Emergency

Oxygen Provider
Course Overview
1 Introduction
• Course philosophy and goals
• Course flow options
• Program options

2 •
Course Standards
Prerequisites
• Supervision and ratios
• Materials and equipment
• Certification requirements and procedures
• Linking with other courses

3 •
Knowledge Development
Uses of emergency oxygen
• Diving injuries
• Emergency oxygen equipment
• Safety considerations and equipment maintenance

4 •
Skill Development
Assembly and Disassembly of emergency oxygen system
• Non-rebreather mask use for a breathing diver
• Demand inhalator valve use for a breathing diver
• Pocket mask use with oxygen for nonbreathing diver
Course Philosophy and Goals
Oxygen, water and food are all very
Emergency oxygen is the primary
important to all animals but of these
first aid given to divers suffering
three things the lack of oxygen will
near drowning, lung overexpansion
lead to death the quickest making it
and decompression sickness.
arguably the most important of
them.

Understanding how to
Timely administration of
administer emergency O₂ is key
emergency O₂ is key to
to the safety of your customers
speedy recovery.
of dive buddies.
Course Flow Options
Rescue
Course In-
tegration
Course Prerequisites

PADI OWSI or
PADI Divemaster higher with O₂ Previous first aid
1 with O₂ Provider 3 Provider 5 and CPR training
Instructor rating Instructor rating recommended

Student must
PADI Assistant only be old
Instructor with O₂
2 Provider
4 enough to meet
performance
Instructor rating requirements
Supervision and Ratios

Maximum of 12 students Direct supervision of all

to 1 Emergency Oxygen student skill development
Provider Instructor is required.

Your Picture Here

Try to keep student to

Ensure all performance
equipment ratios as low as
requirements are met and
possible to improve course
seem easily repeatable.
flow and student practice.
Materials and Equipment
Take care of yours
and your students
health
Clean and sanitize all reusable
equipment before each new student
or class.
Instructor Student
.
01
• PADI Emergency Oxygen
Required
Required
Provider Specialty Instructor Guide • PADI Emergency Oxygen
Provider Manual
• PADI Emergency Oxygen
Provider Manual 02 • Non-rebreather mask
• PADI Emergency Oxygen Care at
a Glance reference. Recommended
• PADI Emergency Oxygen Care
03 at a Glance reference
• Refillable variable rate O₂ unit. • Gloves – blood borne
• Multifunction regulator capable of pathogen barrier
delivering at least 15L per minute
• Non-rebreather mask 04
• Pocket mask with oxygen inlet
•Demand inhalator valve with mask
Recommended 05
• CPR mannequins for use in all
non breathing diver skills..
06
Certification Requirements
& Course Linking
Skill Development Course Linking

Demonstrate skills PADI Emergency O₂

first then have the Provider course can
student perform them. be credited towards
1 They must perform all 3 the PADI Master
skills fluidly, with little Scuba Diver rating if
difficulty and little to all other requirements
no signs of stress. are met.

Knowledge Certification
Development
Give students the All students must be
manual and evaluated by the
knowledge reviews, certifying instructor on
you can do a lecture all skills 1 – 4, fill in a
or independent study 2 PIC form and pay for 4
but you must go the course in order to
through the receive certification.
knowledge reviews
together.
Uses of Emergency Oxygen
What is Oxygen?
Oxygen is a gas, it is odorless, colorless
and tasteless.
As a gas, two oxygen atoms join to form
one oxygen molecule, hence the term
O₂.
What percentage of O₂ is in room air?
Atmospheric oxygen makes up roughly
21% of the total. Most of the remaining
gas is physiologically inert nitrogen.
Why is oxygen Important for life?
In terms of human physiology, oxygen is
carried through our breath into our blood
and circulatory systems to our cells and
used as fuel to process and burn the
food we take in. We inhale oxygen and
exhale carbon dioxide.
What percentage of O₂ is in expired
air?
When a human breathes in air they only
use approximately 25% of the oxygen
before exhaling the remainder. This
means usually exhaled breath contains
16 to 17% oxygen.
Uses of Emergency Oxygen
How does rescue breathing help?
As we just learned we expel 75% of the
oxygen we inhale so because of this
rescue breaths can supply enough
oxygen to support life,
Why is oxygen used to treat scuba
diving maladies?
In general maladies relating to scuba
diving tend to disrupt the amount of
oxygen in the blood or the rate of blood
flow so by hyper-oxygenating the blood
we increase the chances of survival of
damaged tissues with poor blood supply
and accelerates the elimination of
nitrogen from our bodies.
How is rescue breathing improved by
adding emergency oxygen?
By using a pocket mask with additional
emergency oxygen the available oxygen
goes up from 17% to 40%. If a
mechanically triggered oxygen
resuscitator is used it goes up to about
99%.
What are 7 life-threatening problems
emergency oxygen can help with?
• Traumatic injury with high blood loss
• Shock
• Cardiac arrest
• Respiratory arrest
• Stroke
• Near drowning
• Decompression illness
Diving Injuries
What is the difference between drowning and
1 near drowning?
Drowning is when someone suffocates or is asphyxiated
underwater and cannot be revived, whereas near drowning is
when the person in question is successfully revived.
Why is medical evaluation important for a diver
3 after a near drowning incident?
Because the victim may have inhaled water which over time
causes damage to the lungs causing them to fill with fluid and lose
their ability to obtain oxygen. This is called secondary drowning
and it can be fatal. So even if the victim seems fine they should
always be professionally examined.
What is the primary first aid for a near
2 drowning accident?
Begin with a primary assessment, stop, think, act. If not breathing
begin CPR immediately, with emergency oxygen if available with a
pocket mask. If breathing administer emergency oxygen with a non
rebreather mask or an on demand valve. Treat for shock and
monitor the patients lifeline. Transport as soon as possible to the
nearest medical facility.
What is the most common cause of lung
4 overexpansion injuries?
Lung overexpansion injuries occur with breath holding on ascent
while on scuba. They can also occur rarely when a physiological
condition traps air in a part of the lung. The most common cause of
a breath hold ascent is a panicked bolt to the surface as a result of
running out of air.
Diving Injuries
What is the cause and what are the 9 signs
5 and symptoms of an gas embolism?
A gas embolism is caused by expanding air forces through the wall
of the lungs into the circulatory system. Bubbles can travel through
the heart and in the most serious cases block blood flow to the
brain, Signs and symptoms may include: sudden
unconsciousness, paralysis, blurred vision, dizziness, blood from
the mouth, coughing, personality changes, cardiac arrest and
death.
What is the cause and what are the 4 signs
7 and symptoms of mediastinal emphysema?
Mediastinal emphysema occurs when expanding air from the lungs
finds its way into the chest cavity, constricting the heart and lungs.
Signs and symptoms include: difficulty breathing, fainting, shock
and cyanosis (blueness of the skin)
What is the cause and what are the 2 signs
6 and symptoms of pneumothorax?
A pneumothorax is caused by expanding air forcing its way
between the lung and chest wall, partially or completely collapsing
the lung. Signs and symptoms include: severe chest pain and
extreme difficulty breathing.
What is the cause and what are the 3 signs
8 and symptoms of subcutaneous emphysema?
Subcutaneous emphysema occurs when expanding air from the
lungs accumulates under the skin around the neck and collarbone.
Signs and symptoms include: neck swelling, voice changes and
difficulty swallowing.
Note: sometimes you may notice a crackling sound when the area
affected is touched.
Diving Injuries

What is the cause of decompression sickness What are the 11 signs and symptoms of
9 (DCS)? 10 decompression sickness?

Decompression sickness occurs when nitrogen dissolved into the • Pain, typically in the joints • Unconsciousness
tissues comes out of solution and forms bubbles during ascent due • Fatigue • Breathing difficulties
to the decrease in pressure. The most common causes of DCS are • Inability to urinate • Chest pain
rapid ascent or failure to use computers or tables correctly and • Blurred vision, vertigo, hearing • Uncontrollable coughing
conservatively, although even if everything is done correctly there or speech impairment • Death
is always a small risk of DCS. • Paralysis
• Loss of sensation
What is meant by decompression illness What are the signs and symptoms of
11 (DCI)? 12 decompression illness?

For a rescuer it can be difficult to tell the difference between lung Signs and symptoms of decompression illness include all the
overexpansion and decompression sickness in the field since previously mentioned signs and symptoms of lung overexpansion
many of the signs and symptoms overlap but the first aid for both as well as those of decompression sickness.
is relatively the same. For that reason we call the lung
overexpansion and DCS decompression illness or DCI to combine
the two under one blanket term.
Diving Injuries

Why should a diver suspected of having DCI What is the primary first aid protocol for a diver
13 always be transported as soon as possible to
the nearest medical facility?
14 with suspected DCI?

Emergency care and first aid for DCI may reduce or eliminate
symptoms, but not the cause. Only advanced medical care that
includes drug administration and hyperbaric treatment in a
recompression chamber can actually treat the cause of DCI.
Why is administering emergency oxygen to a
15 diver with suspected DCI crucial?
• Have the diver lay down. It has been shown that laying down
assists blood flow to the brain and minimizes the migration of
bubbles.
• Arrange for immediate emergency medical transport and
evacuation of the injured diver.
• Continually monitor the divers lifeline providing CPR and rescue
breaths if needed.
• Provide 100% emergency oxygen (or as high as available) until
medical professionals arrive.
• Protect the diver from excessive heat or cold and manage shock.

Emergency oxygen is crucial because whether a diver is suffering

from DCS or lung overexpansion it is likely that their bodies ability
to properly transport oxygen has been reduced or impaired. By
hyper oxygenating the blood you improve the effectiveness of the
blood flow that is available and assist the victims body in reducing
nitrogen levels.
Emergency Oxygen Equipment
1. What are two basic types of emergency oxygen
equipment?
• Disposable – meant to be thrown away once used and
usually come with preset regulators delivering around 6 liters
per minute. They are not preferred but better than nothing.
• Refillable – High pressure cylinders that can be refilled once
used with adjustable settings capable of delivering 100%
oxygen. These are the unit of choice when treating an injured
diver.
2. What are the six primary components of emergency
oxygen equipment and the function of each?
• Cylinders – Hold O₂ under rate of flow of the emergency
pressure O₂.
• Medical Valve – On/off valve • Hoses – Deliver O₂ from
for the cylinder. regulator to the mask.
• Pressure Regulator – • Delivery Devices – Masks
controls and monitors the and demand or manually
pressure in and out of the tank. triggered valves.
3. What is a nasal
• Flowmeter cannula
– controls and when is it used to deliver
the
emergency oxygen?
Nasal cannulas deliver oxygen through the nose and are not
commonly used to treat diving injuries unless the patient
cannot tolerate a mask and can deliver no more than 40%
oxygen.
Emergency Oxygen Equipment
4. On and emergency oxygen system where can the system
components be found?
Emergency Oxygen Equipment
5. What are the three basic styles of emergency oxygen
masks and how do they differ?
• Simple Masks – can be used on continuous flow or demand
and resuscitator valves, for breathing or non-breathing divers
and are easy to clean for reuse.
• Non-Rebreather Masks – used so the victim does not
rebreathe their exhaled breath and feature an attached
reservoir bag that fills with O₂ in between breaths.
• Pocket Masks – used to deliver supplemental O₂ to non
breathing divers while rescue breaths are being given.
6. What is a demand inhalator valve and when is it used to
deliver emergency oxygen?
Similar to the second stage of a scuba regulator a demand
inhalator valve delivers 100% oxygen to a breathing diver
when the take a breath. They reduce waste of oxygen and can
be easily cleaned for reuse. It is however important to monitor
the diver for breathing because if they stop breathing no
oxygen will be delivered.

7. What is a manually triggered resuscitator valve and when

is it used to deliver emergency oxygen?
These can double as a demand valve on a breathing diver but
are primarily used as an alternative to rescue breaths. They
have a button that when pressed delivers pressurized 100%
oxygen to resuscitate a non breathing diver.
Safety Considerations
• Avoid open flames, do not use emergency oxygen
within 3 meters of open flames or cigarettes.
What are the 7 • Keep oxygen away from electrical equipment that
safety procedures to could spark and don’t use in closed areas.
follow when • Keep all petroleum away from oxygen and cylinders
handling emergency and regulators must be oxygen cleaned.
• Keep oxygen cylinders away from heat and avoid
O₂ equipment?
storing in direct sunlight or a hot vehicle.
• Keep oxygen cylinders secured during transport.

1 • Use both hands when carrying oxygen cylinders.

• Ensure all oxygen cylinders are within hydrostatic
test dates.

2 When and oxygen cylinder is opened quickly, releasing

a burst of gas into the regulator, compression can
result causing heat. In rare cases, this can cause a fire
by igniting any contaminants or particles within the
What is a regulator. To avoid this:
compression
• Have regulators serviced regularly.
fire? • Inspect regulators and valves before assembling.
• Open cylinder valve slowly to turn on the flow.
• Test oxygen flow prior to giving it to an injured diver.
Maintaining Oxygen Equipment
How often must and emergency oxygen cylinder be tested?
1
Generally, emergency oxygen cylinders must be tested every
five to ten years depending on the laws of your country. In
Thailand emergency oxygen cylinders must be hydrostatically
tested every five years.
2
How do you determine if an emergency oxygen cylinder
needs testing?
The hydrostatic test date should be stamped on the neck of the
cylinder showing a month separated by a symbol then a year. If a
cylinder is out of date it must be tested before refilling.
3
Where and how do you fill emergency oxygen cylinders?
• Medical supply and medical gas companies.
• In some areas a doctors prescription may be required.
• Often certified emergency first responders can get cylinder
refills. Take your certification card with you when getting a refill.
• Refill the cylinder only at authorized and reputable dealers.
4
What regular maintenance must be performed on emergency
oxygen systems?
• Disposable items such as some masks and tubing should be
disposed of after use and replaced before repacking a kit for
storage.
• All non disposable masks should be disinfected and rinsed
before storage.
• Secure spare sealing gaskets/washers.
• Check the cylinder for the need to refill.
• Follow manufacturers instructions on maintenance procedures.

Skill Development
Demand inhalator valve use for breathing diver:
• Turn on oxygen flow valve.
• Give the oxygen use statement and self test the
system.
• Place the mask on the divers face so it is
comfortable and has a proper seal.
• Position the unresponsive breathing diver
appropriately.
Skill 2
Skill 1
Assemble and disassemble emergency O₂
system:
• Students demonstrate how to assemble and
emergency oxygen system and attach a pocket
mask, non rebreather mask and a demand valve.
• Students demonstrate how to setup emergency
oxygen so 2 injured divers can breathe off one
system.
• Students demonstrate how to disassemble and
safely store all equipment.
Pocket mask use with O₂ for non-breathing
diver:
• Turn on oxygen and adjust flowmeter to at least
15 liters per minute.
• Connect oxygen to pocket mask via inlet.
• Give the oxygen use statement and self test the
system.
• Open the divers airway.
• Place the mask on the divers face so it is
comfortable and has a proper seal.
• Give mouth to pocket mask rescue breaths, each
lasting approximately one second.
Skill 4
Skill 3
Non rebreather mask use for breathing diver:
• Turn on oxygen and adjust the flowmeter to at
least 15 liters per minute.
• Fill the reservoir bag
• Give the oxygen use statement and self test
the system.
• Place the mask on the injured diver so it is
comfortable and has a proper seal.
• Position the unresponsive, breathing diver
appropriately.
Optional Skill

Manually Triggered Resuscitator Valve Use For

a Non-breathing Diver:

• Turn on oxygen cylinder valve.

• Check the safety valve to ensure it functions
properly to block the oxygen outlet.
• Give the oxygen use statement and self test the
system.
• Open the divers airway
• Place mask on the divers face so it is
comfortable and has a proper seal.
• Trigger the resuscitator valve manually to
provide the diver with oxygen and rescue breaths.
Adding this skill will give
additional value to your
course but not all dive
centers will have this device
available so it is optional to
add flexibility to the course.
Thank You
Please Refer to the
PADI Emergency Oxygen
Provider Instructor Manual
for More Information