Israeli woman drowns during epileptic incident - Sharm el-Sheikh, Egypt

[VikingDives]

I'm so surprised by this. What happens when you are fighting a current? Have you been cold water diving?

I think that is a question for the hyperbaric physicians (pinging @Duke Dive Medicine ). I don't have any other source but the doctors who didn't clear divers diagnosed with this.
There are many variations of asthma, and knowing what induces it, influences the doctor's decision about a diving clearance.

It is interesting that you know of cases of exercise-induced-asthma that never occur during a dive. However, a dive doesn't end at the surface. If it involves climbing a ladder with a full set and 50m walking back to the car, before you can take your set off, then that's also part of the dive (and in case of a diving course, the responsibility of the instructor).

EIA isn't necessarily going to cause an "Asthma Attack" of the type that would be concerning for diving.

When I was a competitive cyclist, and coaching, I recall reading that 40 percent of competitive cyclists had this condition, and again this was my experience. Every one of those folks were doing things that were a lot harder than scuba diving, and many did so without medication.

It's easier to think of EIA as exercise induced bronchoconstriction (EIB). That is, a temporary restriction of the airway, that is caused by excercise. IIRC about 15 percent of the population has this condition, so you know, have dived with, or trained students who had it and (probably) didn't even know it. There's a fair chance you have it yourself.

In my own case, I didn't know I had it until I was in my 40s. It wasn't until I read an article by an Olympic athlete who described their symptoms - things like coughing up phlegm after a hard workout - that made me realize that I had it.

All that being said, there are people who have Asthma, which can be triggered by exercise. That's a totally different situation, and I'm sure that there are people who have severe EIB that might be triggered in the water, but I've not encountered any of them, which is why I was asking for a source.

As far as cold water dives go, I have hundreds of dives in cold water, it has no effect that I can determine. My experience is that I've never encountered a diver who had EIB and had a problem while diving. Maybe it's because the filtration of the air removes pollution and allergens from the tank. I really have no idea.

 

[Miyaru]

@VikingDives - I can understand your point of view.

However, going back to the issue this thread was started about: a person, with a known genetic defect, decided to roll the dice. She went diving despite her genetic defect which was a risk factor.
I'm 100% certain that she never even remotely considered the emotional havoc she has inflicted on the dive guide and/or buddy. To add insult to injury, her husband is blaming those who helped. Nobody even thought about blaming the diver.

To me, the medical is leading.
If a diver doesn't truthfully fill out the medical and fails to surface after diving due to a medical issue, all liability is for the diver.
If a diver has no clearance but requires so according to the medical questionnaire, there won't be any diving.
If the diver's health status changes during a course: new medical!

Medical arguments are not for the instructor/divemaster but for the physician.

 

[BoltSnap]

Medical arguments are not for the instructor/divemaster but for the physician.

The instructor can and should reject accepting anyone for medical reasons, or any reason, even if the physician OK's the person to dive. I frequently have people with medical conditions that I know are contraindication to diving approved by the physician and stating "approved to dive to XXmeters."

 

[Aura]

I'm 100% certain that she never even remotely considered the emotional havoc she has inflicted on the dive guide and/or buddy. To add insult to injury, her husband is blaming those who helped. Nobody even thought about blaming the diver.

I recall another recent thread where the importance of honesty on the medical was discussed, and a surprising amount of people seem to be of the opinion that "My health issues are my business, no one else's". I think that's not only incredibly selfish, but can even put others in physical danger or inflict unknown emotional trauma on others, as is the case here. And the last person to be held accountable is the one who chose to be dishonest about their medical condition.

 

[Duke Dive Medicine]

I think that is a question for the hyperbaric physicians (pinging @Duke Dive Medicine ). I don't have any other source but the doctors who didn't clear divers diagnosed with this.
There are many variations of asthma, and knowing what induces it, influences the doctor's decision about a diving clearance.

It is interesting that you know of cases of exercise-induced-asthma that never occur during a dive. However, a dive doesn't end at the surface. If it involves climbing a ladder with a full set and 50m walking back to the car, before you can take your set off, then that's also part of the dive (and in case of a diving course, the responsibility of the instructor).

The dry air from a scuba tank can be a factor. As part of a fitness-to-dive exam on a prospective diver with a history of asthma, we do a provocative (exercise) test with the individual breathing dry compressed air while on a cycle ergometer. If the person's pulmonary function worsens, we will not clear them to dive.

Best regards,
DDM

 

[BoltSnap]

The dry air from a scuba tank can be a factor. As part of a fitness-to-dive exam on a prospective diver with a history of asthma, we do a provocative (exercise) test with the individual breathing dry compressed air while on a cycle ergometer. If the person's pulmonary function worsens, we will not clear them to dive.

Best regards,
DDM

Now that's why you ask a subject matter expert not somebody who simply slept at the Holiday Inn.

 

[drrich2]

With a FFM you do not drown even when you get an epilectic seizure.
Hence I think that people at risk of epilectic crisis should use a FFM.

In case newer divers run across this thread and wonder about full face masks (FFM), it's worth expanding on the subject a bit, particularly in the context of acting as a counter-measure against risk. Many years ago I did some dives with someone who dove with an AGA Interspiro FFM, so I had a pretty good look at it. Not all FFM's are the same, and I only have experience examining that particular one.

In theory, someone at risk of loss of consciousness for varied reasons might wear one to prevent spitting out the regulator 2nd stage if consciousness is lost and quickly drowning. While people with a history of epilepsy are prime examples, there are people on medications where seizures are an unlikely but real potential side effect, people with a remote history of seizure activity who have reason to believe they are highly unlikely to have one going forward, and others who might fall into this grip.

Whether they should choose to dive, or be allowed to choose to dive, I'm not addressing. Just a bit about FFM's.

The AGA strapped onto the diver's head. In fact, if for some reason I'd needed to pull it off the person, it looked like it would've taken some doing. So yes, it was secured to the head. In the event of an out-of-air or regulator failure underwater, that diver wouldn't have been able to simply spit out the 2nd stage and stick an octopus (mine or his/her's) in.

Equalization was via pushing a 'plate' against the nostrils, harder to do than with a standard mask. And the diver ran through air a little faster than with a standard mask. On the other hand, the thing did not fog!

And of course it doesn't maintain buoyancy control. If you're positive, you go up. If negative and diving over a 40-foot flat bottom in Key Largo or sloping reef wall in Bonaire, it could buy you time. If you're beside a vertical wall, well...

One little catch with the AGA Interspiro was at the surface, there was a little dial/valve thing that had to be turned so the diver could breathe through it. If you took an unconscious diver up and didn't know that, they could still die (after all, you don't just yank that mask off the head easily).

I've never seen a seizure in a diver. I have seen or been on the scene shortly after seizures in my workplace in years past. Often they are over within a few minutes, but followed by temporary loss of consciousness then a confused, lethargic period.

TLDR: if someone is concerned about potential loss of consciousness, impairment from a seizure can last a good deal longer than the seizure itself, and there's more to using a FFM than simply putting one on.

 

[Diver With Altitude]

The dry air from a scuba tank can be a factor. As part of a fitness-to-dive exam on a prospective diver with a history of asthma, we do a provocative (exercise) test with the individual breathing dry compressed air while on a cycle ergometer. If the person's pulmonary function worsens, we will not clear them to dive.

Best regards,
DDM

My concern with asthma has been that the diver could suffer alveolar barotrauma if they ascend with small airway obstruction (even if they’re not having a symptomatic attack). Is this a risk?

 

[drrich2]

I recall another recent thread where the importance of honesty on the medical was discussed, and a surprising amount of people seem to be of the opinion that "My health issues are my business, no one else's".

That's a repeat theme in these discussions, individual liberty vs. informing and bowing to the will of Big Brother, what's legit for a dive op. to 'discriminate' against/protect themselves from, and to what extent the process is about protecting the diver vs. clearing the dive op. from liability (or maintaining a shop's insurability) - often by transferring potential liability onto a physician who may know little about dive medicine or diving. It's a broad issue with many shades of gray.

 

[Akimbo]

The AGA strapped onto the diver's head. In fact, if for some reason I'd needed to pull it off the person, it looked like it would've taken some doing.

I have quite a few hours in AGA, Desco, and Kirby Morgan FFMs. It isn't that hard to remove in an adrenaline-fueled emergency situation. Removing it from another diver might cause a few facial abrasions but no lasting damage.

Aspirating regurgitation in an oral-nasal mask is a very serious downside of FFMs. Unfortunately bringing up some stomach contents preceding or during a convulsion is not uncommon. For example nausea is a common symptom of Oxygen Toxicity.

Relating to your quote, divers who are well-trained to use FFMs are taught and drilled on how to barf in it. The procedure usually involves going face-down and grabbing the mask near the chin. The diver has to pull the mask away from the mouth without actually pulling it off at the moment they up-chuck and discipline themselves not to reflexively inhale until the FFM is repositioned and the purge button is pressed.

I have read on ScubaBoard that some people think barf can be just purged out of the regulator... maybe, sometimes. It depends on the amount and density of the solids. Aspirating a very small amount of acidic liquid is dangerous enough, packing a demand valve with that morning's steak and eggs can force it closed.

Single events that go wrong rarely kill divers. There are usually two or more that conspire to create conditions they are not trained to cope with.