not change the fact that you are going to be doing CPR but it will change the fact that you can convert your pt to a living, perfusing rhythm. Your CPR is at best 33% effective. You are correct, it may not be appropriate in every case of CPR, but without one you will not know if it is appropriate or not. How are you going to assess and treat the pt appropriately without a machine?

Edited December 11, 2013 by ERDoc

[MikeEMT]

But Mike, that's you, you pride yourself on being a good emt and I have no cause to not believe you but we have tons of lazy providers who do not take pride in their care of the patient. To them it's you call we haul and I am sure you work with at least one of them.

The machines are designed at least to me, to be an adjunct to the patient care continuum and to help those lazy providers to do what they should be doing all along, which is look at the patient. If the machine shows a pulse ox of 72% then the provider is prompted to gasp, look at the patient and hopefully make a thorough assessment of the patient as to whether they are truly at 72% or if the machine is off.

Your experiences are anecdotal and valid in your situation, I'm not discounting that, but the manufacturers of these devices I am sure have put a lot more research and development cost and time into producing these machines than you or I have in hours on the street.

This I do, I was raised with the mentality that you don't rely on the "easy way". I was raised in a carpentry family and my grandpa was a huge supporter of air powered nail guns and power tools. Before he even let me touch a nail gun or a power tool I had to hammer nails and cut wood the old fashioned way. He used to tell me that power tools will make your life easier but a hammer will never fail you. Haven't forgot that.

You can't use the argument of the CO poisoning against the use of the technology, it is an argument against the abilities of the provider. Any provider who has access to a pulse ox should know that you can get falsely high readings. Without a pulse ox, how do you titrate your oxygen to your chest pain or stroke pts? A good exam can only tell you so much. How do you determine if the pt is not getting enough oxygen?

EDIT: Saying an AED "has it's place" sounds a bit naive to me. An AED may not change the fact that you are going to be doing CPR but it will change the fact that you can convert your pt to a living, perfusing rhythm. Your CPR is at best 33% effective. You are correct, it may not be appropriate in every case of CPR, but without one you will not know if it is appropriate or not. How are you going to assess and treat the pt appropriately without a machine?

How am I going to assess the patient? Hmmm, Are they responsive? No, then check pulse. No pulse, begin CPR. Not much more to it then that. Can I tell what rhythm the patient is in, no I can't. Even with our AED's I wouldn't be able to but that is moot because as a Basic it doesn't change my treatment. Don't get me wrong, I am pro AED. I just feel that there can be too much expectation placed on them.

As a professional I want to be able to tell someone how everything works and why it works. As a Basic we don't carry fancy gadgets on board our rig but I know how everything I do have works and I under stand it. This is something I think we fail on as a profession. We give providers all this fancy equipment but we don't explain the equipment to them or why it works. How many EMT's know what the official name for a BP cuff is? How many of them know how it works and why we are squeezing to obtain a BP reading? How many know why we carry AED's or why they don't always work and the "no shock advised" does not mean to cease efforts?

I am very pro technology and I subscribe to the mantra that you should work smarter, not harder. That said, technology is ineffective if you don't understand it. Recently I have heard a lot of talk about CPR devices such as the AutoPulse. These have the potential to be great save lives, but will providers understand why? 15 years from now when they are common place like AED's are today, will future EMT's understand how to do manual compressions? Will we be having arguments about "my rig didn't have an autopulse on board should I report them to the state"?

I once went into an ER to take a patient out for an IFT. The RN came in to give me a report and saw me auscultating a BP on the patient with our own cuff. The RN asked me what I was doing and I told her I was getting a BP. She pointed to the monitor and said that is how you get a BP. When I asked her if she had ever taken a manual BP she replied no. I actually taught her how to do it. This is what I want to avoid. Regardless of how far I move up in this field, I don't ever want to become one of those providers that loses sight of the basics.

Would I use a Pulse Ox or any other gadget we have on board? Sure. I'm not going to let lack of a gadget dictate how I treat a patient. Just my humble opinion.

[ERDoc]

You are completely missing the point. We are not talking about taking the easy way out of things. The examples you give are examples of piss poor providers and educators, not problems with the technology. You also missed my point about assessment. As for the AED not changing your treatment, yes it does. It defibrillates your pt when they need it. I highly doubt you can do that with your hands. Any provider who is using an AED should know why you do/do not shock. Again, you are arguing against the providers and not the technology. AEDs have become standard of care.

I ask again, how do you assess if someone is getting enough oxygen? How do you decide when to give a chest pain or resp pt oxygen and how much?

As for your story of the nurse in the hospital, I call total BS. Every nurse is taught and repeatedly made to take manual BPs. Hell, we are even made to do them in medical school.

[scubanurse]

I ditto ERdoc's statement about the ER nurse. Every nurse I know has been made to take manual BP's over and over and over again. On top of that I know most ER nurses who will get one set of manual vitals first or at some point during the visit. In a trauma, you automatically take two manual BP's to compare left and right sides. As a nurse I take manual BP's several times throughout the shift on my patients who require them to be done routinely.

[emt2359]

As a professional I want to be able to tell someone how everything works and why it works. As a Basic we don't carry fancy gadgets on board our rig but I know how everything I do have works and I under stand it. This is something I think we fail on as a profession. We give providers all this fancy equipment but we don't explain the equipment to them or why it works. How many EMT's know what the official name for a BP cuff is? How many of them know how it works and why we are squeezing to obtain a BP reading? How many know why we carry AED's or why they don't always work and the "no shock advised" does not mean to cease efforts?

All new EMTs (not basics) since the new ed standards came out in 2009ish should be able to understand the why's. Very soon EMTs will have as standard equipment (or at least understand): glucometers, SpO2, 12 Lead EKG (to obtain, not read), ETCO2, CPAP and more.