Question: I like to give O2 to patients for pain (when not contraindicated) even if their stats are good. I have done this for years and have found that it seems to help. A fellow paramedic felt that this was a very useless application. I disagreed. I have looked for scientific evidence for this working and have found little on it. I was wondering if you would comment.

 Thanks for asking! Similar questions and answers were posted on this site in November, July and September 2012 relating to the amount and concentration of oxygen that should be administered by paramedics in various situations.

Oxygen administration is a "hot topic" these days throughout the medical literature as you describe. We now know that too much oxygen may not be good in certain conditions and we need to rethink some of our indications for high flow oxygen. One of the limiting issues in this regard however is that up until now, oxygen saturation monitors have not been listed as mandatory equipment making titration of oxygen impossible for some EMS services. For now, oxygen administration is governed by the Basic Life Support Patient Care Standards (BLS-PCS) and paramedics should comply with the directions therein.

As a glimpse to the future, our provincial regional base hospital partners have been very busy this year reviewing the latest literature regarding oxygen and specifically hyperoxia, and then painstakingly comparing their findings to the current standards within the BLS-PCS. Look for revised indications in the near future regarding oxygen administration!

In the 2010 AHA Guidelines (O'Connor et al Part 10: Acute Coronary Syndromes Circulation 2010) it states: "EMS providers administer oxygen during the initial assessment of patients with suspected ACS. However, there is insufficient evidence to support its routine use in uncomplicated ACS. If the patient is dyspneic, hypoxemic, or has obvious signs of heart failure, providers should titrate therapy, based on monitoring of oxyhemoglobin saturation, to ‰¥94% (Class I, LOE C)."

A link to these guidelines can be found here: http://circ.ahajournals.org/content/122/18_suppl_3/S787.full

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