After dive oxygen: shouldn’t the diver decide?

[tomfcrist]

Frank,

You already said that if DAN says evac, you are going to evac... The Immigration laws, boat policy on refunds and how many customers are pissed that their trip got cut short because you needed to evac a passenger is blurring your vision. To sum it all up, if its going to cost you an ass-ton of money, you are ok with playing doctor and making the determination that a persons DCS symptoms are resolved...because that is what you are talking about doing. That is your decision, but realize that it opens the door for litigation...and opens it WIDE.

 

[Akimbo]

It doesn’t sound like anyone wants to deny Oxygen to anyone for almost any reason. Agreed and fair enough. It is more a question of who should pay for it, how much is onboard, and how much is held in reserve for actual medical emergencies.

Is it unreasonable for a passenger to pay for Oxygen used for prophylactic, vaguely suspected DCS, pre-dive, or hangover treatment? I don’t think it is fair to require/expect the boat operator to absorb that cost. Personally, I don’t have any heartburn over being asked to reimburse for emergency Oxygen but it is the boat operator’s decision to ask or not.

There is also a logistics issue for a half-day six-pack compared to a 100' plus liveaboard. Should there be a formula for Oxygen storage requirements based on passengers, number of dives dock-to-dock, and distance operating from shore? We could get serious and add requirements for a chamber onboard and a helipad for liveaboards operating more than a few hours from a DCS treatment center. The trouble is none of us can afford chartering one of these:

 

[Bob DBF]

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.

I don't see it as a gray zone, if you use the boats emergency medical O2, it is an emergency. The first aid responders (crew) are not medical professionals and can not diagnose, the can only treat the victim for the symptoms he brings to them and get the victim to proper medical attention. The victim decides he needs medical treatment unless he is unconscious or incoherent, the responders try to keep the victim alive until they can turn him over to professional medical care.

The patient does has the right to refuse treatment, I believe they should start by not wasting the limited resources on the boat for something they obviously believe is not an emergency.



Bob
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"the future is uncertain and the end is always near"
Jim Morrison

 

[The Chairman]

you are ok with playing doctor and making the determination that a persons DCS symptoms are resolved...because that is what you are talking about doing. That is your decision, but realize that it opens the door for litigation...and opens it WIDE.

Frank doesn't play doctor or enforcer and I don't think his vision is blurred. If the diver makes the call to go on oxygen, then he can make the call to stop it. However, once Frank initiated EMS by calling the CG and DAN, he had an obligation to them as well. I'm sure he made that call with the diver's cooperation and knowledge of what will be happening. It's not something to do on a mere whim. It's horrible to think that US or Bahamian law does not accommodate an emergency such as this with one of it's citizens, and I guess that's what trip insurance is for. Scotty from the Blue Iguana will comp the passengers a day for each day they are inconvenienced. That's a win/win and he seems to be pretty proactive in offering that right up front. Most divers realize that even those these boats sail on deep waters, they don't have deep pockets. IOW, they want what's fair and I'm sure a few want the moon, but I'm hoping that's the exception.

The patient does has the right to refuse treatment, I believe they should start by not wasting the limited resources on the boat for something they obviously believe is not an emergency.

Denial: not just another river in Egypt. Some actions reinforce that. Some remove the barriers. I would err on the side of giving them what they think they need right now.

 

[tomfcrist]

Frank doesn't play doctor or enforcer and I don't think his vision is blurred. If the diver makes the call to go on oxygen, then he can make the call to stop it. However, once Frank initiated EMS by calling the CG and DAN, he had an obligation to them as well. I'm sure he made that call with the diver's cooperation and knowledge of what will be happening. It's not something to do on a mere whim.

Maybe we are talking about two different things. You seem to be talking about a tired or "I just don't feel great" diver...I am talking about one with presumed DCS, which is in my mind a dive injury.

From Franks FAQ:

 "Diving injury: if the injury is dive related, the diver willbe placed on 100% oxygen, and the evacuation plan willbe initiated with the USCG. The diver recall will besounded, all other divers will terminate their dives, andafter appropriate deco, will surface and re-board the​

vessel. The vessel will get underway for shore to meet the

USCG helicopter if available. If the injured diver isevacuated by the USCG, an alternate dive site will be​

picked for the continuation of the trip."

Sounds reasonable to me. Now if he chooses to disregard his own written policy, and someone is seriously injured or dies, what do you think is going to happen? Even if he isn't sued, the USCG can pull his Capt. License. It has happened, and will again I'm sure.

Boat policy is, go on O2, call DAN, follow instructions.

​

Once again...very logical and it is agreeable with his boats written policies:

"Medical grade bottles of oxygen will be provided fordivers to breathe from on the surface. There will be nodisincentive for using this oxygen. Medical oxygen will​

be provided for injured divers."


Pay attention to the last two words.....Injured divers....Now refer to the previously posted policy.

I don't think I'm missing the big picture here....If he want to give free O2 to folks that are winded from climbing the damn ladder, that is a different story completely.

 

[Wookie]

So the question which has stopped all other progress on the subject is "what is a dive injury?". If a dude comes up the ladder with bloody froth coming out of his mouth, he probably has a dive injury (PE or IPE) and he's likely to go get lots of ER help. If he comes up the ladder with a red rash that goes away with time or O2, he's likely to give DAN a call.

But one thing that is interesting is that DAN is not hot and bothered to evacuate every time either. They will consider carefully the results of O2 administration (I spelled that right, but it's the wrong word. Spell check is no help) and diving profiles/general health of the diver before they make a recommendation.

 

[The Chairman]

So the question which has stopped all other progress on the subject is "what is a dive injury?". If a dude comes up the ladder with bloody froth coming out of his mouth, he probably has a dive injury (PE or IPE) and he's likely to go get lots of ER help. If he comes up the ladder with a red rash that goes away with time or O2, he's likely to give DAN a call.

But one thing that is interesting is that DAN is not hot and bothered to evacuate every time either. They will consider carefully the results of O2 administration (I spelled that right, but it's the wrong word. Spell check is no help) and diving profiles/general health of the diver before they make a recommendation.

To me this is reasonable. To have histrionics and call the USCG anytime a diver gets oxygen for what ever reason does not sound reasonable to me.

To limit oxygen to only emergencies disregards therapeutic uses that might actually prevent an emergency from occurring. To me, that's what Frank refers to as a 'disincentive' to getting oxygen. That's great if you want to foment denial. Not so great if you want to keep your divers healthy and happy.

 

[uncfnp]

I don't see it as a gray zone...//...

Bob. There is always a grey zone. In this case, and for much of the thread, its the question whether or not to treat the diver with unclear symptoms.

So the question which has stopped all other progress on the subject is "what is a dive injury?". If a dude comes up the ladder with bloody froth coming out of his mouth, he probably has a dive injury (PE or IPE) and he's likely to go get lots of ER help. If he comes up the ladder with a red rash that goes away with time or O2, he's likely to give DAN a call.

But one thing that is interesting is that DAN is not hot and bothered to evacuate every time either. They will consider carefully the results of O2 administration (I spelled that right, but it's the wrong word. Spell check is no help) and diving profiles/general health of the diver before they make a recommendation.

Exactly. Specifically, DCI is a continuum. From subclinical fatigue to AGE. When to treat and when to seek professional medical evaluation is the conundrum.

I am pleasantly surprised that DAN does not have the knee jerk reaction of most healthcare phone call triage that always seems to cover their liability risk with the standard "go to the doctor/ER" advise.

 

[Wookie]

I am pleasantly surprised that DAN does not have the knee jerk reaction of most healthcare phone call triage that always seems to care there liability risk with the standard "go to the doctor/ER" advise.

Some people would call that denial of medical care and bring up the subject of death panels. IJS. And I'm also just repeating what I've heard before, in kind of a devil's advocate sort of way. I remember in a DAN-bashing thread a year or more ago that if DAN didn't recommend evacuation and chamber treatment, they were being a cheap insurance company.

 

[Bob DBF]

Quote Originally Posted by Bob DBF View Post
The patient does has the right to refuse treatment, I believe they should start by not wasting the limited resources on the boat for something they obviously believe is not an emergency.

Denial: not just another river in Egypt. Some actions reinforce that. Some remove the barriers. I would err on the side of giving them what they think they need right now.

I am not saying to deny the use of Emergency Medical O2, but to treat it's use as an emergency, as you are depleting the only source of that emergency aid available. Contact DAN and let a medical professional decide what to do next or get the victim to medical care.

If you want O2 to make you feel better because you are tired bring your own O2, if the boat doesn't sell it on board.

Symptoms of DCS are fuzzy, to say the least, the use of Emergency Medical procedures and supplies should not be.

It seems there may be a need for non emergency O2, but it should be a separate issue from involving the crew and the emergency O2 supply.


Bob