Prehospital pulse oximetry: useful or misused?

Area of Science:

• Emergency medicine
• Cardiopulmonary physiology

Background:

• Pulse oximetry is a key tool for assessing oxygen saturation.
• Effective use of pulse oximetry by prehospital providers can optimize oxygen therapy and patient outcomes.

Purpose of the Study:

• To evaluate the ability of Emergency Medical Technicians-Assistants (EMT-As) and Emergency Medical Technicians-Paramedics (EMT-Ps) to use pulse oximetry in determining patient oxygen requirements.

Main Methods:

• Prospective case series involving 532 consecutive patients transported by the Cleveland EMS system.
• EMT-As and EMT-Ps clinically assessed patients and predicted oxygen needs.
• Pulse oximetry (RA SpO2) was measured on room air; interventions and subsequent SpO2 were recorded.

Main Results:

• 11% of patients had initial RA SpO2 <91%. EMT-Ps appropriately increased oxygen in all desaturated patients, while basic life support units failed in 20%.
• 60-62% of patients had initial RA SpO2 ≥97%. Both EMT-Ps and EMT-As frequently administered unnecessary supplemental oxygen to these patients.
• EMT-As were significantly more likely than EMT-Ps to administer excessive oxygen to already well-saturated patients (16% vs 2%).

Conclusions:

• EMT-Ps demonstrated a greater ability to appropriately base oxygen therapy on oximetry measurements compared to EMT-As.
• Both provider levels frequently failed to decrease supplemental oxygen in patients with high oxygen saturation.
• Implementing pulse oximetry can help avoid unnecessary oxygen administration in prehospital settings.