by
Larry "Harris" Taylor, Ph.D.
This is an
electronic reprint of an article that appeared in Alert Diver (Summer, 1986,p.
10.) This material is copyrighted and all rights retained by the author. This
article is made available as a service to the diving community by the author and
may be distributed for any non-commercial or Not-For-Profit use.
All rights
reserved.
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Most of the sport diving community is aware that there are no
known contraindications to the use of oxygen in a diving emergency situation.
Yet, the overall legal climate that currently exists has promulgated much
rhetoric about possible legal ramifications of saving another's life (or
preventing a permanent "vegetative state") by administering oxygen at the scene
of a diving problem. Divemaster/instructor attitudes range from "no way will I
give oxygen! (For fear of being sued" to "Do whatever is necessary (within
training and equipment limitations) to keep the patient alive." My favorite
response to any potential legal battle arising from oxygen administration is
"Hell, I'm not giving a drug, I'm administering a welding
gas!"
For years I have heard that oxygen administration was
regulated and that its emergency use was prohibited to anyone outside the
medical community. I heard this in diving classes, as well as in first aid,
lifesaving and CPR classes taught by a variety of organizations. It was
necessary for me to obtain a prescription for oxygen before I purchased an
oxygen cylinder for my personal emergency kit. (DAN has heard from several
callers stating their need for a prescription to have their cylinders filled).
Everyone knew about this oxygen law (as if it were engraved in stone), but no
one could quote its specifics. Recently, I tried to find this "mythical stone
carving".
My search took me first to the law library of Wayne State
University. After several hours and much help from the law librarians, no such
law could be found. (We did find that Michigan standards for *commercial* diving
required a first aid kit and oxygen inhalation unit at all sites where *commercial* diving was practiced.
Incidentally, I also found out that scuba diving in public fountains in downtown
Detroit was prohibited by local ordinance.) Oxygen was not listed in any Federal
Drug Administration compendium of controlled or scheduled substances. Although
pharmacists would call oxygen a drug (indeed, any substance which affects the
human biochemistry can be defined as a drug), there appears to be no specific
legal definition for oxygen.
Next, my quest took me to a well-respected Detroit pharmacist
and accepted pharmaceutical authority serving on the Michigan Board Of Pharmacy. He knew of no such controls and could
find no guidelines for oxygen's supposed restrictive utilization. Since I had
aroused his curiosity, he called some friends of his within the Michigan
Department of Public Health. Two days later, he was informed that Michigan had
no such policy or written guidelines for emergency oxygen administration. They
did, however, offer an informal historical scenario to suggest the origin of the
"prescription required" status of oxygen.
Several years ago, the use of home oxygen therapy for the
elderly with chronic lung problems became readily available. Oxygen therapy is
quite expensive. (Many of these elderly people require permanent oxygen
supplemented breathing). Patients receiving oxygen turned to "third-party"
medical insurance carriers for financial re-imbursement or assistance. Most, if
not all, medical carriers would only pay for prescribed medications and thus,
denied payment for such "over-the-counter" remedies. (The insurance companies
considered, for purposes of financial accounting, anything (like aspirin, cough
drops or sun tanning creams) that was "non-prescription" to be
"over-the-counter".) Since many of these elderly patients could not afford the
required fees for home oxygen use without insurance financial assistance and
their physical condition required continued medically supervised oxygen therapy,
the medical community began writing prescriptions for home use of oxygen to
ensure that those with chronic lung problems could receive the care they
required. Thus, it appears that the "prescriptions-only" status for oxygen was
necessitated by economics, not pharmacology.
The medical/legal status of the lay use of oxygen in an
emergency situation is not only a concern of the diving community. Indeed, any
business where physical or emotional stress could precipitate a medical problem
is concerned. Such establishments include aerobic dance studios, health clubs,
golf courses, funeral homes, etc. Many of these have inquired about their legal
status in emergency oxygen administration scenarios; some have requested
legislation. There are no precisely defined legal guidelines! It also appears
that many political/legal bodies are reluctant to actually "engrave in stone"
any guidelines for emergency oxygen utilization for fear of setting a precedent.
(Note: There are distinct medical differences between chronic oxygen use by the
elderly and any emergency scenario.) The bottom-line: the legal status of lay
use of oxygen in an emergency will, unfortunately, remain undefined for years to
come!
Since there will probably be no clear cut legal guidelines for divers to rely on, divers faced with an emergency must let their conscience, emergency planning and perhaps most importantly, their training be their guide. Personally, I carry oxygen (the DAN Kit with 2 Jumbo D cylinders with an MTV regulator ) to every dive site and would not hesitate to use it! (I do have a prescription for its use, dive primarily in a state which has no emergency restrictions "on the books", and I have actively sought and documented training in oxygen administration.) I chose my dive buddies from those who share this philosophy. I will not dive with someone who would leave me on the beach, lying next to an oxygen tank, while debating with others (in an undoubtedly superb oratory) the legal ramifications of not saving my life! Those who are concerned about USING oxygen should seek training to lessen their fears. However, their concerns are 180 degrees out-of-phase! They should really be concerned about the legal status of DENYING the universally accepted treatment for serious diving maladies!
Post-Publication Addendum:
Michigan now requires a annual renewal prescription for oxygen.
DAN has announced that Prax-Air (a compressed gas vendor) will fill a DAN cylinder for someone with a current DAN oxygen provider certification card.
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About The
Author:
Larry "Harris" Taylor, Ph.D. is a biochemist and Diving Safety
Coordinator at the University of Michigan. He has authored more than 200 scuba
related articles. His personal dive library (See Alert Diver, Mar/Apr, 1997, p.
54) is considered one of the best recreational sources of information In North
America.
At the time this was written, the use of oxygen in the recreational diving community was most controversial. One major recreational training agency at the time was advocating NOT using demand systems (claimed oxygen administration with a demand system was too complex to teach!). The fact that this agency's CEO was also CEO of the company that made non-demand, constant flow delivery systems was, of course, irrelevant.
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