RX: Oxygen

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. 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 insure 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 (3 x 4001) 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!

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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 100 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.

  Article History

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 (too complex to teach!).    

  Copyright 2001-2004 by Larry "Harris" Taylor

All rights reserved.

Use of these articles for personal or organizational profit is specifically denied.

These articles may be used for not-for-profit diving education