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EMS News in Focus
by Arthur Hsieh

Another sacred cow questioned

By Arthur Hsieh

Editor's note: A new study finds a change to the way paramedics use oxygen when treating patients with chronic lung disease could cut the death rate in these cases by up to 78 percent. Editorial Advisor Art Hsieh gives his take on this type of research.

There have been a growing number of articles that have questioned the use of high concentrations of oxygen for sick patients. It will still be awhile before the jury is in on oxygen's short and long term effects, but I am already hearing the gnashing of teeth and wailing at the EMS wall — "How can this possibly be? How can someone get sicker with oxygen?"

Okay veterans, weigh in on this one. I remember that as a new EMT student that the training centered around several types of delivery devices, including nasal canulas, simple face masks, partial non-rebreathers, full non-rebreather masks, and venturi masks.

You had to remember what the percentage of oxygen could be delivered by each device, what the liter flow was, and estimate how long you could run each device on a D or E size cylinder.

During actual practice, most of us chose between a nasal canula and simple face mask, and used non-rebreathers only for "severely" short of breath patients or those with heart attack symptoms.

Sometime in the mid-90s, we began teaching new EMTs that the only devices we used on patients were non-rebreather masks. It was simple, and hey, what harm could it be to patients? We also changed tanks a lot and got scolded by hospital personnel for putting patients on high flow oxygen and watching them be immediately switched to nasal canulas. We sighed and told ourselves, "Well, it's their patient now, too bad for them."

Now, with information coming out that it is possible to worsen a condition with oxygen, this will be a challenge to well-established dogma.

I say no problem. Let's keep encouraging this type of research. Our overriding goal is to protect and heal the patient, so it makes sense that we constantly scrutinize the procedures we follow, from the most basic to the advanced. It's another way we can demonstrate our effectiveness in the health care profession, and it just makes good sense.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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