klausi
Contributor
This incident happened a few months ago at a dive shop I don't work at anymore, but my intention is not finger pointing, but figure out what to best do in comparable situations?
A diver arrived at our resort with his wife and friends. The diver had done many dives (1000+), but was 60yo, moderately overweight, and had suffered two heart attacks 8 years ago. He had a medical certificate stating that he was still fit to dive. He was not smoking (anymore?) but drinking alcohol regularly.
Question 1: Should I have nevertheless rejected the person as a diver right away at this point? Can it be reasonably safe at all to dive with 2 previous heart attacks, even for easy recreational dives? Pointers to relevant studies are appreciated. I knew I was legally safe with the medical certificate, but that's not the main point - I just want everybody to be safe.
The diver and his wife & friends typically did 3 dives per day, almost all on 32% nitrox. The dives in the region are usually 30 meter max, with most time spent at 20 m or less not very challenging or deep dives. The water temperature that time of the year here is 27C.
About 2 weeks into their vacation the diver somewhat collapse at dinner. He then went back to his room I did not witness that part personally. At that point, the bar staff got me from my room nearby, with a brief description of what had happened. I am not a medical doctor, but I am quite well read in diving medicine, from my technical diving training and a long-time interest. I immediately suspected a DCI. On the way I ran into another guest who is a trained nurse, and asked her to come along, which she immediately agreed to.
I found the patient sitting on his bed, visibly pale and shaken. His wife pointed out a large dark red spot on his abdomen likely skin bends. I encouraged him to drink (which he had done, he said), left him with the nurse, and went to fetch our oxygen system. I also asked one of our bar staff to call an ambulance. Once I had gotten the oxygen, I assembled the system with the help of another guest and had the patient start breathing. I again left the nurse with him, and went to wait for the ambulance (it's not easy to find your way around the hotel property if you haven't been there).
After about 10 minutes the ambulance arrived, but the patient refused to head to the hospital in it. Even without formal medical training it seemed clear to me that someone with his age, medical history and symptoms should be under medical supervision for the night. There is a decompression chamber in Cebu City which can be reached in 4 hours from Dauin, and a good hospital in Dumaguete, about 20 minutes from the resort I was at. Once at the hospital he would be already closer to the chamber, and under medical care for the transport, should it be necessary.
Myself, the nurse, and the patient's wife tried to convince him multiple times to go to the hospital, but he refused to go (in front of several people). I explained that I was under the opinion that this could be a serious issue and that my recommendation was to go see a doctor. The red spot had not disappeared but taken a less intense red color (it was pinkish afterwards). He stated that he felt reasonably well. Eventually I sent the ambulance home (it was a free countryside volunteer ambulance, and the patient made no attempt to thank them or donate to them the next day).
The patient decided to stay in his room and continue breathing oxygen. He asked for our 2nd oxygen tank, which I gave him. He ended up only breathing one tank empty and was, at least superficially, fine the next day. Which I consider quite a bit of good luck! I certainly slept light that night, expecting to be woken up due to an escalating DCI.
Question 2: There is nothing one can legally do to force an adult to accept medical treatment, correct? That's why sometimes Jehovahs witnesses die from refusing blood transfusions, right? What is the proper procedure in such a situation? I was quite surprised that anyone would be rejecting medical help like that. I made sure he had stated his intention not to go to the hospital to me before witnesses. What else would there be to do?
Incredibly, the patient, who had been difficult to deal with as a guest to begin with (other guests had complained about him) did not even thank me and the staff for our help. While his wife did thank us the day after the incident, she also took the opportunity to tell me that they did nothing wrong and that her hubby is in top shape. I told her that this wasn't quite the case, that this situation was potentially dangerous, and that diving was over for her husband on this trip. I recommended getting a EKG that day. They did not protest me not letting him dive anymore. They did, however, clearly take my advice as an insult and started complaining about everything and anything at the resort even more than before.
Question 3: How do you best communicate to people ignorant in diving medicine that they are/were in trouble?
A diver arrived at our resort with his wife and friends. The diver had done many dives (1000+), but was 60yo, moderately overweight, and had suffered two heart attacks 8 years ago. He had a medical certificate stating that he was still fit to dive. He was not smoking (anymore?) but drinking alcohol regularly.
Question 1: Should I have nevertheless rejected the person as a diver right away at this point? Can it be reasonably safe at all to dive with 2 previous heart attacks, even for easy recreational dives? Pointers to relevant studies are appreciated. I knew I was legally safe with the medical certificate, but that's not the main point - I just want everybody to be safe.
The diver and his wife & friends typically did 3 dives per day, almost all on 32% nitrox. The dives in the region are usually 30 meter max, with most time spent at 20 m or less not very challenging or deep dives. The water temperature that time of the year here is 27C.
About 2 weeks into their vacation the diver somewhat collapse at dinner. He then went back to his room I did not witness that part personally. At that point, the bar staff got me from my room nearby, with a brief description of what had happened. I am not a medical doctor, but I am quite well read in diving medicine, from my technical diving training and a long-time interest. I immediately suspected a DCI. On the way I ran into another guest who is a trained nurse, and asked her to come along, which she immediately agreed to.
I found the patient sitting on his bed, visibly pale and shaken. His wife pointed out a large dark red spot on his abdomen likely skin bends. I encouraged him to drink (which he had done, he said), left him with the nurse, and went to fetch our oxygen system. I also asked one of our bar staff to call an ambulance. Once I had gotten the oxygen, I assembled the system with the help of another guest and had the patient start breathing. I again left the nurse with him, and went to wait for the ambulance (it's not easy to find your way around the hotel property if you haven't been there).
After about 10 minutes the ambulance arrived, but the patient refused to head to the hospital in it. Even without formal medical training it seemed clear to me that someone with his age, medical history and symptoms should be under medical supervision for the night. There is a decompression chamber in Cebu City which can be reached in 4 hours from Dauin, and a good hospital in Dumaguete, about 20 minutes from the resort I was at. Once at the hospital he would be already closer to the chamber, and under medical care for the transport, should it be necessary.
Myself, the nurse, and the patient's wife tried to convince him multiple times to go to the hospital, but he refused to go (in front of several people). I explained that I was under the opinion that this could be a serious issue and that my recommendation was to go see a doctor. The red spot had not disappeared but taken a less intense red color (it was pinkish afterwards). He stated that he felt reasonably well. Eventually I sent the ambulance home (it was a free countryside volunteer ambulance, and the patient made no attempt to thank them or donate to them the next day).
The patient decided to stay in his room and continue breathing oxygen. He asked for our 2nd oxygen tank, which I gave him. He ended up only breathing one tank empty and was, at least superficially, fine the next day. Which I consider quite a bit of good luck! I certainly slept light that night, expecting to be woken up due to an escalating DCI.
Question 2: There is nothing one can legally do to force an adult to accept medical treatment, correct? That's why sometimes Jehovahs witnesses die from refusing blood transfusions, right? What is the proper procedure in such a situation? I was quite surprised that anyone would be rejecting medical help like that. I made sure he had stated his intention not to go to the hospital to me before witnesses. What else would there be to do?
Incredibly, the patient, who had been difficult to deal with as a guest to begin with (other guests had complained about him) did not even thank me and the staff for our help. While his wife did thank us the day after the incident, she also took the opportunity to tell me that they did nothing wrong and that her hubby is in top shape. I told her that this wasn't quite the case, that this situation was potentially dangerous, and that diving was over for her husband on this trip. I recommended getting a EKG that day. They did not protest me not letting him dive anymore. They did, however, clearly take my advice as an insult and started complaining about everything and anything at the resort even more than before.
Question 3: How do you best communicate to people ignorant in diving medicine that they are/were in trouble?
