O2 Administration

[prolst263f]

I have a question based around the administration of O2 to non diver casualties

I've completed the H&S five day First Aid at Work course and I've also done the BSAC O2 adminstration Course.

We have an O2 kit in my office, I work for an oil company and they tend to have all the bells and whistles.

As a first aider within the company does my BSAC qulaification allow me to give O2 to a non diver casualty in the office? For instance someone who is showing all the signs and symptoms of having suffered an heart attack?

The kit is there, if the need arises can I use it in a non diver situation?

Cheers

Pete

[PeteM]

As a first aider within the company does my BSAC qulaification allow me to give O2 to a non diver casualty in the office?

No - the SDC specifically says not, diving casualties only

[Chris Cherrington]

..
The kit is there, if the need arises can I use it in a non diver situation?
..

Pete is correct a diver's O2 course (any training organisation) doesn't cover non diver injuries.

Whether you would choose to administer O2 if you knew for sure this is the correct treatment is another matter. There are laws relating to first aid and they allow you to act in the best interest of the casualty.

So the question is really how sure are you of what you are doing? If you are not 99% sure, it is not a good idea.

Chris

[ardhill]

Sadly, you probably need an "At Work" O2 qualification unless your HSE first aid covered O2 administration as well.

You may know what you are doing, but litigation is too common these days for my liking. You may well be able to help someone, but if you don't have the correct qualifications and something goes wrong, you could find yourself in court :(

[Steve W]

Some conditions in non-divers can be worsened by O2 administration, we won't know the history of a non-diver so cannot intervene.

Plus there are conditions where giving O2 isn't going to be much help anyway (this is my current understanding as a non-medic ) e.g. cardiac arrest caused by ventricular fibrillation, the heart is not pumping blood around so O2 is of no benefit.

Unfortunately we're living in times where it can be unwise to try to be helpful - sad isn't it?

[MSutcliffe]

For those people with an interest, take a look at http://www.studentbmj.com/issues/04/02/education/56.php

I have serious concerns about what we teach on O2 admin courses. When i ask medical students about O2 admin, they always comment on the issues of 'hypoxic drive' - which is where we can do harm by giving O2. I subsequently spend ages educating them that hypoxic people who are ill need oxygen first, and if they cease to breath as a result, then they need oxygen and artificial ventilation urgently, and then probably some clever assistance later.

I do wonder if, in our O2 admin courses, we should be teaching to use O2 in ALL casualties, but emphasising the need for re-assessment of the ABC's every minute - if the patient stops breathing, the patient need O2 enriched AV. When the ambulance man arrives, he can take over, and withdraw O2 if he feels it necessary.

I was involved in an incident a few years ago, whilst I was still a medical student, and this has left a lasting impression on me. A 6o-ish year old diver, otherwise fit and active, completed a dive, and was very tired on the surface. he had a rest on teh surface, and subsequently took 4 of us to haul him up the ladder onto the boat.

We lay him down, gave him a rest, and some O2. he improved, denied there was a problem, refused the O2 and went into the cabin - where he promptly arrested.

We immediately commenced O2 enriched AV and CPR. (must at this point praise the team I had on that boat - I took on the airway and leadership role, and the team was absolutely EXCELLENT!!)

The upshot is that we managed to do 30mins of CPR as we headed back to the pier, and when we got there we still had a defribrilatable rhythm. Unfortunately, despite this, he didn't survive.

As far as i can tell, CPR alone is highly unlikely to provide sufficient oxygenation to the heart for it to be viable/in a defribilatable rhythm after 30mins! I suspect (and have discussed this with intensive care consultants aswell) that the key things for achieving this were high quality resuscitiation with high oxygen concentrations.

This chap was not bent. he had had a large heart attack, which the post mortem confirmed was unrelated to diving.

I come around to thinking that if a diver is carrying O2, and there is an incident, then whilst early CPR is essential, it is highly likely that early O2 enriched CPR is even more useful, and perhaps we should be educating and facilitating the provision of this service!!

I feel quite stongly that, especially as divers are often around isolated location where ambulance services can take a long time to arrive, then we should be willing and able to provide the best possible first aid/CPR service we can as invidiuals/groups.

Learning Point - if someone is unwell, and you put them on O2, then they STAY ON O2 - no questions, no discussion (that is, until you hand over their care to someone who knows better).

I don't know who the relevant person in the Diver Training Group would be, but if that person is around the forums and would like to discuss modifying the O2 course at all, then i would love to hear from them. i don't know the rationale behind the current instructions, but am interested to hear them.

I have tried to be sufficiently vague in the above description so as to not identify any of the individuals involved. If anyone feels too much information is provided, please say, and i will amend it. Some folks who know the gent in question may be able to identify him, but I am sure they would agree that the case represents an example where the provision of O2 early meant that the chances of survival were maximised.

[Adrian Kelland]

Learning Point - if someone is unwell, and you put them on O2, then they STAY ON O2 - no questions, no discussion (that is, until you hand over their care to someone who knows better).
Doesn't this mean overuling the wishes of the patient in regard to the drug being administered?

I imagine what is a whole new can of worms. We are after all only doing this on a first aid basis.

Adrian

[MSutcliffe]

Adrian,

You will remember that the O2 admin syllabus stipulates that one of the early symptoms of DCI is denial. Casualties will deny that there is any problem.

Now the case above is not DCI, but he got O2 because he was on a dive boat, had been diving, and was unwell.

What does concern me is that there was a startling recovery when he recieved O2 - to the point he felt so much better he refused O2. I do, however, suggest that if he had remained on O2, then it might just be that his heart muscle would have recieved continued oxygen, and he may still be with us today.

you should rationalise this with a casualty, and gain their agreement to stay on it (ideally), but what i am trying to say is that it is probably one of the most important first aid measures you can take, and maintining that measure should be of paramount importance.

[Adrian Kelland]

Adrian,

You will remember that the O2 admin syllabus stipulates that one of the early symptoms of DCI is denial. Casualties will deny that there is any problem.

Now the case above is not DCI, but he got O2 because he was on a dive boat, had been diving, and was unwell.

What does concern me is that there was a startling recovery when he recieved O2 - to the point he felt so much better he refused O2. I do, however, suggest that if he had remained on O2, then it might just be that his heart muscle would have recieved continued oxygen, and he may still be with us today.

you should rationalise this with a casualty, and gain their agreement to stay on it (ideally), but what i am trying to say is that it is probably one of the most important first aid measures you can take, and maintining that measure should be of paramount importance.
Quite possibly and I agree with your general sentiment.

However if we don't get agreement and they deny a problem and treatment, what more can we do? I'm not aware that we as first aiders can over-rule their wishes.

Adrian

[ardhill]

I did DAN Scuba O2 administrartion and it also tells you to put the patient on O2 and keep them on it for just about any Scuba related incident.

But they also tell you that the patients wishes over rule your decision i.e. if they don't want O2 - they don't have it forced on them. Even if you know for a fact that it will help them, if you can't convince them to agree to take it - they don't get it.

A number of you will know that in cases of DCI, giving O2 is beneficial, but before the oxygen has a chance to make the person better, the pain can get worse with oxygen, till the system starts getting saturated. Yes, it is really important for the patient to keep breathing O2 through this point, but if they insist on removing the mask - it is their choice and decision to do so.
.

[Nigel Hewitt]

What does concern me is that there was a startling recovery when he recieved O2 - to the point he felt so much better he refused O2. I do, however, suggest that if he had remained on O2, then it might just be that his heart muscle would have recieved continued oxygen, and he may still be with us today.The first thing I got in hospital for pains in the chest was Nitro-glycerin, the second was O2. This was the point where I MI'ed - the real heart attack. I think I'm here today because I did it on the ward with the consultant doing rounds.

Oxygen was definitely the the right thing. I remember my wife saying "His lips are going blue" so low blood oxygen. That might have been partly due to the vasio-dilator but with the pump stopping I needed all the O2 input I needed.

PS: Passed my dive medical for another year yesterday (22/8/6). The work they did that day was good!

(edit) to fix the month in the date (/edit)

[ardhill]

Passed my dive medical for another year yesterday (22/6/6). The work they did that day was good!
Well done mate - I'd hate to be around you if you couldn't dive :)
.

[William van Niekerk]

I have a question based around the administration of O2 to non diver casualties

I've completed the H&S five day First Aid at Work course and I've also done the BSAC O2 adminstration Course...

I am very pleased that you asked this question. Before I give you my thoughts on the matter, could you please clarify whether your First Aid at Work course contained anything about oxygen administration in its syllabus?

[Tristan Green]

The first thing I got in hospital for pains in the chest was Nitro-glycerin ...

:eek: I am not a doctor, but I work in construction (blasting in particular) and this had me confused and not a little surprised - a quick google got me to wikipedia where I found:

"Medical use

Main article: Glyceryl trinitrate (pharmacology)
In medicine, nitroglycerin (sometimes called Glyceryl trinitrate, presumably to avoid alarming people) is used as a heart medication (under the trade names Nitrospan® and Nitrostat®). It is used as a medicine for angina pectoris (ischaemic heart disease) in tablets, ointment, solution for intravenous use, transdermal patches (Transderm Nitro®, Nitro-Dur®), or sprays administered under the tongue (Nitrolingual Pump Spray®, Natispray®). A recent medical development will include a small amount of nitroglycerin in the tip of a new Durex condom to stimulate erection during intercourse. "The CSD500 condom contains a chemical in its teat, called glyceryl trinitrate (GTN), which is absorbed by the skin and causes blood vessels to dilate."
The principal action of nitroglycerin is vasodilation -- that is, widening of the blood vessels. The main effects of nitroglycerin in episodes of angina pectoris are
subsiding of chest pain
decrease of blood pressure
increase of heart rate.
These effects arise because nitroglycerin is converted to nitric oxide in the body (by a mechanism that is not completely understood), and nitric oxide is a natural vasodilator. Recently, it has also become popular in an off-label use at reduced (0.2%) concentration in ointment form as an effective treatment for anal fissure.
Nitroglycerin patches have also found use as treatment for the bite of the Brown recluse spider, which has a vasoconstricting venom."

All very interesting - especially the new found use in condoms - "How was it for you, dear? Did it go with a BANG or a whimper?" :D

Cheers,
Tristan

ps - sorry for the thread-jack!

[Andy Wade]

Quite possibly and I agree with your general sentiment.

However if we don't get agreement and they deny a problem and treatment, what more can we do? I'm not aware that we as first aiders can over-rule their wishes.

Adrian

Indeed we can't, we're just administering first aid after all. O2 admin is about as close to 'medical treatment' as any non doctor should get.
However, if people are in denial about DCI then why not just say you're giving it to them as a treatment for shock.
We could give O2 in any emergency diving situation so why not just administer it without giving the qualifying reasons and risking starting an argument. Hey, you could call it a hangover cure if you like.
Or just tell them it's good for getting rid of those spots on their a*se... they aren't going to deny they have spots there are they?

[JamesW]

Have a look at this from the HSE Site

http://www.hse.gov.uk/firstaid/faqs.htm#oxygen

Thanks
James

[Andy Wade]

:eek: I am not a doctor, but I work in construction (blasting in particular)

You work in construction and get to blow things up?
Cool. :cool:

Oh, and there's no way I'm putting my ###### in one of those explosive condoms. :D
It's a misandrist (http://www.askoxford.com/asktheexperts/faq/aboutwords/misogynist?view=uk) conspiracy I tell you!

[William van Niekerk]

Have a look at this from the HSE Site

http://www.hse.gov.uk/firstaid/faqs.htm#oxygen

Thanks
James

Thanks James. I had in fact taken a look at the HSE website in my brief search (spending too much time browsing through a government website could result in an intracranial haemorrhage:)) for an HSE First Aid Course syllabus before posting my last note. The three paragraphs you refer to seem to imply that O2 administration is not a requirement of basic first aid training (I may be wrong), but of course it does not categorically state whether any mention is made of O2 at all (it is a five day course for goodness' sake, surely something must be said!:confused:). I assumed from his original question that prolst263f has not had any additional training (diving O2 administartion course aside), either as an extension of the basic HSE course or as a special work requirement. The fact that they have the kit available at work, however, must surely mean that his employer lives in the hope that someone would have the sense to use it in case of an emergency?

[JamesW]

Hi William I thought o2 was POM if so you need a prescription ?? correct me if I am wrong.
I also thought that we were only aloud to give o2 to divers because we are so called medical fit with no medical problems.
How ever I was medic within the forces so I would give o2 to a non-diver if need.
I still think all shopping centres, train stations should be made to have o2 and a AED's.
Thanks

[ardhill]

Hi William I thought o2 was POM if so you need a prescription ??
Divers can buy pure O2 for diving gas and anyone can buy an O2 'medical kit' for home or work (the sort you see on dive boats with small tanks, pin index reg and continuous flow or demand valve masks). I have even seen small cans for sale to the public (about the sze of a deodorant spray) with integrated mask a bit like a 'Spare Air'. You can get them in different flavours too!

You CAN be prescribed O2 by a doctor, but then again, you can also be prescribed Asprin.

Edit: Here are the personal can for anyone interested in having a look - http://www.bodykind.com/productdetails/CatIDx105/ProdIDx471/buy-oxygen-canister-4pac-1x.htm

[Andy Wade]

Hi William I thought o2 was POM if so you need a prescription ?? correct me if I am wrong.
I also thought that we were only aloud to give o2 to divers because we are so called medical fit with no medical problems.
How ever I was medic within the forces so I would give o2 to a non-diver if need.
I still think all shopping centres, train stations should be made to have o2 and a AED's.
Thanks

What even if they have chronic bronchitis?
I wouldn't even go there. Some people should not be given O2.
If you're trained to do it, fair enough. But if you're only qualified to give O2 to divers, leave it at that.
I've been fiddling about with first aid for over 30 years including running the courses, and I still wouldn't do any more than follow the three basic ideals:
Remove from danger.
Preserve life.
Promote recovery.
IMVHO none of these include giving O2 to someone who isn't a diver.

[Andy Wade]

Divers can buy pure O2 for diving gas and anyone can buy an O2 'medical kit' for home or work (the sort you see on dive boats with small tanks, pin index reg and continuous flow or demand valve masks). I have even seen small cans for sale to the public (about the sze of a deodorant spray) with integrated mask a bit like a 'Spare Air'. You can get them in different flavours too!

You CAN be prescribed O2 by a doctor, but then again, you can also be prescribed Asprin.

Edit: Here are the personal can for anyone interested in having a look - http://www.bodykind.com/productdetails/CatIDx105/ProdIDx471/buy-oxygen-canister-4pac-1x.htm

Yes, you can let someone have an aspirin from your medical kit, but you can't prescribe it unless you're qualified. They self administer it. We as first aiders must never administer medical treatment unless we are qualified to do so.
There is a line drawn which a first aider must not cross.
We are first aiders. (the majority of us are only this anyway) Nothing more.

[William van Niekerk]

Hi William I thought o2 was POM if so you need a prescription ?? correct me if I am wrong.
I also thought that we were only aloud to give o2 to divers because we are so called medical fit with no medical problems.
How ever I was medic within the forces so I would give o2 to a non-diver if need.
I still think all shopping centres, train stations should be made to have o2 and a AED's.
Thanks

Hi James

I don't think it is POM - I have only ever had to prescribe it if I wanted someone to have a specific concentration over a prolonged period of time. I do agree with you, however, and I fully understand people’s reluctance to intervene medically, even if they have had some first aid training. I guess that most people realise that a little knowledge can often be a dangerous thing. That aside, and perhaps more important, is the fact that we live in a very litigious society. I often hear my (medically trained) colleagues say that it is safer to turn a blind eye to a casualty situation outside of the hospital environment. Those are the comments of doctors with years of experience, so I can only imagine how someone with only basic first aid training must feel! This strikes at the (ethical) heart of prolst263f’s (I wish he’d left his name!:confused:) question. Clearly people go on first aid courses (or become medically/paramedically trained for that matter) because of an inherent wish to help. It is a sad defeat of the purpose if you are then too frightened to do so. So what are the issues at stake?

Firstly, there is the explosive hazard, especially in confined spaces – as divers, you are more familiar with this than most, so I won’t tell grandma how to suck eggs.

Then there is the question of the appropriateness of O2 administration. There are a few instances where it may be dangerous to give patients supplemental oxygen, most famously in a condition called chronic obstructive pulmonary disease (COPD) (see earlier posting by MSutcliffe). In this disease, which includes the spectrum of emphysema and chronic bronchitis (co-existing in various proportions), the respiratory centre (that bit of the brain which tells you to breathe) is relatively insensitive to CO2 (the usual driver of respiration). This means that they are dependent on “hypoxic drive” for respiration i.e. if you treat their chronic “lack of oxygen”, they may stop breathing. Even so, only COPD sufferers on one extreme end of the spectrum will respond this badly. In almost every other casualty situation, from a broken limb to a heart attack, the administration of oxygen can only be beneficial; in fact, it may mean the difference between life and death. As a surgeon, I would ALWAYS give O2 in the acute situation if I have it available, even if I know the patient to have COPD.

It is a sad truth that prolst263f’s BSAC O2 Administration Course does not extend to O2 administration in a non-diving casualty (I think this is ludicrous). But given that he also holds an HSE qualification I would suggest that he writes to the HSE, listing his qualifications (specifically including the BSAC one) and asking for clarification as to whether they accept him to be competent to administer oxygen outside of a diving environment. If they say no, then I suggest he asks his employers to send him on the relevant course (more study leave, heh?;)), because it would be criminal not to use the kit they have at work in a situation where it may be life saving. In the meantime, if he has cause to administer O2 and ends up in court, I’ll pay for his lawyer!:)

Enough said; this doesn’t even have anything to do with diving. Now hand me one of those GTN condoms, Tristan, and an Aspirin for the inevitable vasodilatory headache (don't worry, I'll self-administer it!)…I’m off to do go and do something constructive (or at least pleasurable).:cool:

[MSutcliffe]

I would ALWAYS give O2 in the acute situation if I have it available, even if I know the patient to have COPD.

The worst that can happen - they stop breathing - which is solved in the community with (O2 enriched) AV. I suspect William would agree - we would rather be seeing people arrive in hosptial still alive, but in need of some help with breathing, rather than them arriving via the back entrance.

The people who are 'at risk' in terms of recieving oxygen are also a group who are 'at risk' in terms of heart attacks etc, and O2 (+/-AV) and CPR is exactly what they need to keep their hearts alive until they can be gotten to definitive treatment.

If we teach resuscitation properly, then our rescuer will be re-assessing the causalty very regularly anyway - so the spontaneously breathing casualty put on O2 who stops breathing will be rapidly identified, and AV can commence.

For Reference - the British National Forumarly (the bible when it comes to drugs in england) does indicates that Oxygen is not a prescription only medicine. It is available for 'over the counter' purchase (see earlier postings for a good way to waste £20!)

[Andy Botten]

Paraquat poisoning is another were Oxygen is very bad for you

So don't give it to your non-organic gardener if he drops in the herbaceous border.

[Andy Wade]

Paraquat poisoning is another were Oxygen is very bad for you

So don't give it to your non-organic gardener if he drops in the herbaceous border.

Can you still get Paraquat?
I thought it had been banned along with a lot of other 'innocuous' garden chemicals, some of which could be used to make explosive devices...
The 'nasty poisons' shelf at your local garden centre is a lot smaller these days.

[Michelle Haywood]

Thanks Andy! :D

It's stupid bits of info like that that will be retained in my (diminishing) grey matter for ever! I'd be a wow at a pub quiz if only they'd ask the right questions!

Michelle

[Andy Wade]

Thanks Andy! :D

It's stupid bits of info like that that will be retained in my (diminishing) grey matter for ever! I'd be a wow at a pub quiz if only they'd ask the right questions!

Michelle

Full of cr*p, me.
Did you know that you can also make garden pesticides from explosives?
Well, you can blow slugs up with bangers... :D

[MSutcliffe]

Did you know that you can also make garden pesticides from explosives?

Troubled childhood, Andy, or are you still living your childhood?

--
Martin

[Andy Wade]

Troubled childhood, Andy, or are you still living your childhood?

--
Martin

I'm a big boy now, I'm six. Hopefully I'll be big enough to mug people for their Ipods next year. :D