Disclosure of health conditions to dive ops/fitness (thread split
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No I didn't. There is neither any indication that the victim here lied on his form or had the doctor's release, nor there was any suggestion that anyone with at high risk would knowingly lie on theirs. Your whole argument is your own imaginary straw man.
PS. to wit, you said you object to "overwhelming willingness to lie on the form". I don't know what you meant, but what you seem to be arguing is: this thread is overwhelmed with internet divers whose health is on the brink of collapse who knowingly and deliberately lie on their medical forms in order to put your life at risk while you rush to rescue them. Did I comprehend that right?
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read what you wrote.
Then read what prompted this whole tangent.
Then explain to me how you got from "I get stress tested every year now and I am fit as a flea with no signs of ischemia or even heart muscle damage" to "People who are told by their doctors that they shouldn't be diving, dive anyway, have a medical emergency consequently put others in danger".
On second thought, don't bother: I need to get back to work
Hello,
This is a very difficult subject. Unfortunately discussions about pre-participation screening of divers always get tangled up by competing issues or priorities like pragmatism (making a dive operation run smoothly), medico-legal concerns, and concerns about preventing harm to divers (either those suffering a medical event or those rescuing them). We see examples of people bringing all of these perspectives to this thread. They never sit well together.
There are a couple of interesting facts you should be aware of based on reasonably hard data (which is a rare commodity in diving medicine).
First, the DAN group published a study suggesting that the death rate among insured DAN members (thus, a reasonably representative group of recreational divers) was 16 per 100,000 divers per year. Hard to interpret this number. Jogging is 13 per 100,000 per year [1]. The key point is that deaths occur often enough, and obviously none of us like it.
Second and more importantly, the same group published a quality study that suggested a cardiac event was the disabling injury in 27% of recreational diving deaths [2]. This is a much more important figure because it identifies a potential point of attack in trying to prevent diving deaths (and I'm sure we can all agree that this is a good idea).
Moving onto the use of pre-participation screening, a third interesting fact is that in recreational diving it is possible for a diver to complete some sort of health evaluation at entry to the sport (eg the RSTC form) but then (unlike occupational divers who undergo periodic medicals) they can transition through a long diving career without any form of health surveillance whatsoever. Completion of health surveys on continuing education courses and on (some) dive charter boats may be the only time many recreational divers will be reminded that health (and particularly cardiac health) surveillance is important as we age and continue to dive. Moreover, these surveys crudely identify whether the individual completing them may be at risk.
In that sense, the RSTC or other equivalent forms should not be seen as tools being employed to try to prevent you diving. They are a tool which attempt to alert you to the possibility that you might be at risk of becoming one of those 16 per 100,000 per year, and that it might be a good idea to take steps to more accurately assess your risk. I completely agree that filling it out as you walk onto a dive boat is not the ideal scenario for its use for obvious reasons. If I could wave a wand and have it magically appear in front of every diver every year or two when they were sitting having breakfast then I would. But equally, if everyone who regularly uses dive boats knew that this was something likely to happen, then it might make them more likely to obtain the form and address any issues that arose at a more convenient time. This is one imperfect way that the issue of health surveillance is put in front of divers and it may help prevent deaths. At the present time we don't have many other obvious options.
I acknowledge the RSTC form is not perfect. This matter was discussed at the DAN fatality workshop back in 2010. Indeed, Fred Bove (who is a diver and was president of the American College of Cardiology at the time) and I published a summary of the discussion which took place [3]. Some of the issues raised in this thread come up. I have uploaded it for anyone interested.
Simon M
1. Denoble et al. Scuba injury death rate among insured DAN members. Diving Hyperb Med 2008;36:182-188
2. Denoble et al. Common causes of open-circuit recreational diving fatalities. Undersea Hyperb Med 2008;35:393-406
3. Mitchell and Bove. Medical screening of recreational divers for cardiovascular disease: Consensus discussion at the Divers Alert Network Fatality Workshop. Undersea Hyper Med 2011;38:289-296
This is a very difficult subject. Unfortunately discussions about pre-participation screening of divers always get tangled up by competing issues or priorities like pragmatism (making a dive operation run smoothly), medico-legal concerns, and concerns about preventing harm to divers (either those suffering a medical event or those rescuing them). We see examples of people bringing all of these perspectives to this thread. They never sit well together.
There are a couple of interesting facts you should be aware of based on reasonably hard data (which is a rare commodity in diving medicine).
First, the DAN group published a study suggesting that the death rate among insured DAN members (thus, a reasonably representative group of recreational divers) was 16 per 100,000 divers per year. Hard to interpret this number. Jogging is 13 per 100,000 per year [1]. The key point is that deaths occur often enough, and obviously none of us like it.
Second and more importantly, the same group published a quality study that suggested a cardiac event was the disabling injury in 27% of recreational diving deaths [2]. This is a much more important figure because it identifies a potential point of attack in trying to prevent diving deaths (and I'm sure we can all agree that this is a good idea).
Moving onto the use of pre-participation screening, a third interesting fact is that in recreational diving it is possible for a diver to complete some sort of health evaluation at entry to the sport (eg the RSTC form) but then (unlike occupational divers who undergo periodic medicals) they can transition through a long diving career without any form of health surveillance whatsoever. Completion of health surveys on continuing education courses and on (some) dive charter boats may be the only time many recreational divers will be reminded that health (and particularly cardiac health) surveillance is important as we age and continue to dive. Moreover, these surveys crudely identify whether the individual completing them may be at risk.
In that sense, the RSTC or other equivalent forms should not be seen as tools being employed to try to prevent you diving. They are a tool which attempt to alert you to the possibility that you might be at risk of becoming one of those 16 per 100,000 per year, and that it might be a good idea to take steps to more accurately assess your risk. I completely agree that filling it out as you walk onto a dive boat is not the ideal scenario for its use for obvious reasons. If I could wave a wand and have it magically appear in front of every diver every year or two when they were sitting having breakfast then I would. But equally, if everyone who regularly uses dive boats knew that this was something likely to happen, then it might make them more likely to obtain the form and address any issues that arose at a more convenient time. This is one imperfect way that the issue of health surveillance is put in front of divers and it may help prevent deaths. At the present time we don't have many other obvious options.
I acknowledge the RSTC form is not perfect. This matter was discussed at the DAN fatality workshop back in 2010. Indeed, Fred Bove (who is a diver and was president of the American College of Cardiology at the time) and I published a summary of the discussion which took place [3]. Some of the issues raised in this thread come up. I have uploaded it for anyone interested.
Simon M
1. Denoble et al. Scuba injury death rate among insured DAN members. Diving Hyperb Med 2008;36:182-188
2. Denoble et al. Common causes of open-circuit recreational diving fatalities. Undersea Hyperb Med 2008;35:393-406
3. Mitchell and Bove. Medical screening of recreational divers for cardiovascular disease: Consensus discussion at the Divers Alert Network Fatality Workshop. Undersea Hyper Med 2011;38:289-296
drrich2
Contributor
I doubt anyone has a problem with this, and if the sole use of this form was to notify divers of the issue, offer the option to pursue those steps of their own free will, and doing so resulted in a report of risk factors & perhaps estimated degree of risk, which the diver could then use however he/she wished (e.g.: forego diving, dive anyway, or take measures to mitigate risk somewhat)...there'd be no argument.
Unfortunately, the current practice all to often is too use the form to identify divers considered 'at risk' in the view of 3rd parties (e.g.: dive op.s, insurance companies) who then dictate as a condition of being allowed to go on dive excursions the follow up measures to be taken (e.g.: consult a Physician) and may take the option to dive out of the diver's hands.
Who makes the call? Will it be you?
Richard.
I myself have mild allergies that are a "yes" on asthma, hayfever, and "frequent bronchitis" questions. I've been well aware of that since I was a kid. And then I turned fifty.
Forgive me if I find the idea of people my age being unaware of their health and needing that form to notify them of their health status a little... mind-boggling.
Forgive me if I find the idea of people my age being unaware of their health and needing that form to notify them of their health status a little... mind-boggling.
If you ask me about my medical history, I'll tell you.
If a dive op gives me a paper to sign that starts with
and then proceeds to ask a series of yes/no questions about my family, I call that BS.
I am not here to participate in a training program, I am here to dive. I came here believing that I am fit to dive. The only way to communicate that on that form is to answer no to every question. And that would be lying, signed, dated, and filed for posterity.
lv2dive
Formerly known as KatePNAtl
I am surprised this hasn't come up yet... it's my understanding that if you tick "yes" to any of the questions, a Doctors sign off is required but the flip side is that if you get the Dr signoff you do not need to fill out the yes/no tick marks. Going back and re-reading the form, it appears that I may be mistaken about that.
Quite frankly I do not feel the need to share my detailed personal health information with random dive ops that may require that form, and in the past, have gotten my Dr's sign off on the form every year at my annual physical. Whenever required, for training or an op, I simply provided the doctors note and did not fill out the page with the Yes/No questions. I do *discuss* my health history with instructors. So far I have not had any issues but in future I will definitely validate this approach with any dive ops that require the form.
As a side note, I had to have a diving physical to become a volunteer diver at an aquarium. I almost didn't pass the physical bc I have a spinal fusion and the dr was concerned with my ability to handle the weight of the standard "working" tank out of the water (I think it was maybe a steel 72 or 80).
Anyway, I was already tech/cave diver and almost exclusively diving steel doubles - every other weekend at that time. I explained a single steel tank would not be an issue, and why... finally I showed the doctor a few pictures of me in doubles, both in the water and above the water. I did pass but I am honestly not sure if I would have without those pictures!
Quite frankly I do not feel the need to share my detailed personal health information with random dive ops that may require that form, and in the past, have gotten my Dr's sign off on the form every year at my annual physical. Whenever required, for training or an op, I simply provided the doctors note and did not fill out the page with the Yes/No questions. I do *discuss* my health history with instructors. So far I have not had any issues but in future I will definitely validate this approach with any dive ops that require the form.
As a side note, I had to have a diving physical to become a volunteer diver at an aquarium. I almost didn't pass the physical bc I have a spinal fusion and the dr was concerned with my ability to handle the weight of the standard "working" tank out of the water (I think it was maybe a steel 72 or 80).
Anyway, I was already tech/cave diver and almost exclusively diving steel doubles - every other weekend at that time. I explained a single steel tank would not be an issue, and why... finally I showed the doctor a few pictures of me in doubles, both in the water and above the water. I did pass but I am honestly not sure if I would have without those pictures!
You are correct. I tell all students to first read the form and check to see if they may have a yes answer. If they do, I tell them not to bother with the form and get a doctor's sign off.
The form is kinda useless. I had a student yesterday who said that "at the moment, everything was OK", but that she was scheduled for surgery On Monday and her surgeon said that she'd be fine by the date of the course. I asked her to get a doctor's note after surgery for her own good. No, I did not feel it was my place to ask what was being done. Was I wrong?
The form is kinda useless. I had a student yesterday who said that "at the moment, everything was OK", but that she was scheduled for surgery On Monday and her surgeon said that she'd be fine by the date of the course. I asked her to get a doctor's note after surgery for her own good. No, I did not feel it was my place to ask what was being done. Was I wrong?
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