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I could write ten bad things about nitrous oxide as a pain management agent, but I’ll leave that for another post.  Don’t get me wrong–the stuff has its uses, but providing analgesia in the field isn’t one of them.

As if to put a finer point on it, a new study about levels of nitrous oxide in ambulances suggests that providers who use it are generally exceeding the current federal standards for exposure.  It’s not the first study, merely the most recent to point out that levels of nitrous oxide can often rise above those considered safe by NIOSH, even with a scavenger system attached.  To wit:

Note that even with a scavenger, the driver reaches the safety limit after just 10 minutes of exposure, to say nothing of that poor sap getting high in the patient compartment.  If, God forbid, it’s winter (closed windows) and you turn off the exhaust fan to hear the command doc over the cell phone, the numbers get considerably worse:

The numbers are a bit better if you have the fan running and windows open–300 ppm for the attendant; a mere 125ish for the driver.

Now, I haven’t dug into the research on the toxic effects of nitrous oxide, but without doing so, I don’t honestly believe that a few hundred ppm of nitrous is going to harm most ambulance folks, when the patient is sitting there puffing on 500,000 ppm.  (The exception is for pregnant women:  I do remember vaguely reading something really bad about the effects on the fetus when a service I once ran for bought nitrous units.)  However, I do like to use this as one more nail in the coffin of an EMS treatment that has outlived its usefulness–especially to people who are more swayed by arguments about worker safety than about what constitutes good medicine.

Conclusion:  Just say no to N₂O!

Filed under: EMS Research