Dive Medicals

[Jonn]

It’s the risk to the public that is decisive here. Pilots, captains, truckers, even regular drivers hold the lives of strangers in their hands with every beat of their heart. The public needs to be assured those are pretty reliable hands, pretty strong hearts. Scuba is different: if we’re not on the surface after 90 minutes the people around us will have to mount a stressful and expensive rescue attempt but they’re not going to die doing it, the risk is ours to take on as individuals.
No medical required.

 

[Nedster]

It's very difficult to get reliable infromation. We operate in a very busy diving area and history has shown us that the last few diving deaths here were all medical related, and the lack of disclosure from the customers themselves was evident in almost all.

 

[kinoons]

It's very difficult to get reliable infromation. We operate in a very busy diving area and history has shown us that the last few diving deaths here were all medical related, and the lack of disclosure from the customers themselves was evident in almost all.

Do you have evidence that adding a requirement for prediving medical exam would prevent those medically related deaths?


The unfortunate truth is many sudden deaths have very little warning and could not be prevented by a routine medical exam.

I also subscribe to the idea that it is very difficult to make a healthy person more healthy. IE if you don’t feel anything is wrong, often times nothing is wrong. Yearly physicals for young healthy individuals is most likely a fools errand. There is a compelling argument that more healthy people are medicalized by routine physicals than unknown sick people found.

Adding another compulsory medical exam for healthy folks is unlikely to make a difference at a population level IMHO. As such I cannot support them as a blanket requirement for all divers.

On an individual basis a person should do what makes sense for themselves. If you have medical issues then see a doc. If you’re healthy and physically fit there likely isn’t much to gain from a prediving physical.

 

[dmaziuk]

It's very difficult to get reliable infromation. We operate in a very busy diving area and history has shown us that the last few diving deaths here were all medical related, and the lack of disclosure from the customers themselves was evident in almost all.

What does "lack of disclosure" actually mean, to you, in practical terms? E.g. if I disclosed to you I have allergies, what are you going to actually do?

Do you have a medical professional on staff capable of assessing said disclosures? Do you employ a records officer to properly safeguard the customers' protected medical information as required by their respective laws? Do you carry cyber-insurance for when someone steals your office PC and you have a "data breach" on your hand? Do you want to pay for all that without passing the cost on to the customers and losing your business to the cheaper operation next door?

Be careful with what you wish for...

 

[ontdiver]

Possibly mentioned in this thread, but worthy of noting nonetheless is an an excerpt from Scuba diving fatalities - Wikipedia

• DAN was notified of 561 recreational scuba deaths during 2010 to 2013. 334 were actively investigated by DAN[8]
• DAN was notified of 146 recreational scuba deaths during 2014. 68 were actively investigated by DAN[9]
• DAN was notified of 127 recreational scuba deaths during 2015. 67 were actively investigated by DAN[10]
• DAN was notified of 169 recreational scuba deaths during 2016. 94 were actively investigated by DAN[11]
• DAN was notified of 228 recreational scuba deaths during 2017. 70 were actively investigated by DAN[12]
• DAN was notified of 189 recreational scuba deaths during 2018.[13]

"According to death certificates, over 80% of the deaths were ultimately attributed to drowning, but other factors usually combined to incapacitate the diver in a sequence of events culminating in drowning, which is more a consequence of the medium in which the accidents occurred than the actual accident.

Drowning occurs as a consequence of preceding problems, such as cardiac disease, pulmonary barotrauma, unmanageable stress, unconsciousness from any cause, water aspiration, trauma, equipment difficulties, environmental hazards, inappropriate response to an emergency or failure to manage the gas supply.

Diving fatality data published in Diving Medicine for Scuba Divers (2015)[3]

• 90% died with their weight belt on.
• 86% were alone when they died (either diving solo or separated from their buddy).
• 50% did not inflate their buoyancy compensator.
• 25% first got into difficulty on the surface
• 50% died on the surface.
• 10% were under training when they died.
• 10% had been advised that they were medically unfit to dive.
• 5% were cave diving.
• 1% of divers attempting a rescue died as a result.

Bottom line is that a mandatory dive medical would not have prevented a significant number of deaths.

 

[boulderjohn]

Are 'fat' divers directly out of shape? Not everybody with a bmi of 30 is really obese. And some can run 10km or more, so are really in a good condition.

About 15 years ago, the Alert Diver magazine (DAN) published an article indicating that obesity was a factor in diving fatalities, and they used the BMI as an indicator of dive fitness. I wrote a letter to the editor in which I challenged using the BMI as they did. Not long afterward, I found myself in a phone conversation with an editor. My letter had spurred them to do a quick search, and that search indicated problems with the BMI. I remember her saying that an Arkansas (I think) high school had gone into something of a frenzy when they found a high average BMI in the school. A closer look indicated that the student body was not nearly as unfit as that average suggested.

Why is that? It is because the the BMI starts with a weight/height ratio baseline determined years ago and assumes any weight pushing the ratio higher comes from additional fat. That means anyone with an above minimal amount of muscle mass will have a higher BMI. Football star Travis Kelce has a BMI of 29.6, which rounds off to the obese level on the BMI scale. In the Arkansas case, the school's football team was skewing the average.

I pointed out that although there are certainly obese divers out there, it is also true that a lot of divers will be very fit, with large amounts of muscle mass, and those divers would score as overweight or obese on the BMI scale.

The editor asked me if I wanted to write an article in response. I declined, saying that I did not have the credentials required for such a task. They instead got a medical doctor to write it. He went through the most common ways of measuring fitness, and the follow-up article he wrote determined that of all those choices, the BMI was the least accurate.

 

[boulderjohn]

Diving fatality data published in Diving Medicine for Scuba Divers (2015)[3]

• 90% died with their weight belt on.
• 86% were alone when they died (either diving solo or separated from their buddy).
• 50% did not inflate their buoyancy compensator.
• 25% first got into difficulty on the surface
• 50% died on the surface.
• 10% were under training when they died.
• 10% had been advised that they were medically unfit to dive.
• 5% were cave diving.
• 1% of divers attempting a rescue died as a result.

This brings up another common statement made in dive threads like this. Look at the ones I highlighted.

When people hear that 90% of people died with their weight belts on, they imply that they would have lived if they had only dropped their weights. What good would dropping the weights do if you are on the surface? What would be the benefit of dropping your weights in a cave?

In response to such a thread years ago, I studied several years of DAN fatality reports, and I only found a handful of cases in which it is possible that dropping the weights would have helped. I highlighted the phrase it is possible because it includes cases of people (a surprisingly large number) who were found alone on the bottom, with no way to know what had happened to them. In many of the cases, the fatality was caused by a medical event such as sudden cardiac death. If you suffer sudden cardiac death, you will not have a chance to drop your weights, and it would not do you any good if you did.

 

[lowwall]

Yep. BMI is only useful when comparing populations. It should never be applied to individuals. Body fat percentage of an individual can be determined directly if that is what you are looking for.

 

[fred32176]

I vote No, my physician is aware I dive and prescribes scopolamine patches so I can boat dive. Having him fill out a form wouldn't make my diving any safer.

 

[boulderjohn]

Yep. BMI is only useful when comparing populations. It should never be applied to individuals. Body fat percentage of an individual can be determined directly if that is what you are looking for.

I was spurred to argue with DAN because I had recently undergone a hydrostatic body fat analysis (the most accurate method) that showed my body fat was about average for my age, but the BMI said I was overweight. The analysis included calculations of what my body fat would be if I lost varying amounts of weight, assuming all weight loss was in fat. In order for me to reach the very edge of what the BMI said I should weigh in order not to be overweight, my body fat index would have to be zero. Note that I had what was termed to be average fat content at the time--I was not excessively lean by any stretch of the imagination.

Since then I have sadly strayed up a bit in fat content, but I do not in any way think that impacts my ability to dive.