Ethics of diving despite contraindications

[Geoff_H]

II am NOT willing to do CPR on the water, or even on the boat, for that matter without a bag valve mask, or a one way mask.

Why is this by the way? I was taught on my Rescue Diver course there has never been a single confirmed incident of transmission of any disease from reciepent to donor during CPR.

Even if you don't want to do mouth to mouth breathing, you could do chest compressions surely?

Even though it might seem "icky' or unpleasant - for me - if there is enough a 5% chance of saving someone's life or prolonging it until paramedics arrive I couldn't accept just standing by and letting someone die. I would certainly not want to train with an instructor who was unwilling to do all they reasonably could to save me in the unlikely event it was needed.

Just interested to hear your view on this - is it a liability issue, or a disease transmission issue, or something else?

 

[fisherdvm]

Disease transmission is my fear. Eventhough there is no documentation of HIV transmission through solid needle, I still take care when operating on HIV patients and double gloved when I do operate. Hepatitis B is extremely infectious, and unless you are sure of your immune status, it is possible through vomitus to transmit the agent. My patients with hepatitis B usually are polite enough to warn my staff of their status, and despite all of us are current on hepatitis B vaccination, I'd never count on it to fully protect me from transmission. Herpes virus certainly is well documented to be transmitted orally, and I would not do mouth to mouth on someone with a coldsore (I am HSV negative).

From an aesthetic standpoint, I really don't want someone to vomit into my mouth. In the several cases of CPR I've performed, the patient would vomit after being terminal (died).

I've been trained to use bag valve mask, and one way valve mask... I carry them in my car.

I'd probably make a case by case determination when to do mouth to mouth CPR on an individual. If it is a child or an infant, I'd likely perform CPR at will. If it is an electrical or lightning injury, I'd perform mouth to mouth rather than looking for a mask, as time is a factor. If it is a severe car accident or trauma with alot of blood on the face, I'd probably wait for a mask. Would I do chest compression without pulmonary resussitation. Probably not. Afterall, it is ABC... Without the A and B, you are not going to have the C.... Without breathing, you are not going to have cardiac function.

If it is a heavily tattooed man with piercing unconscious and collapse on a wheel of a car with blood oozing out of his face - you couldn't pay me enough to do mouth to mouth on the dude.

As a medical personnel, I am likely more qualified to do a risk assessment on my patient than a junior member. Just because no documented cases of oral transmission of infectious agents has been reported, you certainly can put yourself in the position when it could happen.

Do understand, Geoff H, I am a little sarcastic here, as I did not mean to offend a junior member. Most of us are very altruistic, and likely would perform CPR and mouth to mouth on most individual ....

 

[Cacia]

If it is a heavily tattooed man with piercing unconscious and collapse on a wheel of a car

he he...me too.
that "needle life-style" does put one off...

there is a little bit of a difference in being at a job where you encounter something daily and being a layman worried about this on a dive boat.

having said all that, you are probably your wife's "biggest risk factor" since you are a surgeon.

I would so much rather wipe out the risk by just staying off the road on New Year's.

 

[TexasZR2]

Just interested to hear your view on this - is it a liability issue, or a disease transmission issue, or something else?

For me it is a transfer issue. That and the fact that one of the first things CPR recipients do is toss their cookies. :yuck: Without a mask or bag, I'm not doing resuscitative breathing. I'll start chest compressions, but that is it.

 

[Midnight Star]

and the fact that one of the first things CPR recipients do is toss their cookies...

That's why i'm going to carry a mask, so I can help and still retain a good margin of safety.

-----

Mike.

 

[Geoff_H]

I'd probably make a case by case determination when to do mouth to mouth CPR on an individual. If it is a child or an infant, I'd likely perform CPR at will. If it is an electrical or lightning injury, I'd perform mouth to mouth rather than looking for a mask, as time is a factor. If it is a severe car accident or trauma with alot of blood on the face, I'd probably wait for a mask. Would I do chest compression without pulmonary resussitation. Probably not. Afterall, it is ABC... Without the A and B, you are not going to have the C.... Without breathing, you are not going to have cardiac function.

Hi - thanks for clearing that up. I understand your reasons!

One another question - a couple of months ago I was told a change was imminent in the CPR recommendations. I took PADI Rescue with the EFR and my instructor said it was likely that the rescue breathes would be discontinued in favour of *just* performing chest compressions.

Does anyone know if this is now changed or not? Maybe it's better to start a separate thread than derail this one.

 

[fisherdvm]

The changes with CPR is not chest compression alone.

It is the depth of the rescue breath, rather than a deep breath over 2 sec, it will be a normal breath over 1 sec.

The ratio of breath to compression will change, and will be the same whether it is for infant, adult, or child. It would be 2 breaths per 30 compressions. So more compression per breath. Apparently, we will need to increase our effort to circulate the blood, and spend less effort on the respiration part.

So it would not be as difficult to remember - it used to be 2:15 for adults, 1:5 for children.

 

[fisherdvm]

I believe the rationale for a shallower breath is that less air would enter the stomach, and therefore less likely for vomitus to occur. The so called "normal" breath would be just enough to see the chest rise.

 

[maynard.hogg]

I think it is ethically wrong to dive while under a medical condition that is broadly accepted as an absolute contraindication to diving.

Please define "broadly accepted" and "absolute contraindication." I know of at least two dive operators with Web sites specifically banning divers with diabetes mellitus and other contraindications. The one in Honolulu even bans ANYONE over 50. (Way over in my case.)

I call this "practicing medicine without a license" because, the websites for the corresponding certification organizations (NAUI and PADI respectively) supply medical report forms, implying that the matter is strictly between the diver and their DOCTOR. Despite my advanced age, my GP signs off every year with "Diving has proven good therapy."

Since the DAN banner ad is flashing at me, let me add that, if you haven't got a regular doctor, ask them to recommend a doctor with scuba knowledge. There's one in Aruba, for example, who skipped over my "contraindications" and got down to the real issue: narrow Eustacian tubes as the result of a middle ear infection 27 years ago. (Nothing that I can't handle simply by equalizing more often—every meter or so as I descend.)

 

[fisherdvm]

I call this "practicing medicine without a license" because, the websites for the corresponding certification organizations (NAUI and PADI respectively) supply medical report forms, implying that the matter is strictly between the diver and their DOCTOR. Despite my advanced age, my GP signs off every year with "Diving has proven good therapy."

Nah, I don't think it is practicing medicine without a license. Licensed doctors refuse to see patients all the time. Some will not see kids (waste of time, doesn't pay well). Some will not see HIV positive patients. Some will not see males. Some will not see females. Some specializes in only eating disorders or woman issues.

A dive operator can chose to cater to only young, healthy people. That's their choice. Perhaps it is because they like folks to remain in a group. Perhaps they don't like old geezers hanging at the 15 ft safety stop for 10 minutes, and doing another safety stop at 35 ft for 1 min. Perhaps they had a bad incident (threat of a law suit). Perhaps they don't want to buy an AED for their dive boat.

Each state, and city have their own liability problems. I would not blame a dive shop for adapting to the liability crisis in their town. It explains why so many OBGYN docs now quitting delivery of babies....