who can carry o2, with the intent to administer?

Flare, ASN, BSN · Nov 15, 2013

typically when paramedics work, they work under orders of an emergency room MD. They sometimes get pretty comfortable with these standing orders since they are making these decisions of times a day. But - their orders only cover them when they are working in their capacity as a paramedic and are covered by those standing orders that have been endorsed by the ER doc. So short answer, no.

If the school wants to change their job description to include their training - AND the school physician is comfortable signing off that a trained paramedic can administer 02 - that may be a possibility - but i'd strongly suggest that if the district wants that and feels that strongly for it, that they investigate the legality of it with their legal counsel before making any moves.

NutmeggeRN, BSN · Nov 15, 2013

And from where would the tank, tubing, mask and regulator come from?

JustBeachyNurse, LPN · Nov 15, 2013

In the schools where I have worked as a 1:1 PDN, if a child needs oxygen 911 is called as the school does not maintain an oxygen supply on campus. (If an acute condition and there is not an existing oxygen order)

If a child needs or has the potential to need oxygen (trach, vent, high risk respiratory condition, hypoxia related to epilepsy, etc) the child is transported to, from & during school with O2 and the district either provides a 1:1 RN or LPN or pays for a private duty nurse.

Medics in my state are only medics when on duty working under the direction or protocols of an emergency department physician. When off duty they are considered basic EMTs. Medics cannot work off protocols in many other states from anyone other than an ED physician whether in an ED or pre-hospital setting.

As an EMT if we came in with a laboring mother accompanied by medics, the medics could not accompany us to L&D if ED triaged out of ED up to labor as they were no longer considered an ED case. (And therefore no longer under the "care" of the ED physician) EMT basic crew or ER staff had to transfer the patient to maternity.

hobiehobie · Nov 16, 2013

Everyone raises the same questions and concerns I have. There is an intent to use which makes me question Good Samaritan laws if something goes wrong. I also question calibration, quality control, credentials, education, supervision..... First-aid is part of the job description, O2 administration isn't part of the first-aid training so it would be done under the pretense of being a paramedic, which he isn't hired to be.

JustBeachyNurse, LPN · Nov 16, 2013

Check with the state department of emergency medical services (or whatever entity regulates EMS in your state) I know when I did EMS, the state had no issue pulling a medic's cert who elected to act as a paramedic when not on duty/working under the supervision of an emergency dept physician or out of scope of practice. One was censured for accepting orders from a cardiologist in lieu of EMS protocols. The regs in my state at clear that EMT-P/paramedics are considered EMT-B(basic) when not specifically working as a paramedic under medical control.

Is this his own O2 supply? Since oxygen is a drug/medication under who's medical authority is he administering the oxygen (paramedics are not autonomous or independent practitioners ). Here's the national recommendations for education & scope of practice for EMS personnel. http://www.ems.gov/education/EMSScope.pdf

I'd also look into the liability of a staff member carrying a hazardous material on school grounds (oxygen is considered a hazardous material/dangerous goods. There are specific storage and handling requirements and regulations. Oxygen has a dangerous good DOT classification of UN1072, OXYGEN COMPRESSED, hazard class 2.2 non-flammable gas

In many schools the school nurse is the designated OSHA "right to know" officer for the school. If I have a patient that has the potential to require oxygen the school nurse ensures the classroom staff is educated on safe handing of O2 during staff orientation )

akulahawkRN, ADN, RN, EMT-P · Nov 16, 2013

Hi
If a staff member is trained as a paramedic, are they allowed to carry and administer O2 in a school?

It depends upon a number of things. Where I live, Paramedics that are accredited and are affiliated with a local ALS agency are explicitly authorized to provide their full scope of practice when off duty. This is unusual. Most of the time, a Paramedic is only authorized to perform EMT level stuff when off duty. This would include oxygen administration.

That Paramedic would have to be able to get USP oxygen to put in their own bottle. The bottles and regulators aren't usually prescription devices, but the oxygen that goes inside usually is. That's one issue right there.

Now in a school setting, as stated, there's also OSHA issues and local school district policies to contend with. If all of those issues are worked out and the oxygen bottle at school is approved, the Paramedic in question has a prescription to obtain USP oxygen for refills, and has local/school authorization to administer it, then theoretically, yes, it would likely be allowable for that Paramedic to administer it at school.

Paramedics aren't uneducated dunderheads... usually. The physician whose authority they work under may be an ER MD, or probably more commonly, an EMS System Medical Director. Their protocols may be off-line, or on-line, or a combination of the two. Paramedics can take verbal orders, usually, but there may be some issues with how they can take verbal orders from a physician at scene if the physician isn't accompanying the patient all the way to the hospital. All EMS systems should have a policy about physician-paramedic interaction at scene.

Effectively speaking, they'd have to go through the same process you would to be able to administer oxygen at school.

TraumaSurfer · Dec 12, 2013

It depends upon a number of things. Where I live, Paramedics that are accredited and are affiliated with a local ALS agency are explicitly authorized to provide their full scope of practice when off duty. This is unusual. Most of the time, a Paramedic is only authorized to perform EMT level stuff when off duty. This would include oxygen administration.

If a Paramedic is working under a different title or not for the ALS agency which normally employs them, then they must abide by the job description they were hired for and currently working at. If you a Paramedic who is moonlighting as an ER or Monitor Tech in a hospital in California (Sacramento) you can not carry your EMS drug bag with you in the hospital and pull out the Paramedic patch whenever you feel like it. You are ON DUTY but at another job in another scope of practice. The Paramedic has made an informed decision to be employed in a job other than Paramedic and must recognize their "scope of practice" is determined by their new title and employer. Even Paramedics working in the ER as a tech can not initiate O2 without some delegation of duty by an RN in more hospitals and that RN is acting under standing orders. If the RN at the school system is supervising the Paramedic, this will be on them until they can find the policy pertaining to this situation.

Several schools do have emergency O2 tanks available but must abide by the state, county or school district regulations. But, you do not have to be a Paramedic to use it and even the Paramedic will have to be trained for this particular system and the regulations of its use.

Safe storage is another issue for carrying and storing a "personal" tank especially in a public place of business such as a school.