Pulse Oximetry

[EMT86118]

Does anyone elses state prohibit the use of pulse ox by basic squads?

State of Indiana has seen fit to remove them from basic busses because basics are "practicing beyond their scope and aren't trained appropriatley"

Seems to me the ems politicians in Indy are paralyzed from the neck up.

Anyone facing similar circumstance? Are the basics in your state allowed to use pulse oximetry?

[medic235]

If it is beyond the scope of a basic EMT to look at some numbers, interpert them, and apply some O's, then why the hell do they need a cert? just save them a few months of torture and the waiting on there results, make them get a class A Drivers licsence and let them be real "ambuilance drivers" instead of EMT's. In Ohio our EMT-Basics can not only use it but Tube pt.'s as well


No disrespect ment, but that is not right to belittle ANY level of EMT by taking away there basic practice. That would be like if i could only start an IV on Codes.

[DabbleDuke]

The city of Detroit will not allow the EMT-B's check blood sugars.... "It's an invasive procedure."

[ablove21303]

Here in AR we have the same problem as well. How about we fought for 2 years to get glucometers on an intermediate truck. FSBS is invasive but the EMT-I can administer D50. Go figure

[DabbleDuke]

Here in AR we have the same problem as well. How about we fought for 2 years to get glucometers on an intermediate truck. FSBS is invasive but the EMT-I can administer D50. Go figure

Not to mention start an IV.

[CornholioMedic]

Actually, basics can do blood sugars, SpO2 and allowed to do PTL/Combitubes here in the DEMCA zone.

Oakland County, Michigan was the first county in the state to allow basics to initiate I.V.'s and standard intubation. It's all allowable within a zone to practice as long as you are properly trained. However, it doesn't let you practice statewide, just within your own zone.

[DabbleDuke]

Actually, basics can do blood sugars, SpO2 and allowed to do PTL/Combitubes here in the DEMCA zone.




Funny.. they told me as a basic I couldn't do a BS... must be a city thing.

[DabbleDuke]

Actually, basics can do blood sugars, SpO2 and allowed to do PTL/Combitubes here in the DEMCA zone.




Funny.. they told me as a basic I couldn't do a BS... must be a city thing. I also love the fact that I'm a medic anywhere in the state except for the city. Something about having to go through thier training.. I think it's to dummy me down so I can work as a medic in the city.

[medic235]

how does that work with them not allowing you to operate as an medic? seems like they would be opening themselves up for a big law suit, not to mention if you werent providing care to the level trained doesent that leave you liable for a law suit? I dont know you guys aslo have those EMT-specs too .... crazyness

[DabbleDuke]

I couldn't tell you... the city is soooo F*@ked up, I don't try and figure it out. All I know is that everyone starts out as a basic and then you have to be promoted to medic.

[mike]

When I was hired by the city they hired the medics in my class as medics. When you got to the academy they said you were a basic or leave. This is a city fire department that had to send out applications to every EMT, EMT I and paramedic in the state to get a class of 30 or so. We spent 14 or so weeks doing absolutely nothing productive for the most part. Sit and wait was a term I learned well in the Army but literally a 12 year old girl scout could come up with a lesson plan and half ass stick to it. Not so here.. Lift and carry, push ups and that was about it. At the end of it they give you a cert for EMT.

What’s funny is the state requires the NR to become an EMT, the city isn't a testing center and it’s totally worthless. Literally every day of the academy they had no clue what we were going to do, it was make shit up as you go.

Then, to get promoted you had to work x time and then “schedule” an upgrade exam. It took them almost a year to get us to the “exam” at the academy. They sent out copies of the protocols that were out of date and not in order. Page 312 was on the backside of page 2, etc. Then they schedule you for your 48 hours of free labor at the local ER so you can get your DEMCA cert (Medical control). Then afterwards you have to dickdance to get promoted doing 30 days as a 3rd person (2nd medic) but they change that as manpower dictates, maybe you only do it a day, others longer than 30 days.

When I say that Detroit EMS is run by a bunch of incompetent f*cks (some of the management on up..) I am understating the problem. Our chief has been here 3 billion years and the system is so regressive with the “”back in the day” crap that people feed themselves with that the only reason the system works is because of the people on the streets having some standard of care.

I can see why they wouldn’t want you to be the head medic from day one but not to have you work as a basic for a year. Case in point, in the academy one of the instructors (black) asked a student (white) “what’s up my nigga..” to which the student replied “sir I am white.” Had the guy been in a patients house and someone said that (which is a form of friendly greeting in the context it was used) and that was his reply he would have gotten his ass kicked most likely.

I personally think you have to work a while to get to know the city before you become “the man” so to speak. I think you should do so as a medic though, not a basic. Why lose skills? This city has it’s own rules, it’s own way of doing things and if you are not familiar with it a simple reply like the one above might make it your last day period.

And for the record our training put on a “basic upgrade” when they switched some bls units back to ALS.


It mainly consisted of “instead of pt care you will lift and drive and clean…”
One of the things they mentioned was that a basic can’t do Glucose checks. It’s a city thing the chief says basics cant do, apparently he doesn't read the protocols.

[therevengingo]

Here in Denver I work as a basic on an ALS rig. All pt's get an assesment by my medic partner but after that if it is a bls attend, I take it. On top of my EMT cert I took an IV certification which allows me to do Blood sugars and administer D50 as well as IVs. As a result I can attend on diabetic emergencies.

However, it is still not in our protocols for me to do Pulse Oximetry! Evidently it is too complicated for us to understand. What other caveats are there other than CO poisoning giving a false reading? I'm pretty sure we can be trained to recognize that anyway. If anyone can tell me a good reason I would love to be proved wrong.

So we can perform "invasive proceedures" like sticking a 14ga angio is someone's arm but not read a number...

[EMT86118]

Here in Denver I work as a basic on an ALS rig. All pt's get an assesment by my medic partner but after that if it is a bls attend, I take it. On top of my EMT cert I took an IV certification which allows me to do Blood sugars and administer D50 as well as IVs. As a result I can attend on diabetic emergencies.

However, it is still not in our protocols for me to do Pulse Oximetry! Evidently it is too complicated for us to understand. What other caveats are there other than CO poisoning giving a false reading? I'm pretty sure we can be trained to recognize that anyway. If anyone can tell me a good reason I would love to be proved wrong.

So we can perform "invasive proceedures" like sticking a 14ga angio is someone's arm but not read a number...

Indiana is maikng us jump through hoops to "re-certify" for pulse ox.

Some of the "concerns" were that even though a pt. presented w/ soa,tripod pos. and accessory muscle use,some techs were not o-ing them because the meter "showed" 92-98%.Now,yes this would alarm me as well if i ran into it in audit/review,but,lets not act like the whole state is doing the same thing.

Ya know,who ever got this site going should get a big ol' attaboy.......

[CornholioMedic]

I know they did that Mike, I was refering to the zone giving us a REAL upgrade. It's all politics brother. The funny thing is, there are other counties in the state that require a paramedic to test out in their zones too, but it's less hoops and bullshit to do it.

[DabbleDuke]

Indiana is maikng us jump through hoops to "re-certify" for pulse ox.

Some of the "concerns" were that even though a pt. presented w/ soa,tripod pos. and accessory muscle use,some techs were not o-ing them because the meter "showed" 92-98%.Now,yes this would alarm me as well if i ran into it in audit/review,but,lets not act like the whole state is doing the same thing.

Ya know,who ever got this site going should get a big ol' attaboy.......


I'll pass the attaboy on to they guy that started the site... but on your frist note, you are so correct... You shouldn't need a pulse ox to know if someone is in distress or not. If someone is really SOB/DIB, you should be able to look at them and tell before you even thing about hooking up a pulse ox. Like the ol saying goes... "Treat the pt, not the monitor".....

[mediccjh]

I'll pass the attaboy on to they guy that started the site... but on your frist note, you are so correct... You shouldn't need a pulse ox to know if someone is in distress or not. If someone is really SOB/DIB, you should be able to look at them and tell before you even thing about hooking up a pulse ox. Like the ol saying goes... "Treat the pt, not the monitor".....


Damn straight!!!

What is gonna change BLS treatment based on a pulse ox?

[EMT86118]

Damn straight!!!

What is gonna change BLS treatment based on a pulse ox?


I feel the same way.I've watched fng's record a pulse from the blinky and never palp.These are the same folks that get estimated "ocular" BP's ,which is to say they have the uncanny ability to get a BP from looking at the PT.

Happy to say they are not on my service nor any of my trucks.........

[ff1157]

The city of Detroit will not allow the EMT-B's check blood sugars.... "It's an invasive procedure."

Yes, My service feels the same, even though it's a State Level EMT Skill, I guess they don't want us EMT-P's to become obsolete!

[tom10406]

Where I work in Ontario our Primary Care Paramedics (Our version of EMT Intermediate), can monitor Spo2 and have been trained in it. Can do blood sugars using glucometers, they also do lead 2 and 12 lead ECGs and manual D fib. Provincial standard is Semi Auto. Some areas the Primary Care Medics can start IVs give IV Dextrose and use combi tubes.

The screwed up thing of it all is, our fire runs BLS first response with semi auto d fib. Some have been through the First Responder Training but most just have CPR, O2 Semi Auto D fib, and very little other medical training. In our area fire can use SPO2 but have had NO training on Pulse Oximetry. I have had a fire fighter tell me that "I didn't give the patient oxygen because his Spo2 was 100%", mean while the patient is a chest pain patient is pale, diaphoretic, and having severe S.O.B.. Our EMS is separate from Fire in Ontario. We have one city (Hamilton) that the two are under what they call Hamilton Emergency Services there is an EMS side and a Fire side. Fire makes more money and gets more money for budget.

[RES551CUE]

In our region, EMS of Northeast Pennsylvania, as long as your medical command doctor signs off on the use of a pulse ox for BLS, then you can use it. I just can't stand when people treat the machine and not the patient. I'm sure you all know what I mean.

[anthonyt]

Damn straight!!!

What is gonna change BLS treatment based on a pulse ox?

Exactly, I am curious to hear what good it would do on a BLS truck, other than to give medical control another VS to write down.

[medic235]

thats prob true unless youre lucky enough to live in an area where BLS units are doing nebs, but even then its still treat the pt not the pulse ox

[prncssmdc]

In our area - we usually meet up with first responders, they as well as EMT-B's I believe are not allowed to use pulse ox. Most squads have them anyway. I guess the only reason I see why I would really want them to have them is so they can give me a baseline # PRIOR to putting O2 on. Most of the time they are putting the O2 on and then putting the pulse ox on (as they should) - but if they manage to grab one QUICKLY prior to O2 - it's nice to have.

That being said - if you tell them to do that you'll have the group of half wits that absolutely will not allow O2 to be put on until they have the baseline. Probably better to just let them not use it.

Most of them are good, but the ones that are bad........oy...........

[CornholioMedic]

Pulse oximetery is a great tool. It let's the Doc's know what the pt's room air sat is. But, you have to (just like everyone else is saying.) look at how your pt presents and listen to their lung sounds first and foremost.

When I see a pt that's in obvious respiratory distress, it's O2, lung sounds and SpO2...in that order, and it only takes a couple of seconds to accomplish. You can obtain close to a room air sat. just after placing them on O's and see if their sat. rises with O's or meds.

Again, it's a great tool, but some folks need to stop being tools and treat the pt, not the monitor/SpO2.

[dfdmedic699]

Had a good COPD the other day. Accessory muscles, tripod, 2 word sentences, the works. SAT was at 96% RA and 98% on 10lpm. I promptly took the pulseox off and ignored it for the rest of the trip. I won't quote the old cliche!

[anthonyt]

Had a good COPD the other day. Accessory muscles, tripod, 2 word sentences, the works. SAT was at 96% RA and 98% on 10lpm. I promptly took the pulseox off and ignored it for the rest of the trip. I won't quote the old cliche!

Exactly... Anyhow, ETC02 is a better indicator of disteress. I am surprised that it hasn't been incorporated into a majority of EMS systems as a VS to be taken with someone with DIB/SOB etc...

[Ghosty1]

I can see where pulse oximeter has value-you know, the 6th vital, i dont see where its hard to use.
having said that, i dont feel that its a priority tool to treat the pt. we work in EMERGENCY medicine. let the nurses at the hospital check 02 saturation levels. to my mind, its not a tool we need to use to carry out emergency treatments. its nice, but its not needed. remember that 02 sat levels as measured by pulse oximetry can be misleading.
should emt-Bs be allowed? sure. is it needed? doubtful.

[Faster-1]

You can't dispute that a glucose stick is "invasive". However, "THEY" can't dispute that Basics are TRAINED to do it!!!

If you aren't going to be able to practice to the level of NREMT standards, then you shouldn't have to be NREMT certified.

Knock on wood, we haven't had that problem in AL so far. We're still good with Sp02 & sugar sticks.

[tom10406]

We do ETCO2 here for intubated patients and for non intubated patients who are in CHF, severe asthma, poor profusion, poor respiratory status etc.

I find it to be very handy, glad we have it.

[rstacey]

In Maryland, BLS can use both Pulse Ox and Glucometers and only in certain counties can they start IV's if they have been trained as an IV Tech.
If your state cant allow EMT's to read numbers to see how much 02 is in the RED BLOOD CELLS and make changes to that by providing oxygen or naso airways then they need to get with the years its 2006!!!