Medical Issues, At what point do we stop chasing…

This post is somewhat emotive and as a consequence, could generate some discussion. I do not believe there is a right and wrong answer to the question posed – at what point do we stop chasing after those divers who are going to die because they are either being selfish or because they will not follow safe, best practice, medical advice on whether or not to dive.

The reason for the post is because I recently had an interesting discussion with one of the UK’s busiest diving doctors who is certified to conduct HSE and UKSDMC medicals and as a consequence examines a large number of divers covering the full spectrum of age and fitness.

The discussion originated because I was seeking guidance and information on some medication that a diver was taking before he died on a shallow dive and what the medication would have meant as a diver. The request was against the backdrop of a large body of evidence that says the over 50’s are at greater risk from medically related, especially cardiac, problems when diving. However, it is also recognised that even with evidence such as that presented at the DAN Fatalities Workshop in 2010 which concluded that whilst increased medical surveillance within the diving community, especially the over 50’s, should be a good thing, nobody could determine how it should be implemented given that sport diving is a voluntary and discretionary activity. More on these papers can be found here (http://archive.rubicon-foundation.org/xmlui/handle/123456789/9303).

As divers, we are (in the majority) grown adults who can make rational decisions as to the risks that we are taking, even if that means we could die undertaking a dive. So why shouldn’t we be allowed to dive whatever the circumstances, it is our lives that we are playing with after all.

Consider the following scenarios.

The first incident concerns a diver who had had an operation to fit stents in his heart. (These can be considered to be small metal expanding straws which keep the blood vessels open which feed the heart muscles themselves). The diver was also using GTN http://en.wikipedia.org/wiki/Glyceryl_trinitrate_(pharmacology). This diver was a member of dive club (e.g. BSAC, SAA or ScotSAC) and as such would have signed an annual medical declaration (http://www.uksdmc.co.uk/) to say that they had not had any heart surgery or chest pains. If they had ticked ‘Yes’ to any of the questions, they would had have been referred to a UKSDMC doctor to give them the all clear to dive; it is extremely unlikely that this would have been granted . The diver suffered a medical problem on a shallow dive and was rescued. However, despite the best efforts of the rescuer and the boat crew, the diver was declared dead at the hospital. The rescuer and the crew were unaware that the diver was on this medication, nor were they aware that the diver had stents fitted.

The second incident concerns a diver who was booked on an organised trip for a weekend’s diving off the south coast. The skipper had noticed on the Saturday that the subject diver was breathless and struggling on the boat. On the Sunday after a mid-20m dive, a shout for help came from the divers buddy as the diver was on the surface not well. The call for help was accompanied by a call ‘it isn’t anything to do with diving’. The diver was brought onboard where his condition was poor, his lips were blue, he was breathless and had blood in his saliva. The skipper called a mayday after putting the casualty on O2. The diver was evacuated by helicopter and made a subsequent recovery. On the ride back in one of the group was in tears and the skipper consoled them saying that he was alive when left and sure they would be okay. It was at this point that they said that they knew he shouldn’t have gone diving with what had happened recently. The skipper asked what had happened and it transpired that the diver had had heart surgery fairly recently (in the last month or so) and was still on blood thinning medication. The blood in the saliva may have come from a coughing fit on the 6m safety stop. This diver was not a club diver (BSAC, SAA or ScotSAC) and so would not have had to sign a medical self declaration form but they would (or should) have been aware of the issues with diving following heart surgery so recently. The organiser of the trip was certainly aware that the diver had had surgery. Other than not dying, it is not known what happened to this diver.

Both of these divers would have known the risks they were taking, especially the first as they had knowingly lied on the form or not filled in another following his heart operation/major change in medical circumstances. ‘So what?’, you may ask. It is their life to do with what they want. True, but consider the next incident.

This incident concerns a self employed diver who died on an overseas trip. His life insurance wouldn’t pay out as the diver had not dived in something like 10 months, was not dive current for the trip they were on, and finally, due to the pressures of their role on the trip, had made some basic errors in setting up his kit. The family were left in a bad way financially as a consequence as the diver was the main bread winner in the family. This death was not medically related but it does show that insurance may not be paid out in the event of the diver ‘breaking the rules’.

Another diver, again overseas, suffered from DCI, was evacuated to a chamber but his holiday insurance would not pay up because he had not declared a medical issue which pre-disposed them to DCI. The diver was left with a bill in the order of 10’s of thousands of dollars to settle themselves.

At Eurotek 2010, a member of the rebreather experts panel asked the audience if they let their loved ones/next of kin know the risks they were taking in undertaking CCR diving. There was some nervous laughter followed by a general consensus of ‘No, because if I did, they wouldn’t let me go diving’.

Diving is a risky sport, in so much that we cannot sustain life underwater without technical assistance and training, and therefore every time we dive, we take a risk in just being there. However, that risk is not just carried by you, it is also carried by those you leave behind. Not just your family and friends who will grief your loss but also those at the scene (buddies, skipper, rescuers) who will suffer a traumatic event; I know of one boat crew member who recently spent 1hr 20 doing resuscitation to no avail. There is also the fundamental issue about how your family and dependants will be able to support themselves with you gone as the majority of divers, especially technical divers, will be the main income providers in a family. Many life insurance policies will not pay out until a body is recovered, and in the case of some diving fatalities, this hasn’t happened and so the family are left in limbo. Even if they do pay out, it might not be until 5 years or more after the accident.

So even if you are dive current and qualified to do the dive, think about who else will suffer if you decide to push the boundaries that little bit too far by cutting corners or ignoring sound medical advice.

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3 responses to “Medical Issues, At what point do we stop chasing…

  1. Pingback: Banned from the BSAC Forum - Page 28·

  2. Pingback: Subaquaholics (Bristol) Fined by HSE - Page 2·

  3. Pingback: Engaging with those who don’t want to be engaged… | Cognitas Incident Research & Management·

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