Nitrox workshop dings - Divers Alert Network

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Rubicon Foundation Archive (http://rubicon-foundation.org)VI. Final Discussion and Workshop Recommendationsbeing overlooked is that most of us here do teach rebreathers and dive students do come intoentry-level nitrox on rebreathers today.B. Turbeville: Alessandro and Tom are absolutely right. You're going to open up a bucket ofworms if you bring in a recommendation from this workshop on a non-quantifiablephysiological factor. We can't screen it out and can't create a duty of care here.M. Lang: We have a suggestion now that we remain mute on the CO2 retention issue.D. Richardson: I'm happy with that, but the PO2 limit of 1.6 atm is also a physiological factor.I'm suggesting that I've heard that CO2 retention is not a problem. Everyone has advised usthat we don't need to screen for CO2 retention on open circuit enriched air. We have thatmedical advice in our pocket anyway. This topic was on the agenda under physiology, it wasdiscussed and Dr. Kerem's paper will appear in these workshop proceedings. It seems likewe should say that we don't need to screen for this application. I don't see how that's creatingany duty of care.M. Lang: I agree with you Drew. A reconfirmation that CO2 retention screening is not requiredfor open circuit nitrox up to 1.6 atm. That's what I mentioned earlier that should beconsidered as a workshop recommendation.A. Marroni: Isn't that more or less implicit in the bullet "CNS toxicity can occur suddenly andunexpectedly?"W. Jaap: I assume that these recommendations are going into the proceedings along with thepapers, so anybody who wants to get into this retention issue can read about it, right?M. Lang: I've never done it any other way with these types of projects.W. Jaap: Then it seems to me it may not be necessary to actually have a bullet up there about it.M. Lang: This effort is to formulate a consensual summary, a synthesis, of the workshoppresentations and discussions. If there's no consensus on the CO2 retention issue, we canstate that no consensus was reached.A. Marroni: Medically, I'm not happy with CO2 retention screening is not necessary, period.That's not true. There is research going on there. Is it really necessary we mention it now?B.Hamilton: Not practical.M. Lang: I have a simple solution. An entry-level nitrox diver comes to your office for medicalclearance prior to taking the course. As a physician, are you going to screen him for CO2retention, yes or no?A. Marroni: No.M. Lang: Should we consider routine screening as not necessary?M. Emmerman: No evidence was presented that all divers need to be CO2 screened. That'struthful.B. Hamilton: There wasn't much evidence on that topic presented at all.R. Moon: I recommend "a simple routine CO2 retention screening is not necessary."M. Lang: Any more discussion of routine CO2 retention screening not being necessary?M. Wells: The maximum PO2 limit of 1.6 atm is based on more than history of use. I'm going tosuggest the fine scientific studies of Dr. Thalmann contributed to that limit.M. Lang: Are you suggesting to delete "based on the history of use?"M. Wells: From my perspective, add "and scientific studies." That's why it's in the NOAADiving Manual today. The decision was made decades ago, not on history of use.M. Lang: Right, back to the CO2 retention issue. Can we live with that? Raise your hands.Yes? Okay, we're going to leave that on then as a workshop recommendation.191
Rubicon Foundation Archive (http://rubicon-foundation.org)Lang (ed.): DANNitrox Workshop, Divers Alert Network, November 2000R. Moon: One last point. This has been a bit of a bee in my bonnet. I would like to dosomething to get rid of the fly by night mixers which, despite what has been said in thisworkshop, do exist. I would add to the oxygen analysis bullet, which is the fifth one down,that oxygen analysis should be performed by the dispenser and verified by the end user.M. Lang: Does everybody operate that way?R. Moon: Verification I think we understood did not necessarily mean analysis, but the gasshould be verified in some way by either observing the analysis or performing it oneself.M. Lang: Care to re-phrase that suggestion?R. Moon: Oxygen analysis of the breathing gas should be performed by the dispenser andverified by the end user.D. Rutkowski: IANTD will agree with that statement from Richard Moon.E. Betts: That's a standard procedure. ANDI agrees with that.D. Kesling: Sometimes those two processes don't happen simultaneously. That's the only caveatthat I would try to clarify.B. Bjorkman: The person mixing the gas isn't necessarily the person dispensing it.M. Lang: Should dispenser be changed to mixer?B. Bjorkman: Or blender.M. Lang: Blender/dispenser/mixer.J. Hardy: Provider?M. Lang: Provider is not necessarily the person who mixed the gas. You always have to havethe person mixing the gas analyzing the gas.J. Hardy: Bill could probably talk to that, but from a legal point of view, the dispenser would bethe shop owner.M. Lang: Bill Turbeville, which term would you prefer? Blender, dispenser or mixer?T. Mount: The point is the mixer has to verify it, but the dispenser is the person who wouldprobably be legally liable.B. Turbeville: They're all legally liable at some level. The question is on whom do you want toplace the greater burden? If we say that the end user has to verify, that places some of theburden upon the end user, but by no means all of it. The fact is that they're creating aproduct. They cannot get rid of all the liability. They can only get rid of some liability. Interms of the definitions, that's not for the lawyers to say, that's for the training agencies andfor the participants to define.D. Kesling: There are three phases that now come to mind. You can have the glass blended anddelivered by a supplier. You can have a person in the next phase dispense that gas to an enduser and then, of course, the end user. Operationally, there could potentially be a potentiallythree-level process.K. Shreeves: Let me suggest then that the way it's written right now is exactly what we need tosay.E. Betts: The possibility that the dispenser and the blender is one and the same person, iscovered there. We want to say that the gas mixer or the one who creates the breathingmedium analyzes the gas. Then we're attempting to transfer liability to the end user bysaying the end user has to verify the mix. We are trying to cover the ground, but I want toacknowledge the fact that you could have three different phases here.A. Marroni: Why don't you simply word it by the blender, the dispenser, and verified by the enduser?192
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