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by Rosemary E. Lunn
Header image courtesy of DAN Europe
News has broken in the last couple of days that probably one of the most important documents in sport diving has been revised. We now have a new Recreational Scuba Training Agency (RSTC) medical declaration form, and the notes for physicians have been thoroughly reworked too.
The process has taken three years and involved the likes of Nick Bird M.D., Oliver Firth M.D., the late Professor Tony Frew, Alessandro Marroni M.D., Simon Mitchell M.D., Associate Professor Neal Pollock Ph.D., and Adel Taher M.D..
The resulting document is succinct. The 30+ questions have been cut to 10 with the aim of reducing unnecessary and avoidable referrals, while doing a better job of screening those medical issues truly associated with diving injuries.
It certainly demonstrates a willingness by the diving doctors and relevant bodies to make this key document work for our global community.
This international collaboration of volunteer diving experts also demonstrates that, in the main, hyperbaric doctors involved with diving are ardent fans of our sport. Probably their most common complaint is that they dive a desk more often than they would wish, but I think we would all say that too. When a patient walks into their consulting room, the last thing they want to do is inform the patient “I am very sorry, but you cannot go diving”. The doctor wants you to leave with a medical that enables you to embrace diving. In rare cases, however, they have ended up signing what is effectively a death warrant, because their diving patient has been less than truthful with them. That’s really not big, clever, or funny.
Now I can understand divers getting frustrated with their local doctor, a General Practitioner or Family Practitioner when it comes to diving medicine. Although I am not medically trained, I do have a far greater knowledge of diving medicine than personnel at my local surgery. I am not boasting, just lucky I get to work with some extraordinary professionals who have improved my education in this field, and I am a curious cat by nature. I always want to know more.
“A GP saying you should or shouldn’t dive again ain’t worth squat in most situations. A proper dive doctor that does a dive medical is much more relevant”Post, ScubaBoard 10JUNE 2020
A classic case in point about the lack of diving medicine education springs to mind. A friend of mine took an unprovoked hit. The chamber medical staff thought he might have an undiagnosed PFO (patent foramen ovule) and recommended that he get this checked out before he thought about recommencing diving. The diver toddled off to his GP and asked to be referred to a cardiologist to check if there was a shunt or perhaps a hole between his right and left atrium. His doctor responded with “what is a PFO”? My friend was aghast. Yup. Scary stuff. So I can understand a diver being a tad reticent about discussing dive medicine with their local doctor.
This doesn’t give anyone carte blanche to be economical with the truth when consulting their diving doctor though. It can have fatal consequences. We had a tragic case in the UK where a 70 year-old was taking a rebreather class at an inland quarry.
The Coroner’s Report stated that a diver “was undertaking a `re-breather’ course with an instructor and was diving at Stoney Cove, Stoney Stanton in Leicestershire on the 25 September 2018 when his instructor noticed that something was wrong with the diver. They made an emergency ascent to the surface and attracted the attention of centre staff who immediately pulled the diver out of the water and called the emergency services. Unfortunately, after resuscitation attempts failed, the diver was declared deceased at the scene. He was an experienced diver and had been diving since about 1992.”
It transpires that the diver had cut short a dive in 2015 because he had experienced breathing difficulties. He had therefore been investigated by a consultant cardiologist for symptoms of immersion pulmonary edema. The conclusion was that the diver should not dive again “not only for the sake of his safety but for the sake of the safety of the rescuer”. The cardiologist confirmed this in writing to the diver’s GP on 27 December 2017.
However when the diver went for a diving medical on 30 January 2018, he was passed fit to dive by a highly experienced doctor. This was not the fault of the doctor because they worked with the data they were provided with. This doctor is an Occupational Health Physician, a UK Sport Diving Medical Referee and an HSE Approved Medical Examiner of Divers. In other words, a doctor educated in diving medicine. The doctor passed the diver as ‘fit to dive’ for two years based on the information given to them by the diver in the medical questionnaire and the doctor’s physical examination of the diver. They did not have access to or knowledge of the cardiologist’s letter.
As a direct result of the diver being less than honest with the truth with the diving doc, he contributed to his own death.
And then there is one case I remember while I was working in the Red Sea as a fulltime dive pro. I would regularly get to visit Dr. Adel Taher at the Sharm-el-Sheikh hyperbaric centre with potential divers.
The first thing that is completed on any diving course is the paperwork, and part of that is of course the medical declaration form. It was quite normal for at least one student to need to get a medical signed-off prior to training.
One morning I took a family to the chamber. The parents and their offspring were due to start an open water course. One of the children had a medical issue. I got lucky because on that particular day the diving doctor on call was a pediatrician. (Dr. Adel does employ some remarkable staff at the chamber). This man wasn’t just a normal child doctor, he was a consultant at one of the Cairo hospitals. A rare thing, and just the combination of medicine expertise we needed in this instance.
The pediatrician is a kind and knowledgeable man. After examining the child he thoroughly explained in a very gentle manner to the parents that “at this time he could not sign off their child as ‘fit to dive’. However, the good news was that he thought the child would grow out of the condition, and in two to three years the child would be ok to dive. He recommended that at that point, the family consult a diving doctor for a medical.”
The family took me to one side and asked if I could arrange a second opinion because they believed the doctor was incorrect and didn’t know his stuff. I was a bit stunned to say the least. You can’t just pull, as if by magic, a diving doctor who is also a consultant pediatrician out of a hat. This experience has stayed with me, and I have pondered about it over the years.
In hindsight, I have come to two conclusions, and I could of course be wrong in my private thoughts. Either as a white English family they saw a dark-skinned Arab and were prejudiced in their thoughts, or they saw an Egyptian doctor and considered his training and knowledge to be third world. “What does he know about my child’s condition? How can he think they cannot be fit to dive?”
I was embarrassed and angry, and put in the horrible position of diplomatically explaining to the parents that the diving doctor was not out to ruin their holiday. He was not out to spoil their fun. He was in fact giving the very best advice he could to keep their daughter safe and well. And he gave them positive advice for the future. They just didn’t want to hear any of it.
Rule of diving: Diving docs are not out to ruin your fun. They also don’t want to sign your death warrant. Just be honest with them and they will keep you as safe as they can.
Dive industry “Fixer,” Rosemary E Lunn (Roz) is Business Development Director at The Underwater Marketing Company. This British firm specializes in providing marketing, communications, social media and event management for the tecreational and technical diving industry. Rosemary is a PADI IDC Staff Instructor, BSAC Advanced Instructor, Trimix and CCR diver. Before moving into the public relations field, she worked as a professional recreational instructor in the United Kingdom and abroad, on History Channel and National Geographic documentaries, and as a safety diver and model underwater.
She established TEKDiveUSA and organised Rebreather Forum 3 on behalf of AAUS, DAN and PADI. In 2008 Rosemary co-founded EUROTEK, the European advanced and technical diving biennial conference. She has organised the last six events: 2008, 2010, 2012, 2014, 2016 and 2018. Roz is a respected and prolific diving author, an Associate Member of the Women Divers Hall of Fame, and an SSI Platinum Diver. She takes an active role in the scuba diving industry and sits on the SITA Board (Scuba Industries Trade Association) and the BDSG (British Diving Safety Group).
Our Most Read Stories of 2020
Dive into our most read stories of 2020. Can cameras kill? What about those peculiar GUE rebreathers? Gradient factors anyone? Was it a world record dive? Find out.
Header photo by Sean Romanowski
This December marks the second full year of publishing InDepth, and what a crazy year it’s been. With the pandemic still raging throughout most of the world, it has been a most challenging year for the diving industry, as I’m sure you’re aware. I would like to take this opportunity to thank you, our readers for your continuing interest and support, and also thank our thoughtful contributors who make the blog possible.
Over the last year, we published nearly 100 InDepth stories covering the latest developments in exploration, technology, training, conservation, diving science & medicine, image making and technical diving culture. We also added select translations into Chinese, Italian, and Spanish . In doing so, I believe that we have grown our coverage in terms of breadth, depth and sophistication. Call it, a geeky labor of love!
In addition, we’ve added some depth-full sponsors to the mix, that have made it possible to grow and sustain InDepth. Our special thanks to DAN Europe, Dive Rite, Divesoft, Fourth Element, Halcyon, The Human Diver, and Shearwater Research. May your brands continue to flourish!
Similar to 2019, we celebrate the coming new year with our Most Read Stories from 2020/2019. If you like what you read, please SUBSCRIBE, it’s free! That will ensure you’ll get our latest stories and content delivered to your inbox. Here’s to a hopefully wet and most excellent 2021!
1. Cameras Kill Cavers Again
Cave explorer, photographer and instructor Natalie L Gibb wants to make “taking pictures” the sixth rule accident analysis. How can toting a camera underground get you into trouble? Take a breath, clip off your camera, and say cheese, Gibb will explain.
2. The Thinking Behind GUEs Closed Circuit Rebreather Configuration
GUE is known for taking its own holistic approach to gear configuration. Here GUE board member and Instructor Trainer Richard Lundgren explains the reasoning behind its unique closed-circuit rebreather configuration. It’s all about the gas!
3. Gradient Factors in a Post Deep Stop World
World-recognized decompression physiologist and cave explorer David Doolette explains the new evidence-based findings on “deep stops,” and shares how and why he sets his own gradient factors. His recommendations may give you pause to stop (shallower).
4. Fact or Fiction: Revisiting the Guinness World Record Dive
Newly released information calls into question the validity of former Egyptian Army Colonel and instructor trainer Ahmed Gabr’s 2014 world record scuba dive to 332 m/1,090 ft in the Red Sea. InDepth editor-in-chief Michael Menduno reports on what we’ve learned, why this information is coming out now, and what it all may mean.
5. Can We Save Our Planet? What About Ourselves? Interview With Sea Shepherd founder Paul Watson.
Managing editor Amanda White poses the BIG questions to environmental activist Captain Paul Watson, founder of Sea Shepherd Conservation Society and the architect behind its strategy of aggressive non-violence. His answers may surprise you—and even bring you to tears. What motivates the 70-year Environmental Hero of the 20th Century to keep up the fight despite widespread ignorance, apathy and greed? Find out.
6. Isobaric Counter Diffusion in the Real World
Isobaric counterdiffusion is one of those geeky, esoteric subjects that some tech programs deem of minor relevance, while others regard it as a distinct operational concern. Divers Alert Network’s Reilly Fogarty examines the physiological underpinnings of ICD, some of the key research behind it, and discusses its application to tech diving.
7. Deepest Freshwater Flooded Abyss in the World
The efforts to explore and map Hranice Abyss, located in Hranice (Přerov District) in the Czech Republic span more a century. Currently, the monstrous chasm is known to reach 384 m/1260 ft deep. Explorer and member of the Czech Speleological Society Michal Guba has the deets.
8. Urination Management Considerations for Women Technical Divers
Tech diver and doctoral student, Payal Razdan, offers an in-depth review of the options available to women tech divers for handling the call of nature.
9. Situational Awareness and Decision Making In Diving
Situational awareness is critical to diving safety, right? But how much of your mental capacity should be devoted to situational monitoring, e.g., How deep am I? How much gas do I have? Where is my buddy? Where is my boat? More importantly, how does one develop that capacity? Here GUE Instructor Trainer Guy Shockey, who is also a human factors or non-technical skills instructor, explores the nature and importance of situational awareness, and what you can do to up your game.
10. Examining Early Technical Diving Deaths
The early days of technical diving were marred by an alarming number of fatalities that threatened the viability of this emerging form of diving. Here InDepth editor-in-chief Michael Menduno presents the original accident analyses of 44 incidents that resulted in 39 fatalities and 12 injuries, as reported in aquaCORPS Journal and technicalDIVER in the early to mid 1990s.
11. A Voice In The Wilderness
Just when you thought you’ve seen it all, along comes underground picture-maker SJ Alice Bennett, who is shedding new light on the dark, moody, twisting karst passageways that form what explorer Jill Heinerth calls “the veins of Mother Earth.” If you’re ready for a new perspective on the ‘doing of cave diving,’ switch on your primary and dive right in.
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