After dive oxygen: shouldn’t the diver decide?

[The Chairman]

After dive oxygen: shouldn’t the diver decide?

Let’s face it: there are a lot of facts and fiction about the use and alleged misuse of oxygen. Ask any diver about this and you’re bound to have to wade through a litany of myths interlaced with a few facts, a number of unfounded phobias and lots of apocryphal anecdotes. Ask the captain or crew of a dive charter or live aboard and watch those myths, phobias and anecdotes compound geometrically due to the specter of legal ramifications. It’s like we’re living through the voodoo gas days all over again, and I just don’t think it’s necessary, wise or legally defensible. In fact, a friend recently went through a lot of this on a dive boat that I have the utmost respect for and I don’t think he should have had to. It’s my opinion that he should have been allowed to make a decision about whether to use oxygen on his own with no interference. Unfortunately, I see this same rule and attitude on most every boat I’ve been on. I think they are afraid of oxygen, afraid of making a decision for you about oxygen and that their rules are based on their misunderstands and phobias about oxygen. I am starting this thread in an effort to begin a dialog on what I see as a diver’s right to use oxygen on the surface as they see fit. It should be viewed like we view oxygen bars or an athlete using oxygen after a strenuous play: as simply a non-event. It’s time to remove the stigma from using oxygen and give the decision to the diver and not base it on simple inflexible rules. To that end, I’ll list a few of the facts and myths as I see them and invite everyone, including medical doctors and captains, to chime in. Heck, you might add a perspective I had not thought of or forgotten to include. You might even change my mind if you can provide real facts and studies that contradict my understanding. I don’t expect to go unchallenged here and neither should you, so let’s remain civil and hash this out.

• · Fact: Oxygen is not a drug. While it has therapeutic value, it will not cause hallucinations or other deleterious effects on a relatively healthy adult breathing it at one atmosphere. Be assured that we’re already addicted to it and that there’s a lot of money to be made when drug companies treat it like a drug. That doesn’t mean we should treat it like Oxycodone or even alcohol.
• · Fact: Oxygen is fairly accessible. There are very few barriers to obtain oxygen, even medical oxygen. You can get a prescription for it, but that’s really not needed, nor should it be.
• · Fact: Oxygen is highly therapeutic. There are many benefits to be had from breathing pure oxygen, and this is especially true for divers and for those undergoing certain stressors. If you’re feeling tired or sluggish, fifteen minutes of oxygen therapy is better than a cup of coffee. That’s been my anecdotal experience.
• · Fact: Oxygen is used by deco divers. If it can be used safely beneath the water, then why not above it? In reality, oxygen only becomes a problem if you take it too deep but this isn’t a thread about using oxygen as a deco gas.
• · Fact: there is no contraindication for using oxygen excepting a fire being present.
• · Myth: Only a doctor should take you off of oxygen. If they didn’t put you on it, why do you need them to take you off of it?
• · Myth: Using oxygen requires a call to DAN. If there’s an accident, this should be a standard protocol, but not for prophylactic use.
• · Myth: Using oxygen contraindicates further diving. This myth should be apparent since deco divers often make additional dives.
• · 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.
• · Myth: Oxygen is explosive. In actuality, oxygen is an accelerant, not an explosive.

Based on this, I would like to see dive boats change their policies in regards to after dive oxygen. First, oxygen should be freely available and offered after any incident such as an accident, missed stop (safety or obligated), long surface swim or any time a diver seems to have undergone stress. “Would you like some oxygen?” should be a common question on a dive boat. Second, captains and crew should never, ever try to talk someone out of using oxygen. You’re setting yourself up for litigation by doing this. Rules that limit a diver’s actions afterwards effectively do this and should be eliminated as well. Thirdly, the diver and only the diver should have the final call on whether to use oxygen or not. Letting the diver decide their own fate, as it were, is the best way to limit your legal exposure and to maximize their feeling of empowerment which is critical during an incident. I certainly understand that it’s your boat, so it’s your rules, but we divers have options too. I know what works best for me and will naturally gravitate to those businesses that cater to my needs and wants.

Caveat: my use of the word oxygen in this thread refers to pure or medical oxygen and this is not a thread about the relative merits, dangers and pitfalls of using oxygen as a deco gas. Get the training for that, please, and discuss it in a different thread.
Additional Caveat: I am not a medical doctor by any stretch of the imagination. I used to fix sick networks. Now I own/manage ScubaBoard, am a Social Media consultant and teach Scuba. My standard medical advice is “I don’t know. Why don’t you ask a physician?”

 

[decompression]

Good post, Pete.
I for one, have on many deco dives finished up by having a nice rest after the dive using the last of my O2.


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[Kmart4321]

Oxygen is not benign and harmless.
There are side effects from release of free radicals following administration.
ACS and CVA treatment guidelines now encourage caregivers to forgo administration of oxygen unless saturation levels are 95% or lower on SaO2 monitoring. Routine administration of high levels of oxygen are being associated with worse outcomes.
Administering oxygen in high concentrations to someone with COPD with hypoxic drive can be deadly. Because their bodies are used to high blood concentrations of CO2, they rely on lowering O2 levels in the blood to stimulate breathing unlike a healthy person who rely on elevated CO2 levels. Granted, not a lot of COPD'rs dive but just thought I would add for your reading pleasure.
Oxygen is a drug. It is a substance that can be administered to a patient in various concentrations and has the potential improve or worsen a pts condition.
Use it when required but it certainly should not be part of a routine post dive regimen imho

 

[Freewillow]

Agreed with everything you said. Nic and useful post.

Just one remark: at some places O2, and especially "medical grade" O2 does not come cheap and is not always readily available.

So the idea that one could elect to take for free "medical grade " O2 at leisure, like he would take some soda does not make it for me. I am referring, for example to a VERY long discussion on the subject "should O2 be free of charge" that went for pages and pages in a french speaking forum.

Just a thought, but great idea

 

[knotical]

... Administering oxygen in high concentrations to someone with COPD with hypoxic drive can be deadly. ...

However, such folks are unlikely to be diving.

---------- Post added March 30th, 2015 at 12:18 PM ----------

fact: making oxygen freely available will either cost the dive boats more money or risk oxygen not being available when needed for an emergency.

 

[tomfcrist]

Best part is, I always have my own supply on the boat...who's gonna stop me from continuing to suck down my deco bottle while getting my gear off? Technically the surface IS the last deco stop right?

Do I think the dive op should be on the hook to supply O2 to anyone who wants a hit?? No.

 

[The Chairman]

ACS and CVA treatment guidelines now encourage caregivers

So, what's the protocol for DCS? How about anyone with difficulty breathing. As best as I can ascertain, dive boats don't have SaO2 monitoring on board, so we're SOL there. Dive boats don't even have physicians unless one is a diver, so how would they identify COPD'rs??? They can't, which is why I think the decision to go on oxygen or not should be left up to the individual. Make it available, but make them decide. No need for the ship's crew to be involved in that decision.

 

[tomfcrist]

No need for the ship's crew to be involved in that decision.

That I don't agree with. If the crew suspects DCS, over expansion injuries etc, they have s duty to highly suggest to a conscious person to get on O2....that is being part of the decision.

If said person becomes unconscious, the crew has a DUTY to follow thier training which unless I'm way off base here...means going on O2.


If a diver thinks he has the niggles and wants O2..put him/her on O2 obviously, but that in my mind automatically get a call to USCG and has EMS waiting at the dock at a very minimum.

 

[MarineResearch]

I bring my own oxygen and oxygen blender, so it's purely a personal decision at that point. I have seen a lot of stressed divers that could have benefitted from a few minutes of oxygen had it been readily available. However, I'm not sure it should be handed out like candy or post-dive beers. From a liability standpoint, I'm not sure I would want to make oxygen available outside of the normally accepted criteria for any diver that does not have advanced deco and/or oxygen provider training.

 

[Akimbo]

I’m a big fan of using pure Oxygen in the right setting and in high doses (partial pressures). Unfortunately I think expecting a charter boat operator to offer pure O2 to any passenger who isn’t showing symptoms exposes them to more liability and expense than they care to incur. Divers or groups certainly have that option to BYOO2, especially if they use it sitting on deck.

Some divers may find this post useful: Oxygen Toxicity Limits & Symptoms

I have purchased or directed the purchase hundreds of thousands of cubic feet of Oxygen over the years and it has all been industrial grade. The purity is the same except it comes in bottles with Brass instead of chromed valves. Most of it came in multi-packs of +/- 230 Ft³ cylinders like this: