After dive oxygen: shouldn’t the diver decide?

[KenGordon]

Are you saying there are hyperbaric physicians who think if someone has DCS, they can just breathe oxygen on the surface interval and then go on their second dive?

My experience of hyperbaric doctors is that they may well leave it to the diver to decide whether to get in the chamber or not.

Really it all depends on the circumstances. If a diver has a rash, or can't stand up, walk straight or know what day it is then yes, give them O2 and call the coastguard. On the other hand, if for whatever reason they think they are at risk of DCS and it just isn't manifesting yet then what? It isn't clear cut, for any degree of severity of risk we can just pick a slightly less severe but still above normal risk and ask the same question.

 

[bakodiver391]

Beano, If you read my post, I say 24hours of no diving. That's pretty clear, and yes there are MDs who abide by this. FWIW, I have had an MD hide classic skin bend symptoms and continue to dive and be generally uncooperative, I have also had a diver who made only 1 dive to 15 feet for around 15 minutes (likely on a set point of 1.2 on her rebreather, so nearly pure oxygen) swear up and down that she was bent, and never was convinced otherwise. So it takes some judgement and some finesse to get divers to admit to a problem and then to deal with it effectively. Essentially intelligent, informed decisions every step of the way, not knee-jerk reactions.

 

[freewillie]

Just to reinforce the issue. The definitive therapy for DCI/AGE is time in the hyperbaric chamber. And the number of therapies will depend on how many sessions until symptoms disappear. The use of oxygen will help improve symptoms but is never considered a therapy in and of itself. It a splint so to speak until you can get more definitive treatment. The timing of the need for hyperbaric therapy depends on the triage - emergent, urgent, or timely.

And you just don't know for sure if you are dealing with DCI/AGE if you start therapy and feel better or if you didn't but you would feel better anyways. If you potentially have symptoms consistent with DCI/AGE they should improve once starting oxygen. It is also very clear and it becomes one of the biggest mistakes is the then assume the patient does not need further therapy or evaluation. And there in lies the rub.

You can simply be tired, fatigued, and achy and not have DCI/AGE or you might be exhibiting mild symptoms. You simply don't know. To make matters worse both will get better with oxygen. Anecdotal experience doesn't count either since you may have thought you had DCI symptoms that improved with oxygen or you actually didn't but it felt better anyways. Just don't know.

Bottom line is you have to decide before you start the oxygen if you have a dive related injury or not. And that is the concern. Yes there are barriers to speaking up and issues surrounding what will happen next. You will then have to take stock of how your body is feeling and how serious do you think your symptoms are at that time. Never forget that you are the only one that can determine how your body is feeling. Not the doctor. That's why we ask you question and try and get you to explain your symptoms. But the decision is actually before you start O2.

 

[Wookie]

As an operator, I have an entirely different response to "please refill my oxygen cylinder" then I do to "I need to go on emergency oxygen".

the first case is just something we do. The second case activates an event tree.

But I would never go as far as Pete suggests "Here, have some oxygen, you look tired"

 

[NAM001]

That is not my point. First off i have never been on a boat that had a rec diver ask for preventive O2. The point is that Emergency O2 needs are fed from Emergency supplies. recreational uses should come from recreational/non emergency supplies. If the ice maker breaks the boat brings a chest of ice, they dont allow the passengers the CO2's to chill thier drinks. If one had a portable concentrator and was ALLOWED to bring it onboard one should be able to use it. I would also expect the boat to ask why i was briniging it. If i said i only have 1/2 a lung and i tire quickly, then i should be booted off the boat for not being fit to dove. And in that case if the boat had to return to port cause of an emergency related with his medical problems Yes the boat should reinburse any divers expences for allowing that limited diver onboard. If the person says i just like the high form the O2 (when there is a medical issue) then the person should pay the expences for lying to the boat captain for the purpose of getting passage.

I have never met any of these 'convenience inhalers' so I don't think rules are needed to deal with them. I could be wrong and US boats might be dry of O2 daily, is that the case?

---------- Post added April 3rd, 2015 at 04:15 PM ----------

Its an interesting thought, dont know mcuch about it but off the cuff i would think that such a thing would increase the margin of safety for sollow on dives. On the other side of the coin, can a boat run say a 25% O2 atmosphere and still operately safely ? (fire concerns)

Instead of after-dive snacks, how about an on-board Oxygen Bar?


Oxygen bar - Wikipedia, the free encyclopedia

Seems safe enough for recreational imbibers. Makes me wonder.

DC

---------- Post added April 3rd, 2015 at 04:31 PM ----------

If you bring your own O2 on board the How did you get it? If you have a perscription then why do you have it? If its a health need then you are not fit to dive. If you are not fit to dive you dont get on the boat. That is the hole in a previous post i read about if you dont have your own O2 then you aren't prepared for your dive. Rec dives do not need O2 as a preperaton item. Once agsin Rec divers should never need O2, If they do ther is a problem with the diver. If a problem exists then treat them and ground them to a boat and make the calls. O2 on the boat is a reasonable aspect for normal/contingency preperations for tech divers and I suppose RB divers.

Just wondering whether this is actually an option, or whether the boat crew is compelled to react, since otherwise they would potentially be risking a lawsuit (especially when there are likely to be multiple witnesses that they were aware of the condition, and looked the other way). What legal obligation does the crew have in such a case?

 

[Akimbo]

The trouble with the vast majority of hyperbaric doctors is they don’t see bent divers until hours or days after symptoms present. I think that gives them a much different perspective than the experiences of commercial divers with chambers and operators onboard. Treatment usually began within minutes of reporting suspected symptoms, which is consistent with my naval training.

We saw lots of bent divers with joint pain and rash. I am confident that the severity of symptoms would have rapidly progressed with delayed treatment. Most supervisors would blow a diver down to 60' on O2 at the slightest hint of symptoms — with the exception of irritability accompanied by foul language.

To be fair, the bends cases we treated resulted from dives well outside of recreational limits, but within what some technical divers perform. That certainly changes the severity of DCS cases, but I believe does not change the positive effect of immediate treatment.

There is no debate that the definitive treatment for bends is a chamber ride, but that is across the board for the entire range of symptoms. I’m not so certain that O2 on the surface for very mild cases of skin bends is always inadequate.

So where does that leave us? I’m in agreement with NetDoc that barriers to getting on Oxygen should ideally be minimized. The real question is what to do after that and how does the reaction create barriers to O2 treatment? Obviously it’s time to call DAN and the Coast Guard if symptoms aren’t alleviated. The sticky part is what to do if they are. It is a legal, ethical, and practical can of worms.

The simple solution for advanced divers is to BYOO2 and follow their gut. Unfortunately, most divers wouldn’t know what to do even if you had an O2 BIBS mask hanging at every dive station, which is as close to “zero barrier” as I can image. It’s easy on a day boat or the last day on a liveaboard. Just say “no more diving and you should see a hyperbaric doc when you get ashore”. It gets a lot more complex at the beginning of a Galapagos liveaboard trip.

All things considered. I’m firmly in the “treat and ask questions later camp”. It’s not like everyone is going to suspend thinking or stop observing until after an hour on O2.

 

[NAM001]

Wookie

What would a diver need to get a tank of O2 from you. I ask because if you need a nitrox card to et gas up to 40% and a tech card to get 100%, are you saying thta you would dive anyone who asked a tank of O2 or only those that are carded to get it? I would think that form a legal point of view giving O2 out with out a card / or a script would be tabo. I nkow i gcant get O2 in other than welding form without a perscription.

As an operator, I have an entirely different response to "please refill my oxygen cylinder" then I do to "I need to go on emergency oxygen".

the first case is just something we do. The second case activates an event tree.

But I would never go as far as Pete suggests "Here, have some oxygen, you look tired"

 

[dumpsterDiver]

Just to reinforce the issue. The definitive therapy for DCI/AGE is time in the hyperbaric chamber. And the number of therapies will depend on how many sessions until symptoms disappear. The use of oxygen will help improve symptoms but is never considered a therapy in and of itself. It a splint so to speak until you can get more definitive treatment. The timing of the need for hyperbaric therapy depends on the triage - emergent, urgent, or timely.

And you just don't know for sure if you are dealing with DCI/AGE if you start therapy and feel better or if you didn't but you would feel better anyways. If you potentially have symptoms consistent with DCI/AGE they should improve once starting oxygen. It is also very clear and it becomes one of the biggest mistakes is the then assume the patient does not need further therapy or evaluation. And there in lies the rub.

You can simply be tired, fatigued, and achy and not have DCI/AGE or you might be exhibiting mild symptoms. You simply don't know. To make matters worse both will get better with oxygen. Anecdotal experience doesn't count either since you may have thought you had DCI symptoms that improved with oxygen or you actually didn't but it felt better anyways. Just don't know.

Bottom line is you have to decide before you start the oxygen if you have a dive related injury or not. And that is the concern. Yes there are barriers to speaking up and issues surrounding what will happen next. You will then have to take stock of how your body is feeling and how serious do you think your symptoms are at that time. Never forget that you are the only one that can determine how your body is feeling. Not the doctor. That's why we ask you question and try and get you to explain your symptoms. But the decision is actually before you start O2.

Anecdotal experience does count??? Just my case alone. I have done thousands of dives and I do one and only one dive where I come up with total numbness on one side and it is totally resolved by oxygen in 15 minutes ,,, and it is not reasonable to conclude that it was the bends and that oxygen and time resolved it? The oxygen and the diving "didn't count" because a doctor didn't make a definitive diagnosis?

 

[Wookie]

Wookie

What would a diver need to get a tank of O2 from you. I ask because if you need a nitrox card to et gas up to 40% and a tech card to get 100%, are you saying thta you would dive anyone who asked a tank of O2 or only those that are carded to get it? I would think that form a legal point of view giving O2 out with out a card / or a script would be tabo. I nkow i gcant get O2 in other than welding form without a perscription.

I carry emergency O2 for emergencies. I carry regular old aviator o2 when I have techies and rebreathers. I don't typically carry O2 at other times.

 

[TSandM]

A few years back, we did a couple of three day trips on a charter boat in the Channel Islands in California. We had 20-odd divers on the boat (and 23 scooters!) and although no technical profiles were contemplated, we had about a dozen deco bottles full of O2 on the boat, just in case somebody got ambitious. (The majority of the divers were in doubles, too.). On that trip, if somebody had wanted to huff a little O2, all they had to do was slap a regulator on one of the tanks chilling in the fish holding tanks at the stern.

I still think that a prudent operator, if someone requests O2 because of symptoms, would end that person's diving and make arrangements to get them to medical care. The liability is just too awful if they don't. Yes, a little O2 may resolve your skin bends -- but skin bends are considered in the same category as neurologic symptoms, and if the diver went on oxygen, felt better, and went down to his bunk to lie down, and four hours later couldn't move anything from the waist down, do you think he'd absolve the dive op of responsibility for his paraplegia?

It DOES present a barrier to requesting oxygen, but there probably should be at least a little of one, for the reasons I stated earlier. An unfamiliar ache, a little more fatigue than usual, or a mark where a strap was sitting . . . maybe it's not bad to make someone wait a little while to decide if the symptoms are significant or worsening. Heaven knows I see enough people in the emergency room who have panicked over relatively minor symptoms and come in because they were afraid to wait at all to see if the symptoms would resolve. In that case, the only downside is inappropriate use of emergency services. In the case of the overanxious diver, the inconvenience to the rest of the boat, and the costs to the operator, would be significant.