Oxygen use by 1st responders

[FFLEEMS]

I am the EMS coordinator for a government agency. We provide BLS, with no transport. Transport/ALS has 10 minute +/- reponse time. We have EMTs and 1st responders. I have a couple of questions for any of you who have or are 1st responders. Do you allow your 1st responders to use O2? If so how much training do you do with them? Those of you who are 1st responders that currently use O2, how much training did/do you get and are you comfortable with your training to use O2. My 1st responders currently use O2, but don't get much chance to use it. I have to make some decisions in this area and welcome any comments about this. Thanks in advance.

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[FF McDonald]

Training is key. As well as making sure you are "allowed to" carry O2.

You need to check with whomever is 'medical control' and/or check your protocols on the subject. I know that in some areas of the country, Medical grade O2 is considered a drug, and a doctors presecription is needed to be in possesion of Medical grade 02.

Training being the second part-- if your first responders don't know how to use the equipment, then they have no reason to be touching it.

First and formost, check and make sure you are 'allowed' to have your 1st Responders use 02. If you are, then train them.

Hope this helps.: )

[emsbrando]

We allow our first responders to use oxygen. All first Responders are trained to at least the Emergency Care Attendant level here in Texas. That's really the 40 hour First Responder Trainig Criteria. This way they know not to give too much oxygen in situations where only a liter or two over the maintenance flow for someone with COPD will help them. Unless of course the patient is blue, (cyanotic) to where the flow has to be greater. Our Medical Director oversees the program, and some first responders are even ALS, with intubation and IV equipment. We have an exhange program to where we supply the responders with an oxygen bottle, they buy the yoke, and we exchange the bottle when it's empty, as well as all disposable equipment. This is done at no charge to the First Responder agencies. All First Responders are under contract with us since in Texas you cannot be a first responder agency unless you are affiliated with an EMS provider.

Train your personnel on how and when to use oxygen, and have the local EMS provider come to your station during a drill or an employee meeting and assist in the training. they should be glad to do it.

Ed Brando

[chief4102]

FFLEEMS
Sir;
What FFMcDONALD said about local protocols and Medical Control is correct.
Here in Michigan, 1st responders are instructed in O2 use and applications during their 1st responder class, and, in most areas, are expected to use the drug when appropriate. The oxygen module is usually six hours long per state guidelines, but can be longer. In my area all 1st. responce agencies carry and use oxygen, all also use pulseoximitry, getting a pre-oxygen reading, and a post O2 reasing that are recorded for the ambulance. If I can help you in any way, please e-mail me, and I will try to help.

Be Safe

Dan Deyo
EMT-P I/C

[BURNSEMS]

I would like to interject a point here, The Term First Responder should mean CERTIFIED persons trained to a specific Level of care, NOT joe blow VFD who just arrives stands watches and Leaves, we have a Dept near us that Responds to MVA Scenes and does NOTHING, they have no Certified People not Even the minimum 40-HR E.C.A., they have no Jaws,soooo if its not on Fir and they are not going to help WHY COME and add to the confusion...AS far as the O2 issue I agree with emsbrando, Our Primary Provider is out of a Local City, we provide a.l.s.firts response and that Service E.T.M.C. provides our Med Control, Transport Ground and Air, and our Supplies as well as Contiueing Ed so they provide a excellent platform for us to serve the Public.... OOps off the subject and I will shut up now....

[FF McDonald]

Mr Brando...Just a question here....

...the program, and some first responders are even ALS, with intubation and IV equipment....

I have been trained as a First Responder, and also as an Emergency Medical Technician. HOWEVER, my training as an EMT, superceded my first responder training. What I am trying to say is... First Responder is a title given to a specific training curriculum, authored by the Department of Transportation. Not whomever arrives on the scene first... hence, the FIRST responder. I hope I am making sense here, even I am getting confused.

If you have someone who is a Medical doctor, and a paramedic-- he can operate in two capacities-- either as a doctor, or a paramedic, not both.

If you have someone trained in ALS, then they are acting in that capapcity-- not as a First Responder-- as titled by the DOT.



[This message has been edited by FF McDonald (edited October 14, 1999).]

[FFLEEMS]

Thanks to everyone for the quick reply. By the way I do mean the DOT level of training, not the first on the scene. Sounds like no one has any problems with it, and yes I plan to have ongoing training with them. Would still like to hear from others on this subject. thanks again

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[JPerkMCFD3]

Our department is in the central part of Upstate new york. State protocol defines the FIRST RESPONDER training level as minimum for delivering oxygen.

As for the use protocol, they have recently changed and now require that high flow oxygen be given to all patients with chest pain, difficulty breathing, head injury, etc.

The old rule for low flows on COPD, etc has been eliminated in favor of recent research preferring the high flows.

[j crooke]

just a thought...
There isn't really much that you can screw up by administering O2. except pushing the cannula too far up the nares! As long as the people using have half a brain and use common sense. ( as far as this goes I've run calls with some Medics that don't have either of these )
As for training..
-the COPD issue should be stressed, with the understanding that we should not deprive the pt of O2 ( back to the old axiom...BLUE is BAD )
- signs & symptoms of hyper oxygenation , and how to combat it ( stop the flow dummy! )

PA has just recently ( w/in the past 2?? years ) approved the usage of O2 by the FR.
As far as i know...i haven't heard of any deaths due to O2 usage by the FR



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Jeff Crooke
engineer291@yahoo.com
Marshalls Creek fire/rescue
PA

[emsbrando]

Mr. FFMcDonald:

The term First Responder is used for anyone here that responds before an ambulance gets to the scene.

We have Sheriff's officers that are First Responders as well as fire fighters.

True the term "First Responder" was coined by D.O.T. as someone with a 40 hour training course that does only the very basic level of work, but here in Texas as in other states, with the proper Medical Control they can be Paramedics, function as such, and still be known as First Responders. This means that our Medical Director has had them pass a level of skills tests, and a Protocol Test.

If you are an EMT, then the level of care you provide is basic. As a Paramedic, if I were to go out with a Fire Department that is a basic first responder agency,(and I was off duty and a member of that F.D.) then I am only to administer basic level care until a Paramedic unit arrives. I can funtion as a Paramedic only if it is a unit for the company I work for. It is a matter of Medical Control.

I'll give you another example:
I am a Paramedic, and I travel a lot in a company vehicle. If I were to be in an area that is not covered by my company and stop at an accident or even a cardiac arrest. I can only administer basic level care, and when the local ambulance arrives, assist them in care and packaging until they are ready to transport. All this time I am only to provide basic care.

If I were to come up on or first respond in my vehicle to an accident or cardiac arrest in our service area, then I can function as a Paramedic until one of my units arrive. In my van, I carry all the jump kits an ambulance carries along with supplies to set up a command post.

I hope I answered your question, sorry it took so long, I was out of town for a few days.

HOW BOUT DEM GIANTS!!!!!!!

(I was born in Newark, and raised in Matawan Township before it was called Aberdeen.)

Ed Brando

[DED1645]

First I don't know what First Responders curriculum consist of, but the biggest question is what does you local or state protocal on oxygen. Who can and to what extent are they permitted. Most PD's only have CPR-C or first responder and they use oxygen prior to our arrival. EMT police officers are on the rise and that's a great thing. A few have defib also. More urban dept's in Jiosey are starting defib units in their cars. Not to get off the subject, but I would recommend to check you local protocal for the right answer.

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David DeCant
firefighter/NREMT-B
Mantua,NJ

[Romania]

Here in Arizona the state doesn't even reconize first responders! How rediculous is that? Therefor, technically first responders are not alowed to use oxygen... however many hospitals have signed off on first responders using oxygen with the appropriate training. If you think about it, 8 hours of training covers all that you need to know about oxygen administration for the BLS level. I fully agree that first responders should be alowed to use oxygen. I can't count how many "ALS" patients with chestpain, difficulty breathing, weakness, etc have had their S/S resolve with highflow oxygen alone. IT is an underrated medication. A very easy way to train your first responders is American Red Cross' Oxygen Administration class. It gives you a pre-set standards that are approved and reconized nationally, prepared teaching materials and resources, and your students get a ARC card upon completion.

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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.

[Romania]

I also have to add, in pre-hospital you can never give too much oxygen. You will not shut a COPD'ers hypoxix drive down with 15l of oxygen for less than a couple hours (if you have long 1 hour+ transports you need to be careful).

The basis of this theroy that you can hurt people with oxygen was a creation to scare basic EMT students. Do what you Base Hospital/Medical Direction tells you to do. However, remember that oxygen is good :-) and doesn't hurt for short periods of time, we are not long term care providers. This is what I was taught in medic school, this is what I teach, this is what both of my base hospitals want.

Do not be afraid of putting a patient on high-flow oxygen.

Sorry about the rant, seen too many chestpain patients on nasal canulas a 2-4 lpm.
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Alan Romania, CEP
romania@uswest.net
IAFF Local 3449

My Opinions do not reflect the opnions of the IAFF or Local 3449.




[This message has been edited by Romania (edited October 27, 1999).]

[cacfpd]

In our area First Responders must be certified,(most are EMT level responders)and attend a certain amount of continuing education every year. The Project Medical Director in charge has several standing protocals which include the administration of oxygen by First Responders. We also have protocals for the use of an AED.
Every responder is equiped with a basic kit wich includes Oxygen. AED are scattered around the county and will increse in numbers as the dollar$ are available.

Oxygen is a basic necessity for life, and the earlier you can provide it for the patient the better their chances are.

Supplies are exchanged with the responding ambulance.

Stay Safe
Dave