After dive oxygen: shouldn’t the diver decide?

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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:D
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.

Is 100% oxygen necessary in the emergency management of decompression illness?
First aid oxygen administration for diver.
 
From the abstract for the second paper above:

When oxygen is provided prior to recompression, symptoms may be relieved earlier, and there is a slightly lower chance of post-treatment residua. Despite this, DAN America data indicate that only 30 to 40% of injured divers receive oxygen. This provides an ongoing challenge for the diving community.

And so if the diving "community" gives divers the impression that using O2 is an indication of failure, a hassle, will have consequences etc then that "community" is contributing to worse than necessary outcomes for hurt divers.

Btw, can anyone produce an example of non therapeutic use of O2 on a boat?

---------- Post added April 1st, 2015 at 05:56 AM ----------

In sum there is no definitive yes. A qualified probably is all you can get.

Are you saying that we are not sure O2 helps a bent diver?
 
  • · Myth: Only oxygen providers can or should administer oxygen. While I certainly believe that every Scuba diver should take a class on handling compressed gasses, I think that this would and should be enough. Every first aid class should cover the use of oxygen
The DAN "Basic Life Support: CPR and First Aid" does cover oxygen administration albeit briefly. 2nd edition (2012) page 28. The instructor told me it was so you could administer o2 during an emergency without the fear of being sued for going beyond your first aid training... or something like that. He told me that o2 helped many medical problems, and was detrimental almost never. Basically, use it if you have it.

My understanding was that DAN and the Red Cross (and others?) worked together on the first aid materials so they would be the same. I can't remember where I heard that so it is quite probably poppycock.




A for preventative o2 administration on the boat. Why not use nitrox? You could use your scuba regulator or get something like the rescuean (I have one, but have never used it). If it's just for preventative purposes and o2 is not abundantly available, perhaps nitrox will be more available. I always dive nitrox and have never hit the deck with a tank on bingo. Plenty of spare enriched air in that recently used tank, and it solves the problem of people wanting to declare an emergency because you went on o2 at the surface. Sure it's not as good as 100% but it's better than 21%. It also doesn't include the diesel fume air additive you get for free on some dive boats.
 
If you receive O2 therapy at anytime during the day you will not get int he water from my boat. If you came to me and stated concern of a DCS hit but refused any and all treatment you are still done for the day. I mean even if you walked up to me and said wow i feel funny is this possibly DCS bam you are done for the day
Sounds like a sound practice. I'm just curious what you'd say in a situation I've been in.

On one dive, I was underweighted since I was diving a new suit and hadn't dialed in my weighting properly. So, not unexpectedly, halfway into the dive I had an uncontrolled ascent. Not the Polaris missile impersonation, but still uncontrolled since my boots had popped off so I lost my fins and weren't able to fin downward. After I'd tended my bruised ego for a couple of minutes, it was suggested I used some of the club's oxygen, just to be on the safe side. I declined, but if my ascent speed had been on the unhealthy side, I'd probably taken up the offer.

Would you have offered oxygen in a case like this? And would accepting oxygen grounded the diver for the rest of the day, even if they were non-symptomatic?
 
I did not address this becasue I thought it would be obvious but dumpsterDiver brought it up so I will address it as well. If you receive O2 therapy at anytime during the day you will not get int he water from my boat. If you came to me and stated concern of a DCS hit but refused any and all treatment you are still done for the day. I mean even if you walked up to me and said wow i feel funny is this possibly DCS bam you are done for the day

Seems like that policy might serve to discourage open communication from your divers... if they are aware of the policy.
 
A for preventative o2 administration on the boat. Why not use nitrox?.
It is not so effective. If you have run out of O2, rebreathers and proper rich gas then yes. If you are too scared to ask for O2 because of the consequences then you should dive with a boat or people who care about divers rather better.
 
Some people would call that denial of medical care and bring up the subject of death panels.

While others would call that sensible use of limited resources...
 
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.

(Lemme guess, a smoker right? Anyone who uses the phrase "nanny state" is probably so locked into a way of thinking that coversation is pointless, but lemme try.)

The funny thing about worrying about liability is that it is the same thing as worrying about safety. Insurance companies' audits make workplaces safer, though they are really only trying to reduce liability.

There is doing something long term which always involves thinking about risk and liability, and then there only doing it for a couple of years and counting on the law of averages to ensure safety. As I have said many times when parting ways with operators, dive boats, and instructors, "you are free to do what you like."

Life rarely punishes bad decisions.

People dove for years without any scuba training, and certainly without emergency O2, let alone deco O2. Paying attention to the outlying cases (or as you would say, living in a "nanny state") brought basic training into scuba, and then emergency oxygen, and then redundancy, and then tech training, and then deco o2, etc etc.

Someone running a tech training operation is in deep debt to intelligent discussion about managing risk and liability. The idea of "tech diving" simply would not exist without all the previous thoughtful people talking about things.

---------- Post added April 1st, 2015 at 04:54 AM ----------

Sounds like a sound practice. I'm just curious what you'd say in a situation I've been in.

On one dive, I was underweighted since I was diving a new suit and hadn't dialed in my weighting properly. So, not unexpectedly, halfway into the dive I had an uncontrolled ascent. Not the Polaris missile impersonation, but still uncontrolled since my boots had popped off so I lost my fins and weren't able to fin downward. After I'd tended my bruised ego for a couple of minutes, it was suggested I used some of the club's oxygen, just to be on the safe side. I declined, but if my ascent speed had been on the unhealthy side, I'd probably taken up the offer.

Would you have offered oxygen in a case like this? And would accepting oxygen grounded the diver for the rest of the day, even if they were non-symptomatic?


Look at the situation from the other side:

What kind of person risks permanent disability just to not miss the second dive of the day?

Is someone who managed to have an uncontrolled descent the best judge of best practices?

In the end, a day of diving is infinitely replaceable. Permanent disability is permanent. Asking someone to risk their livelihood so that I can engage in risky behavior that I have already shown myself to be perhaps under-qualified is asking too much.

And anyone who loses sight of those fact for the most trifling of reasons (I still want to dive!) is engaging in rather selfish behavior.

Of course, if someone is diving on their own time, with their own gear, anything is fine. Do in water recompression on 100% O2 at 60 feet. Whatever! If it's all your own gear (tanks included), and you are shore diving, and diving by yourself, and drove yourself to the dive site.

But otherwise, it's time to grow up a little.

Once a diver is not the only customer on the boat, or they are asking on operation to run support, they are not in charge of what happens. We are in charge. Don't like the rules? Don't do it in our house.

But, really, once we are adults need to be told this? What about diving makes people act like such children?
 
Look at the situation from the other side:

What kind of person risks permanent disability just to not miss the second dive of the day?

Is someone who managed to have an uncontrolled descent the best judge of best practices?
Someone uninformed, untrained or with their brain function muddled by fizziness. Or just meek and not used to the activity, not wanting to make a fuss etc.
But, really, once we are adults need to be told this? What about diving makes people act like such children?

Again, does this actually happen? Are there people behaving like children?
 
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