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).
The Price of Helium is Up in the Air
With helium prices on the rise, and limited or no availability in some regions, we decided to conduct a survey of global GUE instructors and dive centers to get a reading on their pain thresholds. We feel your pain—especially you OC divers! InDEPTH editor Ashley Stewart then reached out to the helium industry’s go-to-guy Phil Kornbluth for a prognosis. Here’s what we found out.
By Ashley Stewart. Header image by SJ Alice Bennett.
Helium is one of the most abundant elements in the universe, but here on Earth, it’s the only element considered a nonrenewable resource. The colorless, odorless, and tasteless inert gas is generated deep underground through the natural radioactive decay of elements such as uranium and thorium in a process that takes many millennia. Once it reaches the Earth’s surface, helium is quickly released into the atmosphere—where it’s deemed too expensive to recover—and rises until it ultimately escapes into outer space.
Luckily for divers who rely on the non-narcotic and lightweight gas for deep diving (not to mention anyone who needs an MRI scan or who uses virtually any electronic device), some helium mixes with natural gas underground and can be recovered through drilling and refinement.
Yet the world’s helium supply depends primarily on just 15 liquid helium production facilities around the globe, making the industry uniquely prone to supply chain disruptions, which this year caused the industry’s fourth prolonged shortage since 2006. The shortage has caused many technical dive shops around the world to raise prices, limit fills, or stop selling trimix altogether, according to an InDEPTH survey of GUE instructors and affiliated dive centers.
Longtime helium industry consultant Phil Kornbluth, however, expects the shortage will begin to ease gradually now through the end of the year, and for supply to increase significantly in the future.
While a majority of the world’s helium is produced in just a few countries, a new gas processing plant in Siberia is expected to produce as much as 60 million cubic meters of helium per year, about as much as the US—the world’s largest helium producer—was able to produce in 2020. The Siberian plant ran for three weeks in September, but experienced major disruptions over the past year, including a fire in October and an explosion in January, that delayed its planned opening until at least 2023.
Meanwhile, according to Kornbluth, the U.S. Bureau of Land Management in Texas closed down from mid-January to early June due to safety, staff, and equipment issues, wiping out at least 10% of the market supply. The plant reopened in June and is back to normal production as of July 10. The supply of helium was further reduced as two of Qatar’s three plants closed down for planned maintenance, a fire paused production at a plant in Kansas, and the war in Ukraine reduced production of one Algerian plant.
With the exception of the plant in Siberia, Kornbluth said virtually all of the recent disruptions to the helium supply chain have been resolved and should yield some relief. And the future looks promising. Once the Siberian plant is online, it’s expected to eventually boost the world’s helium supply by one-third. While sanctions against Russia could prevent some buyers from purchasing the country’s helium, Kornbluth expects there will be plenty of demand from countries that as of now are not participating, like China, Korea, Taiwan, and India, though there could be delays if those countries have to purchase the expensive, specialized cryogenic containers required to transport bulk liquid helium. “Sanctions are unlikely to keep the helium out of the market,” Kornbluth said.
Meanwhile, there are at least 30 startup companies exploring for helium, and there are other projects in the pipeline including in the U.S., Canada, Qatar, Tanzania, and South Africa. “Yes, we’re in a shortage and, yes, it’s been pretty bad, but it should start improving,” Kornbluth told InDEPTH. “The world is not running out of helium anytime soon.”
To find out how the helium shortage is affecting divers, InDEPTH surveyed Global Underwater Explorers’ (GUE) instructors and dive centers and received 40 responses from around the world.
The survey’s highest reported helium price was in Bonaire—a Dutch island in the Caribbean that imports its helium from the Netherlands—where helium costs as much as US$0.14 Liter(L)/$4.00 cubic foot (cf) and is expected to rise. At that price, a set of trimix 18/45 (18% O2, 45% He) in double HP100s (similar to D12s) would cost around $360.00 and trimix 15/55 would cost $440.00.
“We have enough to support both open circuit and CCR, but in the near future, if the situation remains, we may be forced to supply only CCR divers,” Bonaire-based GUE instructor German “Mr. G.” Arango told InDEPTH. “We have enough for 2022, but 2023 is hard to predict.”
Not far behind Bonaire was the Philippines, where helium costs around US$0.13 L/$3.68 cf—if you can even get it. Based on the responses to our survey, Asia is experiencing the greatest shortages. Supply is unavailable in some parts of the Philippines, limited in South Korea, and unavailable for diving purposes in Japan as suppliers are prioritizing helium in the country for medical uses, according to four instructors from the region. In Australia, it’s relatively easy to obtain.
Four US-based instructors reported that helium prices are increasing significantly and supply is decreasing. Helium remains “very limited” in Florida and prices in Seattle increased to $2.50 from $1.50 per cubic foot ($0.09 L from about $0.05 L) in the past six months, and there was a period when the region couldn’t get helium as suppliers were prioritizing medical uses. In Los Angeles, prices have reached as high as $2.80 cf (nearly $0.10 L) and one instructor reported helium is only available for hospitals and medical purposes, even for long-term gas company clients who are grandfathered in. Another Los Angeles-based instructor said direct purchases of helium had been limited to one T bottle per month, down from three.
“Currently, we are only providing trimix fills for our CCR communities,” GUE instructor Steven Millington said. “Possibly this will change, but the current direction for active technical divers is CCR. I agree (and already see) that open circuit technical diving in some regions will go the way of the dinosaur.”
In Western Europe, helium is becoming more difficult and expensive to acquire, 10 instructors in the region told us. Instructors in the United Kingdom, Spain, Italy, and Germany reported longer wait times, high price increases, and limited supply.
Meanwhile, Northern Europe appears to be a bright spot on the map with comparatively reasonable prices and general availability. In Norway, two instructors reported helium is easy to obtain, with no lead time from suppliers. Likewise in Sweden and Finland, though one Finnish instructor told us that in the past year prices have increased significantly.
Three instructors in Northern Africa and the Middle East said helium is easy to get, but is becoming more expensive. The price of Sofnolime used in rebreathers is increasing in Egypt as helium becomes more expensive and more difficult to obtain. Lebanon has minimal lead times, but helium is among the most expensive in all of the responses we received at US$0.10 L/$2.83 cf.
Helium is generally easy to obtain in Mexico, though prices are increasing dramatically and instructors are starting to see delays. In Brazil, prices in São Paulo quadrupled in the past 12 months and by 30% in Curitiba. Suppliers there aren’t accepting new customers and existing customers are having difficulty obtaining supply. Supply is mostly constrained in Canada, with the exception of one outlier: an instructor who has a longstanding account with the gas company and pays less than US$ 0.035 L/$1.00 cf. “I have been hearing of helium shortage every year for the last decade,” instructor Michael Pinault of Brockville Ontario told InDEPTH, “but I have never not been able to purchase it.”
Many instructors around the world said that helium shortages and skyrocketing prices are, no surprise, fueling a shift to CCR for individual divers and exploration projects. “CCR is saving our exploration projects,” GUE instructor Mario Arena, who runs exploration projects in Europe, said. “These projects would be impossible without it.”
US Geological Survey: Helium Data Sheet: Mineral Commodity Summaries 2021
The Diver Medic: The Future of Helium is Up in the Air,” Everything you wanted to know about helium, but were too busy analyzing your gas to ask—talk by InDEPTH chief Michael Menduno
InDepth Managing Editor Ashley Stewart is a Seattle-based journalist and tech diver. Ashley started diving with Global Underwater Explorers and writing for InDepth in 2021. She is a GUE Tech 2 and CCR1 diver and on her way to becoming an instructor. In her day job, Ashley is an investigative journalist reporting on technology companies. She can be reached at: email@example.com