Low Oxygen Readings Without Difficulty Breathing?

There have been multiple discussions amongst QPR groups regarding the most appropriate protocol for a patient who is on oxygen, breathing normally, asymptomatic, but is showing low oxygen readings. Some say Protocol 26: Sick Person (Specific Diagnosis) as there are many reasons someone could be showing low oxygen (my husband says they get dispatched for calls often where they just forgot to turn the tank on) or the pulse oximeter is not reading or working properly. And technically there is no "difficulty" breathing—it's just showing a low reading of oxygen on a machine. If we are scoring them based on rules within protocol, Chief Complaint Selection Rule 5 says there is no "foremost symptom" as they are having no symptoms at all.

The other side of the argument is that breathing problems would likely send a CHARLIE response over the ALPHA response from Protocol 26 and if they are hypoxic in any way, we should aim for the higher response. But agencies and reviewers alike keep looking for some guidance in this area. A Journal entry might be beneficial. I found one close, but it does not address this scenario that we keep coming across.

Appreciate your feedback on this.

Joan Cruickshank
Independent Contractor
Quality Performance Review (QPR) Division
Priority Dispatch Corp.
Medicine Hat, Alberta, Canada

Hi Joan:
An accommodation for low O2 saturation levels only has been significantly discussed at the Medical Standards Rules Committee several times. In fact, during the COVID-19 pandemic, when patients were being sent home from the hospital relatively early and during a time of specific risk of asymptomatic but dangerously low O2 saturation levels (they were sent home with saturation monitors), we created a placeholder with various limits specific to the UKE version of the Protocol where this phenomenon was happening. However, this accommodation was not sought elsewhere, presumably because patients were not being released early in other parts of the world with this device to watch. Therefore, this protocol accommodation was not implemented elsewhere.

Since that time, O2 saturation monitors have gained popularity and are now available to the general public—many folks have them built into their fitness watches—so the question keeps coming up. However, we have not had any documented cases of under-triage with asymptomatic hypoxia, so we have not yet implemented any universal changes to the MPDS.

For now, without a complaint of breathing problems, or other priority symptoms, and with a complaint of low saturation numbers alone, Protocol 26 is appropriate.
Brett A. Patterson
Chair, Medical Council of Standards
International Academies of Emergency Dispatch^®

Hi Brett,
Thank you very much for the clarification and timely reply.

Much appreciated,
Joan

Doc says,
In 2015, my best friend, The Goose, went to his doctor for a scheduled appointment while coincidentally having a viral respiratory infection that was bugging him. When the doctor spoke for a minute and watched him, he said, “Steve, you don’t look so good,” and put a small pulse oximeter on his finger, which read out at 76 (normal for most people is 95 to 100).

Goose, over the years, had developed a significant case of emphysema (COPD) from years of smoking, which made this finding somewhat more ominous. Needless to say, 911 was not called, no ambulance or paramedics responded, but the doctor arranged to have him admitted to a nearby hospital for a deeper evaluation and possible treatment.

He was still basically asymptomatic (priority symptoms-wise) and required care soon, but it was not a prehospital emergency. No, he didn’t die, and he got better, but he remained on a bottled-oxygen cannula at home.

As my de facto “big brother,” he continued to teach me many more “facts-of-life” for several more precious years.
Onward through the asymptomatic fog
… Doc