The easiest solution to all this testing is to convince family members that they shouldn't attempt to sue everyone in a 10 mi radius if you kick the bucket while diving. Suing for true negligence or gross negligence is one thing. Getting an ambulance chasing attorney to file suits against everyone in the hopes that someone's insurance will cough up some dough is another.Easy solution to all of this testing -- be a hypochondriac! As a hypochondriac in recovery, I've had more tests in my 45 years than most people get in a lifetime so I think I've examined every avenue of what-if's over the last decade!
Dive Medicals
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heftysmurf
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Yes in young athletes, but as part of a diving medical? We do seem to be "slipping" into more and more testing for diver
Yes in young athletes, but as part of a diving medical? We do seem to be "slipping" into more and more testing for diver
That's because 10 pages into the thread we have not yet determined the purpose of the testing. If you don't know where you're going, more and more tests will take you there.
(Hopefully Carroll mis-quote will please the mods better than the Nietzsche one did.)
OMyMyOHellYes
Contributor
I did not think your tone or presentation was discourteous.
I respect/honor your decision re: your dive medical. I ask that you respect mine. Simple golden rule implementation.
No rage.
It may be a linguistic or cultural variance, but someone wanting to impose their will on another because they think they know better than that person is considered presumptuous.
To me, a required dive medical, annually, is more of a full(er) employment measure for (already overworked) doctors than anything that will result in any real meaningful contribution to dive safety. It would result in a contraction in the population of the active dive community, and many divers that would not be impacted outside of having to trundle into a doctor office for unneeded services would simply hang up their flippers. I might characterize it as having to present a current medical certificate to play pickleball or play a pickup game of basketball.
A wise old man once notably said, "Government is not the answer to the problem. Government is the problem."
On a tangentially related note, after a couple of decades of allowing pilots to self-certify their medical (via "Driver License Medical" - sport pilot category), the FAA is in the process of expanding that privilege via a mechanism called "MOSAIC" potentially allowing carriage of more passengers, faster, higher, night, instrument, and multiengine operation, maybe turbine engine operation, without specific flight medical certification. If you can legally drive, then you can operate a plane if you do not assess that you are medically impaired (and were not grounded for medical condition). Comment period is passed and final rule making is in progress. Standby for what that will actually look like ...
They made it a few years ago that one could operate by self-certifying full privileges under private (or better) pilot license at a 3rd class medical level. It seems there was no appreciable demonstrated marginal safety buffer offered by biennial flight physicals. Or the cost/beneift bang for the buck was just not there.
For what it's worth, the only two diving deaths I've personally witnessed were related to undiagnosed cardiomyopathy in mid-30's aged men. I'm not saying that to try to influence anyone's thinking, just to note that this not a binary yes/no issue. There is a lot of gray and thus a lot of room for debate. There's also, apparently, considerable variability internationally. This thread has been really informative for me.Yes in young athletes, but as part of a diving medical? We do seem to be "slipping" into more and more testing for diver
Best regards,
DDM
Yes in young athletes, but as part of a diving medical? We do seem to be "slipping" into more and more testing for diver
I’m not even sure it’s appropriate for young athletes. Rate of sudden cardiac death during sports is still exceedingly low. How many exams would need to be performed to prevent one death? Tens of thousands? Hundreds of thousands?
I’m not an expert in hypertrophic cardiomyopathy to know to what degree it contributes to this phenomena. Is there a 1:1 correlation between exam findings and impending cardiac demise (I’m guessing not). Since there likely isn’t, what is the next step? Is there additional testing to further delineate who is at risk vs who isn’t? How many folks must undergo further screening after the first screening to see who is absolutely at risk?
On the individual level I can understand why someone would want this answer. However at a societal level it becomes exceedingly difficult to justify the cost of such a program without rock solid evidence that the benefits to the one person found to be at the most risk outweigh the harms to everyone else who gets caught up in the testing loop.
Same now goes for pre diving medical exams. Demonstrate to me that performing them will save lives without unduly harming all the other folks who do not benefit from them and I’m listening. Until then, I’m not interested.
No, some with HCM get cleared for diving and some run marathons. In earlier days it was a no for any sports, but now they look what is possible, but also look at the 'happinness' of a diver or sporter. It is now an individual thing, how bad is the hcm, where exactly, etc.
I have met a woman in her 80's last year in Indonesia, a very avid diver. She had stage 4 cancer and was cleared to dive. The doctor had said to her: or you will die due to your age, or during diving, or you will die from cancer. Take the time you have and do as much as you like.
The problem with some doctors is that they stick with strict rules, for example bmi over 25 or 30, is unfit to dive and they don't look further. Or 1 time a problem under water with panic=never diving again as panic can happen again. I know these examples. Other doctors are more human and say: maybe there is a very small risk, but that risk is also there at home sleeping in bed, so you can go.
Remember being healthy is not that black-white. There is physical part, but also a psycological part.
It is easy to say: search another hobby, but it is not that easy for the person.
Some get depressed and won't accept such 'advices'.
And a risk to die is not for everybody the same risk, it is also a question, do you want to take the small risk? And there are enough examples of people who ignored advices and did not got any problem. I know examples of people who got a pfo closed and did not want to wait 3 months, getting a stent and did not want to wait a year and nothing happened. You can be on the safe side but still people die, you can be on a less safe side and nothing happens.
Simply you don't know everything and it is impossible to know the future. Even not if you do for 1000's of euros on testing. You will find in everybody something then. But is it a real risk?
The no no no list is a guideline, help some beginners in diving, and it works for divecenters. As diving was that dangerous, more people would die.
And for those we a pro medicals, what if a buddy comes and has a limit on their medical such like no longer than 60 minutes, no deco, and no deeper than 30 meters? You know that the diver has some limitations. Would you accept this diver as your buddy on a dive that goes to 29.5 meter? What if you go to 30.5 then? What if you have a problem with your bcd and you go down due some stress to 35 to solve the problem? Do you want this buddy to help you or not? And what is deco? Tables give you from 15 to 20 minutes most times at 30m on air as ndl. Is a safetystop of 3 minutes too long if the dive will be then 63 minutes, so ignore the safetystop?
Would you accept a buddy over 75 that has a medical without limitations? As you know that older people are closer to their date of death and need some help to get out and in the boat becasue they are less strong or stiffer?
But the biggest risk to die is the way by car to the divesite. More than the diving itself.
Hello,
This is one of the most controversial issues in diving medicine! However, there is now quite a significant body of relevant evidence that helps us formulate sensible policy. I'll try to walk you through some of it. Warning: there are entire courses on this topic, and distilling it down is challenging.
However, first, I think there is one hard reality that we need to acknowledge and (sort of) accept. That is, no matter how compelling the 'freedom of choice' philosophy is (and I'm a believer that informed competent adults should be able to make choices) a complete 'free-for-all' simply will not cut it in our modern world of regulated activity, health and safety, litigation etc. We cannot expect that a dive operator should accept a self-approved brittle-asthmatic-epileptic in heart failure onto a course or their boat just because that individual doesn't care about the perceived risk and wants to dive. There are multiple reasons for this, not least being that the individual is not the only risk acceptor in the equation (the operator, buddies, family, rescue services, etc), and in the absence of being counselled by someone knowledgeable, how do we know that the individual even understands their risk? There needs to be some sort of screening process that responsible operators can rely on / refer to as defining acceptable practice. The question is, what is that process?
This thread asks the question 'should dive medicals be mandatory'? It was not that long ago in Australia, New Zealand and other places that they were. The vast majority of routine recreational diving medicals conducted under this system essentially represented fit and well diver candidates getting “signed off” by a doctor, with no relevant medical problems being discovered. In many respects this represented a waste of medical resources, and a waste of time and money for diving candidates. A debate raged for some time about whether a simple screening questionnaire would suffice with little evidence to bring objectivity to the discussion.
During the 1990s, when the Scottish Sub-Aqua Club operated the traditional 'everyone has a medical' system, Glen and colleagues evaluated 2962 face to face diving medicals and compared responses to the screening questionnaire completed by all divers prior to seeing the doctor to the doctor's findings and final outcome. They reported that no unexpected abnormalities were found on the examinations, and that conditions preventing the subjects from diving were detected by the questionnaire. [1] In another similar Australian study 1000 candidates completed a screening questionnaire, then saw the doctor. Just under 700 of them ticked 'no' to all the questions, and under a 'questionnaire-only system' would therefore have been allowed to proceed to diver training without seeing a doctor. Of these 700, 9 failed the medical when they saw the doctor. [2] The reasons for some of the fails were somewhat tenuous (such as ear clearing issues which would almost certainly have been picked up on the course itself, or failure to meet arbitrary lung volume targets). In any event it fairly clear that there is little likelihood that someone who ticks no to all questions on a well-designed screening questionnaire will subsequently have something significant found in a face to face medical. One can argue that a candidate might lie on the questionnaire, but they can do that too in a face to face medical.
If we accept that screening questionnaires are therefore an acceptable first pass in medical selection of diver candidates then the discussion devolves to what questions should be on the questionnaire? Again, we want to have this as evidence-based as possible. This could be a very long discussion but suffice it to say that there have now been numerous studies evaluating the causes of diving fatalities, and cardiac events in older divers are overwhelmingly the most important medical problem. Denoble and colleagues found that 28% of recreational diving deaths have a cardiac event as the disabling injury. [3] Lippmann has published several papers with remarkably similar results. [4,5] That is why diver screening questionnaires place a fairly heavy emphasis on identifying risk factors for coronary artery disease. The South Pacific Underwater Medicine Society recently published guidelines for identifying at risk divers. [6]
The questionnaire system, now operant in most places, results in way fewer face to face medicals so that doctors with an interest in diving medical issues are not overwhelmed with unrewarding 'routine' tick box medicals. Instead they can engage in more focused medicals for divers with an actual potential problem and ensure that problem is properly characterized and the candidate / diver properly informed about the risk it implies in diving. Most doctors with good knowledge of diving are discretionary in their approach (e.g., a decision based on objective appraisal of risk) rather than proscriptive (e.g., if you even mention the word 'asthma' you are out the door faster than you can say 'but it only affected me as a child and that was 20 years ago). No system is perfect, but I think the questionnaire-based system is a good solution for recreational diving.
Simon M
1. Glen S, White S, Douglas J: Medical supervision of sport diving in Scotland: Reassessing the need for routine medical examinations. Br J Sports Med. 2000;34:375–378.
2. Meehan CA, Bennett MH. Medical assessment of fitness to dive - comparing a questionnaire and a medical interview-based approach. Diving Hyperb Med. 2010;40(3):119-124.
3. Denoble PJ, Caruso JL, de L Dear G, Vann RD. Common causes of open-circuit recreational diving fatalities. Undersea Hyperb Med. 2008;35:393–406.
4. Lippmann J, Lawrence C, Fock A. Compressed gas diving fatalities in Australian waters, 2014 to 2018. Diving Hyperb Med. 2023;53(2):76−84.
5. Lippmann J, Taylor DM. Scuba diving fatalities in Australia 2001 to 2013: Chain of events. Diving and Hyperbaric Medicine. 2020;50(3):220–229.
6. Jepson N, Rienks R, Smart D, Bennett MH, Mitchell SJ, Turner M. South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers. Diving Hyperb Med. 2020;50:273–7.
This is one of the most controversial issues in diving medicine! However, there is now quite a significant body of relevant evidence that helps us formulate sensible policy. I'll try to walk you through some of it. Warning: there are entire courses on this topic, and distilling it down is challenging.
However, first, I think there is one hard reality that we need to acknowledge and (sort of) accept. That is, no matter how compelling the 'freedom of choice' philosophy is (and I'm a believer that informed competent adults should be able to make choices) a complete 'free-for-all' simply will not cut it in our modern world of regulated activity, health and safety, litigation etc. We cannot expect that a dive operator should accept a self-approved brittle-asthmatic-epileptic in heart failure onto a course or their boat just because that individual doesn't care about the perceived risk and wants to dive. There are multiple reasons for this, not least being that the individual is not the only risk acceptor in the equation (the operator, buddies, family, rescue services, etc), and in the absence of being counselled by someone knowledgeable, how do we know that the individual even understands their risk? There needs to be some sort of screening process that responsible operators can rely on / refer to as defining acceptable practice. The question is, what is that process?
This thread asks the question 'should dive medicals be mandatory'? It was not that long ago in Australia, New Zealand and other places that they were. The vast majority of routine recreational diving medicals conducted under this system essentially represented fit and well diver candidates getting “signed off” by a doctor, with no relevant medical problems being discovered. In many respects this represented a waste of medical resources, and a waste of time and money for diving candidates. A debate raged for some time about whether a simple screening questionnaire would suffice with little evidence to bring objectivity to the discussion.
During the 1990s, when the Scottish Sub-Aqua Club operated the traditional 'everyone has a medical' system, Glen and colleagues evaluated 2962 face to face diving medicals and compared responses to the screening questionnaire completed by all divers prior to seeing the doctor to the doctor's findings and final outcome. They reported that no unexpected abnormalities were found on the examinations, and that conditions preventing the subjects from diving were detected by the questionnaire. [1] In another similar Australian study 1000 candidates completed a screening questionnaire, then saw the doctor. Just under 700 of them ticked 'no' to all the questions, and under a 'questionnaire-only system' would therefore have been allowed to proceed to diver training without seeing a doctor. Of these 700, 9 failed the medical when they saw the doctor. [2] The reasons for some of the fails were somewhat tenuous (such as ear clearing issues which would almost certainly have been picked up on the course itself, or failure to meet arbitrary lung volume targets). In any event it fairly clear that there is little likelihood that someone who ticks no to all questions on a well-designed screening questionnaire will subsequently have something significant found in a face to face medical. One can argue that a candidate might lie on the questionnaire, but they can do that too in a face to face medical.
If we accept that screening questionnaires are therefore an acceptable first pass in medical selection of diver candidates then the discussion devolves to what questions should be on the questionnaire? Again, we want to have this as evidence-based as possible. This could be a very long discussion but suffice it to say that there have now been numerous studies evaluating the causes of diving fatalities, and cardiac events in older divers are overwhelmingly the most important medical problem. Denoble and colleagues found that 28% of recreational diving deaths have a cardiac event as the disabling injury. [3] Lippmann has published several papers with remarkably similar results. [4,5] That is why diver screening questionnaires place a fairly heavy emphasis on identifying risk factors for coronary artery disease. The South Pacific Underwater Medicine Society recently published guidelines for identifying at risk divers. [6]
The questionnaire system, now operant in most places, results in way fewer face to face medicals so that doctors with an interest in diving medical issues are not overwhelmed with unrewarding 'routine' tick box medicals. Instead they can engage in more focused medicals for divers with an actual potential problem and ensure that problem is properly characterized and the candidate / diver properly informed about the risk it implies in diving. Most doctors with good knowledge of diving are discretionary in their approach (e.g., a decision based on objective appraisal of risk) rather than proscriptive (e.g., if you even mention the word 'asthma' you are out the door faster than you can say 'but it only affected me as a child and that was 20 years ago). No system is perfect, but I think the questionnaire-based system is a good solution for recreational diving.
Simon M
1. Glen S, White S, Douglas J: Medical supervision of sport diving in Scotland: Reassessing the need for routine medical examinations. Br J Sports Med. 2000;34:375–378.
2. Meehan CA, Bennett MH. Medical assessment of fitness to dive - comparing a questionnaire and a medical interview-based approach. Diving Hyperb Med. 2010;40(3):119-124.
3. Denoble PJ, Caruso JL, de L Dear G, Vann RD. Common causes of open-circuit recreational diving fatalities. Undersea Hyperb Med. 2008;35:393–406.
4. Lippmann J, Lawrence C, Fock A. Compressed gas diving fatalities in Australian waters, 2014 to 2018. Diving Hyperb Med. 2023;53(2):76−84.
5. Lippmann J, Taylor DM. Scuba diving fatalities in Australia 2001 to 2013: Chain of events. Diving and Hyperbaric Medicine. 2020;50(3):220–229.
6. Jepson N, Rienks R, Smart D, Bennett MH, Mitchell SJ, Turner M. South Pacific Underwater Medicine Society guidelines for cardiovascular risk assessment of divers. Diving Hyperb Med. 2020;50:273–7.
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