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Oxygen Therapy Standard

General Directive

The paramedic shall:

  1. administer oxygen therapy using an oxygen delivery system and flow rate to attempt to maintain a patient’s oxygen saturation between 92-96%, as measured by SpO2, unless specified otherwise in the Standards;
  2. continuously administer high concentration oxygen for patients who have,
    1. confirmed or suspected carbon monoxide or cyanide toxicity or noxious gas exposure,
    2. upper airway burns,
    3. scuba-diving related disorders,
    4. ongoing cardiopulmonary arrest,
    5. complete airway obstruction, and/or
    6. sickle cell anemia with suspected vaso-occlusive crisis; and
  3. if pulse oximetry equipment is not functioning or not providing an interpretable wave form, administer high concentration oxygen to all patients specified in paragraph 2 above, as well as those with critical findings, which include,
    1. age-specific hypotension,
    2. respiratory distress,
    3. cyanosis, ashen colour, pallor,
    4. altered level of consciousness, and/or
    5. abnormal pregnancy or labour.

Oxygen Therapy and COPD

If a patient with chronic obstructive pulmonary disease (COPD) has increased dyspnea, a decreased level of consciousness, an altered mental status, and/or has suffered major trauma, the paramedic shall:

  1. administer oxygen therapy as per the General Directive above. If pulse oximetry equipment is not functioning, administer oxygen by nasal cannula with oxygen flow at two litres per minute above the patient’s home oxygen levels, or two litres per minute if patient is not on home oxygen;
  2. re-assess the vital signs approximately every 10 minutes;
  3. maintain oxygen flow rate at that level, if the patient’s status improves;
  4. increase oxygen by increments of two litres per minute above starting level approximately every two to three minutes if the patient’s status deteriorates or the patient indicates they feel worse; and
  5. be prepared to ventilate.


Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5