This story on the use of nitrous oxide in ambulances seems to come out of nowhere, which is often a good starting point for a news story. It covers the costs of the drug. It quotes multiple sources. It discusses the harms of the drug. But it also fails to answer too many questions. Deep in this story about nitrous oxide being used on ambulances, we catch a glimpse of a story that is still to be written. It’s in one sentence that reads, “The renewed use of nitrous on ambulances comes as some states have begun to allow advanced EMTs, which have less training than paramedics, to administer it, in line with national guidelines.”
The question could have been: “Are local governments, in search of lower costs associated with emergency medical care, looking for new ways to cut corners?” Instead, the story presents us with a few anecdotes about the use of nitrous oxide in ambulances. It is unclear whether the actual number of people being given nitrous oxide is really on the rise. It is unclear whether there are true benefits to using it. It is unclear how it stacks up against alternatives. And because the specter of the nation’s opioid epidemic is raised, we end up with a story that creates disease mongering around addiction to painkillers when it could have just as easily followed a more informative path.
Without a discussion of the research on using nitrous oxide in ambulance settings, readers are required to rely on anecdotes and personal statements from people interviewed in the story.
The story touches on costs, saying:
Stowe, a largely volunteer squad, is adding a unit to a second ambulance this fall at a cost of about $3,800, plus costs for disposable supplies and some cleaning agents, as well as the nitrous cylinders, which cost about $14 to refill. Brinkman estimates the drug costs less than $10 per use once the equipment is purchased.
It’s not exactly clear what the consumer cost would be, but readers can infer that it’s likely to be inexpensive.
There is no quantification of benefits in this piece. What have clinical trials measured? How much does it help reduce pain and anxiety, in numerical terms?
The story sufficiently explains the potential harms of the drug:
Not all is rosy. Nitrous oxide in and of itself has the potential to be used as a recreational drug and can be misused by providers and patients, or can be stolen for personal use or sale on the street, according to the American Ambulance Association.
And while it has its advantages, nitrous oxide also can cause nausea, vomiting and light-headedness, which could cause complications with some patients, said Dr. Edward Yaghmour, chairman of the American Society of Anesthesiologists’ Committee on Obstetric Anesthesia.
The gas cannot be used in patients with head injuries, or who have abdominal pain or pulmonary concerns.
This is enough to be Satisfactory. But two major risks weren’t discussed adequately: Intermediate EMTs may not be able to recognize a patient with early or initial stages of shock. Giving nitrous to that patient could be disastrous and lead to death. There is also a problem with patients who have underlying lung disease and who need extra oxygen. Giving nitrous is usually a 70% nitrous to 30% oxygen, which may not be enough oxygen for some patients with heart or lung diseases.
There is nothing in the story about any evidence supporting the use of nitrous oxide over other anesthetics. What research has been conducted on it? How high-quality is the research? Are there any current studies underway?
We feel that without any explanation of the evidence in support of nitrous oxide or any quantification of the benefits to using nitrous oxide that when the topic of opioid addiction is raised it has the effect of disease mongering. Is the standard or practice in most ambulances today really contributing to the opioid epidemic in the country? Is there evidence for that? Do we have any proof that using nitrous oxide reduces opioid addiction? All we are given is an anecdote: “a woman who dislocated her shoulder asked not to be given narcotics because she was recovering from addiction.”
We would have liked to have seen more scientific expertise tapped for this piece, but we give the story credit for talking with a wide range of sources. We did not detect any potential conflicts of interest.
The story does not compare nitrous oxide to alternatives in a meaningful way.
The story makes it clear that nitrous oxide is currently available in 30 states. It would be hard to quantify, of course, just how frequently it is actually used in ambulance runs. But the story does not overstep to indicate that it is a rapidly rising trend. The story says:
Nitrous oxide equipment has been sold to ambulance crews in at least 30 states in the past three years, including Maine, New York, North Dakota, Oregon, Texas and Wisconsin, according to Henry Schein Medical, the sole distributor of the version for ambulances. Nitrous has been more commonly used in ambulances in Europe and Australia.
The novelty of nitrous oxide or of the trend in using it in ambulances is not established here. We are not left with a clear picture of what is really going on. Did the reporter just happen upon an ambulance company using nitrous oxide or was there a legitimate trend that was uncovered here?
The story does not rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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