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If the diver is conscious, then the injured diver himself can  insist on the
use of the 100% 02 that the divers have. The EMT is bound by the patient’s
right to self determine his own care. The EMT needs informed consent to use
his partial rebreather mask, which the injured diver can refuse, and opt to
use his own instead. A liability conscious  EMT will document the diver's
insistance and ask the diver to sign a waiver on his report.

Teach the EMT class to know divers may wish to decline their 02 treatment and
use their own, and this is fine.

If the diver is unconscious, but breathing on his own, then the EMT has
implied consent to work on the diver as he sees fit. Other divers' advice
will have little bearing on the matter.

As a technical point, how many of us have with us 100% 02 that can be
administered to an unconscious, spontaneously breathing diver, for our use or
as an alternative to the EMS equipment. The SCUBA regulator from a deco stage
bottle or an aviator’s mask from an M tank will not work here. What is needed
is the non rebreathing mask with high constant flow (rare even on ambulances)
or a medical oxygen demand valve (even rarer in my experience.)

If the diver is unconscious and not breathing, then the EMT will provide
ventilation with a device that will also, if used correctly, provide 100% 02.

So the crux of the problem is the unconscious diver breathing for himself. I
do not know if you will be able to impress upon an EMT student to use divers’
gear even if it is the right stuff. As a suggestion to all of us divers, the
best thing to do for this situation is have a medical oxygen demand valve at
the dive, and know how to use it. Also, get a real non rebreather mask and
keep it with the 02 kit. Just prior to the EMT’s arrival, place the non
rebreather mask on the injured diver, with high constant flow, and remove the
demand vavle. (Medical oxygen regulators for the demand valve have a constant
flow outlet too.) Chances are, the EMT now task loaded with an unconscious
patient will not notice that the diver has a true non rebreather mask on; he
will assume it is like the one he uses all the time, a partial rebreather
mask. Like I said the true non rebreather masks are rare, and examining it
will be the last thing on his mind. The worse thing that could happen is that
he does notice, and will just change over to his. Other divers’ advice on
using the non over the partial rebreather mask at that point could be made,
but do not expect a positive response. Arguing about it and delaying further
care and transport would be counterproductive.

Possibly teach the class, if it is within the scope, about the non rebreather
mask and how it is better so that advice at the scene is not the fist time
they hear of it.


Lee C Kresge wrote:

> I've been asked to give a short seminar on water/diving accidents
> (specifically DCS and AGE) for my sisters EMT class which she is
> teaching.  I'm not asking for people to do my work/research for me, I
> think I can pretty well handle the information/theory, etc.  What I would
> like is suggestions on is how to convince the EMT's that 100% O2 is
> significantly better than the partial rebreather O2 that most
> EMT/Ambulance units provide.  Another point:  If there is 100% O2 avail
> at the accident site (provided by the divers), will the ambulance people
> refuse to use it due to increased liability?  (Liable for using something
> that is not theirs and they have no first hand experience with).
>
> Any suggestions on that, or for content would be appreciated.  Use you
> own judgement, reply in private or to the list.
> I have 20 mins.
>
> TIA
>
> Lee
>
> Brief outline:  DCS
> What it is
> How/Why it happens
> Symptoms  Types 1 + 2
> Treatment
> DAN
>
> Similar for AGE
>
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