After dive oxygen: shouldn’t the diver decide?

[Wookie]

DCS symptoms are not blisters.....

My personal opinion (of which you have every right to disagree with) is that as a person with a business to protect, one should error on the side of extreme caution then it comes to liability protection.

Well, they can be. Having had symptoms of type 1, type 2, and skin bends, they can be. I am no DCS expert, but I've seen 100 cases and been bent 4 or 5 times myself. Skin bends can present as crepitus, for which O2 or time is the only treatment. Must be careful that they are not masking other symptoms. Pain only will resolve with O2 if treated quickly, but again, as in your description, you must be careful that the pain only is not masking neurological symptoms. Obviously, O2 is first aid for DCS, and a chamber is critical treatment if first aid doesn't work.

I can't speak to your day boat example, I don't run one, so for us, treatment is a 8 hour boat ride, and the end of the dive trip away. If we call the evacuation helo, it is $52,000 for non-Monroe County residents. Not quite the same as having an ambulance waiting at the dock. In the case where the victims insurance company refused to pay for the evacuation of an NPS employee, (a clear workman's comp case) the NPS employee was made to pay for his evacuation himself. That one was in litigation for years, resolved last summer. So there are 2 ways to look at things. If the guy who wants to go on O2 decides he needs to be evacuated, and his insurance company decides that the helo to evacuate does not charge reasonable and customary service fees, the guy who called the evac helo is on the hook for it. That would be the captain.

The more I dive, and the more I see the medical conditions brought on by diving, the less nervous I am about them. I'm a little surprised no one has brought up the specific recent Nautilus Explorer event specifically, but maybe that's what this thread is about. Specifically, I have seen divers come up with bloody frothy sputum and bleeding as they breath. It's a freakshow to look at, but more O2 is the last thing you want them on.

 

[The Chairman]

30 minutes into his drive the symptoms become so painful that he loses control of his vehicle and veers off the road, ending up upside down in the mangroves after plowing over a couple of bridge fisherman shuttling their gear out to the bridge. Who do you think is getting sued?

Awesome fiction dude, you should write a novel. What if you put that same diver into an ambulance, and the moon falls on it as it's on the 20 mile stretch, and it slides into Florida Bay??? Who's gonna get sued then? What if, what if, what if. I have yet to hear of a dive op being sued for giving a diver in distress oxygen. Have you? Let's not allow our imagination to run wild in the 'what if' department. That's how phobias are propagated and that's why there are so many myths circulating about using oxygen. Logic would indicate that it's far more likely that a diver would sue over being denied oxygen, than being offered it. While I have no way to accurately quantify it, I would put that at least to a thousand to one odds.

 

[charlier]

It's time to hijack the thread, but only for a moment. As a former member of the professional ski patrol, we occasionally arrived at work at about 6am with a mild hangover. Perhaps after a long avalanche cycle, with long work days, we found that supplemental O2 improved our mental alertness, mitigated the funky headaches, and made us feel better. On a more serious note, we usually administered O2 to many patients (all of us were EMT trained as a minimum). I know that sometimes I would appreciate O2 at the end of the day, in particular after a week of guiding. ;-)

 

[tomfcrist]

Awesome fiction dude, you should write a novel. What if you put that same diver into an ambulance, and the moon falls on it as it's on the 20 mile stretch, and it slides into Florida Bay??? Who's gonna get sued then? What if, what if, what if. I have yet to hear of a dive op being sued for giving a diver in distress oxygen. Have you? Let's not allow our imagination to run wild in the 'what if' department. That's how phobias are propagated and that's why there are so many myths circulating about using oxygen. Logic would indicate that it's far more likely that a diver would sue over being denied oxygen, than being offered it. While I have no way to accurately quantify it, I would put that at least to a thousand to one odds.

LMAO...Maybe I should write a novel....

Liability in this day and age is absolutely a game of "What if". I'm not saying deny anyone O2...

 

[uncfnp]

Interesting discussion and perspectives.

First 100% oxygen is a drug, just as is tylenol, pcn and nitrous oxide. And just like any other medication it can have beneficial and harmful effects.

The discussion so far has included two separate aspects of therapy that probably need to be clarified, O2 used prophylactic and oxygen given as treatment for symptoms. In my opinion, O2 for prophylactic use (and this includes the use of O2 at deco stops as well as the guy that just wants a hit to feel better) is not the responsibility of the dive boats unless by prior arrangement.

Now, O2 as a medical treatment is an altogether different scenario. And yes, from my earliest days diving I heard that if you go on O2 you go to the hospital for evaluation. This was one reason for my surprise when I read a thread on SB posted by a member that had symptoms after diving, used boat O2, felt better, drove home and ended up in a chamber. But the question as to whether this requirement is a reasonable is valid. It could very well deter use when it is indeed needed.

 

[Bob DBF]

I've been on a boat when I heard a request to go on the boat's O2 meant a required call to have EMS waiting at the dock. Talk about a disincentive to go on Oxygen!

Sounds reasonable to me. You are asking to use the emergency medical O2, which is administered as medical treatment by non medical staff. Reasonable procedure would dictate you would be evaluated by a medical professional as soon as possible to ascertain your condition. In addition, most of the boats I've been on do not have enough O2 to handle more than one real emergency.

As before I have nothing against using O2 on the boat, just not the emergency medical O2. The emergency O2 there to save a life, not to make someones day a little easier.



Bob
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I think that advocating unsafe and dangerous practices is both stupid and foolish. That is why I don't tell people to do what I do. Dsix36

 

[The Chairman]

The discussion so far has included two separate aspects of therapy that probably need to be clarified, O2 used prophylactic and oxygen given as treatment for symptoms.

This is an astute observation and maybe even a revelation. Perhaps, the problem is so many see any use of oxygen as a medical Rx. Just like deco diving, oxygen can and is used as a prophylactic and that changes the perspective.

Now, O2 as a medical treatment is an altogether different scenario. And yes, from my earliest days diving I heard that if you go on O2 you go to the hospital for evaluation.

But it's not the O2 that necessitates going to the hospital, but the accident. Like Frank, our whole attitude towards O2 is evolving. I rarely saw O2 on boats ten/fifteen years ago, but they are becoming more common place. Our old paradigms just won't work with the new realities. Is going on O2 for exhaustion a medical treatment or just prudent? We see athletes going on it all the time and they are in top physical shape. I'm in shape in so much as round is a shape. If I have to fight a current to get back to the boat a little dose of oxygen only makes sense.

This was one reason for my surprise when I read a thread on SB posted by a member that had symptoms after diving, used boat O2, felt better, drove home and ended up in a chamber.

Dude, without it crashing into the mangroves, how do you expect us to take you seriously???

But the question as to whether this requirement is a reasonable is valid. It could very well deter use when it is indeed needed.

That's the crux of my problem with this 'one rule fits all' strategy: the unintended consequences. The 'if oxygen then hospital' mentality really inhibits a diver from seeking oxygen at a time when it can do the most good. I think we need to take the onus off of oxygen and evaluate these incidents on their own merits. I've never been a fan of 'zero tolerance' rules and this smacks as being one of them.

In addition, most of the boats I've been on do not have enough O2 to handle more than one real emergency.

Which is stupid since many divers are bent in pairs and not singly. They need to think like a cave diver here: two is one, one is none. Multiple redundancy should be the norm, not the exception.

 

[Bob DBF]

The discussion so far has included two separate aspects of therapy that probably need to be clarified, O2 used prophylactic and oxygen given as treatment for symptoms. In my opinion, O2 for prophylactic use (and this includes the use of O2 at deco stops as well as the guy that just wants a hit to feel better) is not the responsibility of the dive boats unless by prior arrangement.

Agreed.

Now, O2 as a medical treatment is an altogether different scenario. And yes, from my earliest days diving I heard that if you go on O2 you go to the hospital for evaluation. This was one reason for my surprise when I read a thread on SB posted by a member that had symptoms after diving, used boat O2, felt better, drove home and ended up in a chamber. But the question as to whether this requirement is a reasonable is valid. It could very well deter use when it is indeed needed.

This is exactly why the requirement to see a medical professional is reasonable, said example would not have masked the symptoms and postponed proper treatment. As far as deterring the use of O2, from my experience it won't deter you long if you are bent.



Bob
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That's my point, people, by and large, are not taught that diving can be deadly, they are taught how safe it is, and they are not equipped with the skills, taught and trained to the level required to be useful in an emergency.

 

[uncfnp]

But it's not the O2 that necessitates going to the hospital, but the accident.

Agreed. Its not the treatment but the reason for the treatment. So that said, if a diver needs treatment it stands to reason that they need evaluation by a trained medical provider as well.

The problem develops in that gray zone, the diver with vague symptoms including that diver that is "exhausted." Is it the responsibility of the crew to determine the severity of the symptoms? Is it the diver's responsibility? Or is it most medically prudent to require a medical evaluation once treatment is initiated? Who decides?

And a "patient" always has the right to refuse transportation/treatment.

---------- Post added March 31st, 2015 at 11:24 AM ----------

Agreed.
...//...As far as deterring the use of O2, from my experience it won't deter you long if you are bent.

Bob

No way to know the numbers but I can tell you that denial in general can be a huge factor in delay of treatment with medical emergencies.

 

[Wookie]

You are on a week long liveaboard to Cay Sal. Boat policy is, go on O2, call DAN, follow instructions. DAN takes the conservative route, evacuate. Fair enough. Since it's a US citizen on a US flagged boat, Coast Guard will fly. Except this happens after the 4th dive of the day, when whomever the Coast Guard has to get permission from in the Bahamas has gone home, so the Coast Guard says "Meet us part way, we'll pluck him off the boat". And by 3 AM the boat is back in US waters and we might as well go the rest of the way to the dock.

We've just broken a number of US laws, by the way. Immigration laws, CG regulations, and etc. etc. We've entered the country illegally. The fine is $5,000 per passenger. So we are now $60k to the bad. It's going to take me 2 days to straighten out the CBP issues so I can run the next charter, to say nothing of finishing this one. One customer exclaims that his vacation is ruined (it is, I have sympathy) and he wants a refund. Now, 10 other passengers want a refund too. The victim is very quiet about all of this, because his symptoms were completely resolved after 30 minutes on O2 and did not recur.

Now, I would never withhold medical treatment or evacuation to any customer regardless of the personal cost or corporate cost or any cost, but maybe it isn't all as cut and dried as "If you are bent, you are going to a chamber".