Lazarra, Hillier challenge EMS dogma

Justin
Justin Crann
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New data may overturn old practices

There are plenty of myths and misguided notions among paramedics.

Pete Lazarra (left) and Tim Hillier (right) discuss some of the myths of and major shifts that have occurred within emergency medical services at the 14th annual First Responders/EMS conference at the Heritage Inn on Jan. 26, 2014.

On Sunday at the Heritage Inn, Tim Hillier and Pete Lazarra — who, combined, have more than 60 years of experience in EMS — took the time to address some of those misconceptions and provide new information.

One of the first topics they tackled was the use of high-flow oxygen on patients.

"What were you guys taught?" Hillier asked the room of more than 100 First Responders and paramedics. "If somebody is sick, in any way whatsoever, throw a non-rebreather on them and give them high-flow oxygen. What can it do? It can't be bad.

"The trouble is, it can be bad," he added. "And it can hurt your patient."

According to Hillier and Lazarra, statistics and modern science are showing high-flow oxygen can cause problems for a wide range of different patients.

Lazarra presented data that showed trauma victims — in particular, victims of penetrating trauma, such as stabbings — tend to have poorer outcomes when receiving high-flow oxygen through a mask.

"The dogma we've always listened to is to always use high-flow oxygen," Lazarra said. "We know now, as science has shown us, that it can cause some harm."

For patients, there is an effective range where oxygen can help: between 91 and 98 per cent blood oxygenation.

But sometimes, Hillier noted, oxygen can be administered when it makes a patient feel better.

Ultimately, he said, "if we look at oxygen as a drug, the same as everything else we administer in EMS, then we'll look at it in a different way. We have to be giving the right dose at the right time."

Another urban legend tackled by Lazarra and Hillier was the Golden Hour — a rule that states trauma victims must be at a centre and receiving care within one hour.

The Golden Hour, Hillier said, was "based on inaccurate data from a very respected physician and nobody questioned it," but when investigation was done into the facts behind it, it was discovered that the interval is far more varied.

"There's a certain subset of patients who do die in what they call the Golden Hour, but that's a very small subset," he said. "We don't know what the actual interval is."

"This is a hard pill for me to swallow," added Lazarra. "I think time is definitely tissue, and if you've had someone who has had a penetrating trauma to the chest … I firmly believe there's a time — a window — where they need to get to a surgical suite.

"(But) there's no evidence that shows us what that window is," he added.

Ultimately, however, both men encouraged EMS and First Responders in the room to follow local protocols — just that they should keep this information in mind, because it may become the new dogma.

The challenge, noted Hillier, is how quickly the science can change.

"Half of what I tell you is wrong. I don't know which half it is. And it's all going to change tomorrow," said Hillier. "But as of today, this is the science that's out there."

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Organizations: Heritage Inn

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