After dive oxygen: shouldn’t the diver decide?

[dumpsterDiver]

The only time I get bent (for sure) was when diving air, after the flu, on a hard swimming dive that was up to the no-deco limits on a Marathon Skinny Dipper computer (which was aggressive). I did my safety stop and felt fine and then 5 minutes later, the skin on one leg was completely numb. No paralysis, no pain, no weakness .. I was freaked out and took the wetsuit off real quick.

This allowed me to scratch and feel my leg and it was as if I was touching someone else's leg. I immediately asked for oxygen and we were going in anyway (maybe 30 minute ride to dock). I was scared and nervous and the adrenaline release was uncomfortable. I tried to relax, drink water and huff Oxygen. Before we hit the dock, all symptoms were completely gone and had no residual symptoms. I'm pretty convinced that without oxygen, I would have needed a chamber ride.

Since that time, I have seen several people get "a little bent" and resolve it with oxygen.. these were elbow, forearm and shoulder pain.. that were not severe.. Oxygen can address these minor injuries, but these were on private boats with friends.

In a recreational setting, with the potential for divers who are barely qualified to dive... running a free oxygen bar and allowing people to "walk it off" (with a little Oxygen).. just seems terribly dangerous from a liability perspective.

 

[beanojones]

When I became a tech diver I changed my whole attitude regarding O2 use on the boat. Before, if you went on O2, DAN was going to get a call. In fact, O2 is first aid for many diving accidents, like a band-aid is first aid for a stubbed toe and ripped toenail, or a fin blister. If you get a fin blister, you don't go to the Emergency room, why all the push to make someone get medical attention?

Now, if you tell me that you suspect that you are bent, you will be given O2. If you get better on the O2, we'll probably call DAN, or let you call DAN. Once DAN is called, we follow their advice, which isn't always to seek higher medical attention. If you don't get better on O2, we will probably suspect that you pulled a muscle climbing a ladder, or whatever.

Point is, going on O2 should not immediately drive you to a chamber. If you want a chamber, we will do everything in our power to get you to one.

I am kind of with the previous poster about "on o2=chamber" at least from o2 from the boat.

Have you run this current standard of practice by your liability carrier?

My worst case no seeming defense scenario is this:

A diver goes on the boat's O2. They contact DAN, and DAN says they are clear. Problems happen.

In the unfolding of the actual story, it becomes muddy as to whether diver decided not to go to the chamber AMA (Against medical advice).

Phone calls are not something I would trust my future with. Also in general, sick people tend to try and refuse help. As the saying goes, the number one symptom of DCS is a diver thinking they are not bent.

I have to say, if it was my boat, the bright line would be "Boat O2=EMS", because I can see to many paths to liability. It seems close to me acting in a role that involves making medical decisions. And it involves a person who, because they are on a boat, are not free to make some choices.

(This idea that people on a boat are coerced might be me mistakenly over-extending/over-extrapolating from the known-to-me fact that liability forms signed once people are on a boat are basically of little value becuase they are signed by people under duress.)

 

[Bob DBF]

Out of curiosity, can you envision a medical emergency where first aid is rendered, but no followup is necessary?

Yes.

As long as Emergency O2 is a limited commodity, it should be treated as such. Lowering the bar for it's use gives a greater chance it will not be available when it is desperately needed.

I've used O2 to feel better, for one reason or another, but it was not the Emergency Medical O2.


Bob

 

[lowviz]

... running a free oxygen bar and allowing people to "walk it off" (with a little Oxygen).. just seems terribly dangerous from a liability perspective.

Yes, but it is also the correct first step in avoiding a lasting physical injury. The threat of losing one's life savings to a lawyer is the real threat.

 

[NAM001]

Ken
What would your position be on use of CO@ fire extinguishers. Also emergency equipment. If our beer was not cold enough should you be able to demand the CO2 to cool your beer. If I was a boat owner, I would ask you if your were declaring a medical emergency on your self. You would not go back into the water again and all the calls would be made in support of an emergency. I would also be talking to my ins agent to see if you using your O2 constituted reason to say you are not fit to dove on my boat. If you want take your own bottle down with you and suck it at 20 ft for a while, then perhaps OK. Even that is a problem when the dives are no deco dives, no deco gas should be needed and should raise a flag. To a business man his livelihood trumps your medical claims. If you want O2 then there is a problem that conflicts with the basic dives being done. On the other hand if you said you were using O2 to shorten the SI or enhance the SI that would be good enough for me. Still not going to get access to emergency O2 though. Dive nitrox next time. There are too many options other than Med O2 from the boat. Perhaps the boats can carry O2 concentrators for the purpose of SI enhancement without shortening the SI time. That sounds like a good proactive stance to minimize the possibilities of DCS even more from follow on dives. OR bring your own.

On a boat I expect O2 to be available to anyone at any time for any reason. I don't think it is a good plan to blackmail divers into not using it with what amounts to threats about calling an ambulance or helicopter.

.

 

[Akimbo]

… If our beer was not cold enough should you be able to demand the CO2 to cool your beer...

OK, now that is an emergency.

 

[The Chairman]

OK, now that is an emergency.

Indubitably.

 

[drrich2]

If you make it an 'oxygen buffet' for whoever, whenever, seems to me you're opening an 'oxygen bar,' risk annoying customers if you can only serve 2 at a time (just think of all the people who will want to try it to see if they can tell a difference), and so the boat would need a big jump in oxygen carrying capacity/equipment. That would be an expense.

As for people bring their own onboard, now tec. divers can bring deco. bottles onboard tec. charters, yes. But do you want the regular 'run of the mill' recreational divers bringing a bunch of private or rented oxygen bottles on board?

While oxygen is technically an accelerant, I recall a DAN Alert Diver Magazine article awhile back recapping the story of the guy who may've knocked over an O2 cylinder in his garage, triggering an explosion that mutilated him badly. Turns out some think the cylinder wasn't properly cleaned when service, so there may have been some residue that was flammable.

An extenuating circumstance, yes. Which can recur.

If a customer asks for O2, & staff provide it without stopping the diver diving, etc..., and the diver gets bent, is this going to trigger one of those liability claims that boat staff 'knew or should have known' or had strong cause to suspect the customer, despite denials, was having symptoms of DCS?

On a final note, when newbies ask about dive boat etiquette, a common 'rule' is keep your stuff in your space, not strewn everywhere, as personal space on a dive boat can be quite limited. With that in mind, 8 customers bring O2 bottles onboard with all their other stuff...

Richard.

 

[Kmart4321]

I had a long winded response with arterial blood gas values, oxygen dissociation curve changes and saturations of haemoglobin with oxygen and effects of carbon dioxide etc etc.

Then I stopped and looked at it. Way way too in depth and beyond what anyone on here needs to understand as a lay rescuer.

I read through my Emergency Medicine Manual, 6th edition and they state to deliver high flow oxygen without delay to someone suspected of having DCS. They also mention hyperbaric treatment to put the Nitrogen back into solution and provide a number to some group called the Divers Alert Network for further guidance
I guess I am looking for documented proof that oxygen improves outcomes, not anecdotal evidence. Lots of things are done in medicine "that's the way we have always done it". I just like to look beyond that and understand why something works or does not.

 

[bakodiver391]

I realize that I live in the third world where life is cheap and lawyers are few, but if your primary concern as a dive operator is liability, you should probably find a new career. This is not directed at anyone in particular, just a general observation. If I were a lawyer (and thank God I'm not), I could easily argue that a policy of notifying EMS every time oxygen was requested PREVENTED my client from reporting symptoms and subsequently led to his untimely demise. There is no end to these scenarios, so my feeling is you should do what your training and gut feeling says is right and forget about the lawyers. I only deal with tech divers, and my attitude is that it is insanely dangerous, much like climbing Mount Everest, and that all participants enter with full knowledge, and have no right to point fingers when something goes sideways. Your experience in your nanny state may differ.