Is oxygen a prescription drug? It comes up in discussions at aquatic conferences, workshops, and around the proverbial water cooler: Is giving too much oxygen harmful to the victim? How hard is it to adopt emergency oxygen into our Emergency Action Plan (EAP) protocols? This article will clarify the benefits of providing emergency oxygen to a victim of an aquatic incident or drowning, and lay out a clear path of how to incorporate emergency oxygen into your agencies protocols, lifeguard certification, in-service training, and EAP.

Dr. Justin Sempsrott, co-founder and executive director of Lifeguards Without Borders, the medical director of Starfish Aquatics International and one of Aquatics International’s  2015 Power People, found time to speak with me about emergency oxygen between his duties as an emergency room physician and drowning prevention advocate.

He referred directly to the Food and Drug Administration website: “The [FDA] generally regards oxygen to be a prescription drug. Nevertheless, FDA recognizes that there are many circumstances under which it would be impractical to insist that oxygen be administered only under the supervision of a physician. Oxygen units may be marketed without a prescription when used for emergency resuscitation and when administered by an individual who is authorized, certified, or licensed by the state authorities.”

When asked about what emergency oxygen does for a victim of a drowning, Dr. Sempsrott responded: “Remember that drowning is a process that ranges from mild to moderate to severe; drowning does not equal death and drowning does not mean unconscious. The drowning process causes decreased oxygen in the blood (hypoxemia), which causes decreased oxygen to the brain. Mild, moderate, and severe drowning patients will have varying degrees of hypoxemia and should have as much oxygen as possible delivered to replace the depleted blood oxygen levels. The brain is so sensitive to hypoxemia that it starts to die after just 4 to 6 minutes without oxygen. Providing oxygen to the drowning patient as soon as possible interrupts the drowning process and replenishes the much needed oxygen to the brain.”

Dr. Sempsrott also addressed the concern about giving too much oxygen. “There are studies that show that too much oxygen (hyperoxia) can be harmful in patients that have had heart attacks or strokes. Oxygen can create “free radicals” which can damage brain or heart cells that are healing and repairing themselves in the areas around the heart or brain blockage. These studies are based in the intensive care unit on patients that receive high levels of oxygen for several hours or days. In the lifeguard setting, when a patient has just suffered a drowning, then they need as much oxygen as possible and the risk of causing damage from the oxygen is negligible.”

If your agency is going to move forward with adopting emergency oxygen protocols, it will be imperative to verify which governing bodies are empowered to regulate the use of emergency oxygen. Governing bodies that could have oversight could include your city’s EMS department, your city, county or state. It is important to do your homework.

There are many recognized training organizations, including the American Red Cross, American Safety & Health Institute, and Divers Alert Network, that can provide the training and certification to administer emergency oxygen. The training is usually offered as a standalone course or additional component integrated into an existing lifeguarding course depending on the certifying organization.

If your agency decides to move forward with adopting emergency oxygen protocols, your staff will need to be trained, certified, and recertified. Your agency will need to track the certification for proof of compliance, and have a daily equipment log to verify the oxygen equipment is in working order. Development of an in-service training component should be integrated into your training curriculum.

Startup costs will include a regulator (fixed flow or variable), several oxygen cylinders, oxygen delivery adjuncts and a medical pack to hold the supplies.(Please note that all medical oxygen cylinders and regulators utilize a universal two-pin system that prevents cylinders being filled with any other gas, and the regulators being used on any other non-oxygen cylinders.)

Access to a constant supply of medical-grade oxygen for training and use is the next hurdle. This challenge can be eased by establishing a cylinder exchange with your local fire or EMS department. Prior to purchase, make sure your cylinders are the same size as your partner agencies, so the exchange is hassle free and contributing to the cache of available cylinders. If the cylinder exchange option is not feasible, you’ll have to find a vendor that fills emergency oxygen cylinders. Check with your local SCUBA diving stores, medical supply, or compressed gas providers for cylinder refill availability and pricing.

If your agency doesn’t want to pursue emergency oxygen use, Dr. Sempsrott wants you to consider this: “The air in the environment is approximately 21 percent oxygen, and we exhale approximately 16 percent oxygen. If no supplemental oxygen is available, then using a BVM will deliver 21% oxygen instead of the 16% delivered by pocket mask. The drowning or apneic patient is receiving 0% oxygen if you don’t intervene. For those agencies that are doing rescue breaths while the patient is still in the water, 16 percent oxygen delivered immediately is better than zero percent for the 90 seconds that it takes to extricate followed by 100 percent oxygen once on the deck. It is always better to start with what you have and advance as needed and as the equipment becomes available.”

Emergency oxygen or not, lifeguards should continue to train frequently in providing effective care to victims with breathing emergencies. Remember: refreshers and recertification courses allow lifeguards to use the equipment. Breathing emergency drills and scenarios, both on land and in water, prepare the lifeguard team to be successful in the field. Proficiency and urgency should be expected in the use of the pocket mask, BVM, and emergency oxygen adjuncts.

Good luck, and keep training.