Let's Open a Can of Worms - Epilepsy in Diving

[TSandM]

It's a can of worms, all right.

I think that, to a great extent, people should be able to make their own decisions about acceptable risk. That is, of course, assuming that they are educated as to what those risks are, and it's also assuming the risks are known. I don't think there is enough data to be able to look at a given epileptic and tell him or her what the risk of having a seizure underwater is. Clearly, people who are poorly controlled are horrible risks, and equally clearly, there is some literature to suggest that people who have gone long periods without a seizure, off medications, are at lower risk. But I think it will remain that diving will remain a decision that has to be made by an educated patient AND his buddy AND his instructor, any of whom can refuse to shoulder the risk.

However, I feel very strongly that anyone who has a known medical condition that could incapacitate them in the water should NOT instruct. As an instructor, you are accepting responsibility for the safety of your students, and I think you need to be as sure as you can that you will be physically and mentally able to do that. JMHO.

 

[AndyNZ]

There are two questions mixed up in the OP, firstly can a person with epilepsy dive? Secondly, can a person with epilepsy become a diving professional in charge of supervising divers and student divers.

To my mind, I wouldn't choose to accept someone into a DM or instructor programme if they were epileptic, irrespective of the extent or nature of their condition. In good faith, I couldn't encourage someone down this path. I'm certainly not denying them the right, just asserting my right to not do it.

With regards a non-professional diver, tricky. I know a number of people with conditions that are not really conducive to diving - they regularly lie about them when filling in medical questionaires for charter boat trips etc. Whilst they haven't had any major incidents (yet?) I'd much prefer that they were open about their conditions - it helps the charter companies be prepared in the event of something happening (though, of course, may lead to the company requesting the person not dive).

 

[String]

There's a clear difference here legally between fit to dive vs fit to lead.

The normal fitness to dive medical is best performed by a fully qualified diving referee as opposed to a normal GP who aren't trained and often understand little about the subject. These can authorise the medical but place certain restrictions such as depths, what gas to use etc.

Fitness to lead (ie commercial medical needed) has a far higher standard to meet - you can get the normal personal fitness to dive medical even with conditions that definitely mean you wont pass a full HSE commercial medical in a million years.

At the end of the day if you dive and are a risk to yourself to a certain extent, that's your choice and even your right. However, once you place yourself in a situation where others have to rely on you its a whole new ball game.

Also, to echo the above, i've seen no end of people who have obviously lied on the self cert form.

 

[stimpy4242]

I have to agree, I think the OP is two seperate things...yes sure they can dive. However as an instructor, of course they can't fulfill all the responsibilities of an instructor...certainly I am sure they can handle all the physical responsibilities, wait, until they seize underwater while taking new divers on the first OW tour during dive one and wait, they kept going after that one student who kept sinking to the bottom, and wait the visibility in the quarry is only 10 feet and now no one knows where that student is or the instructor who drited off during the seizure...yeah there are certainly MANY issues with have an instructor with epilepsy...

Also I would like to state that I think many primary care physicians have NO idea what they are signing off when allowing their patient to dive. All of them sign off on the patient, I know that is a generalization, but many PCPs don't really know what they are signing off on even with the guidance sheet from say PADI or another agency.

 

[Downing]

I just wanted to thank everyone for participating in this thread. Lots of great information here and elsewhere, but this thread is the most current on the board and it appears the issue has evolved considerably just in the last ten years.

My 18-year old daughter was diagnosed with epilepsy last fall. Given that our son would be taking an OW class in college in the spring (he's doing his dives next weekend, in fact), she would be the only non-diver in our family. I remember at the time thinking how sad it was that she would never be able to dive with us.

Thankfully, her epilepsy is very mild. She describes the "episodes" not so much as like what I would think of as a "seizure" but of becoming slightly dizzy and somewhat disoriented for a few minutes. The good news is that her doctor says it should be controlled by medication; however, there is always a risk of a reoccurrence in the foreseeable future. She was cleared for driving after four months of being seizure free and that was a few months ago with no seizures since.

Recently she's expressed a strong interest in learning to dive. I think it's a combination of her feeling left out by the rest of the family, understandably, and wanting to prove to herself and to her parents and brother that she can still do this. Initially, I was dead set against it. But being the stubborn young woman that she is--gee, I wonder where she gets that from?--she went to our LDS, talked to them about it and now has her doctor's permission as long as she uses a full face mask.

We'll see what happens. As her father, I'm still pretty nervous about this. But I have to accept that she's old enough, if not necessarily wise enough, to make her own decisions. Given that the doctor and my LDS are on board, if she's really going to go through with this then I should support her. After all, short of cutting off her college funding, which would be a real jerk thing to do, I can't control her life. And I admire her courage.

 

[rollerboi]

However, I feel very strongly that anyone who has a known medical condition that could incapacitate them in the water should NOT instruct. As an instructor, you are accepting responsibility for the safety of your students, and I think you need to be as sure as you can that you will be physically and mentally able to do that. JMHO.

IMO, persons with epilepsy desiring to dive should be handled on a case by case basis. However, instructing, as Lynne mentions, is a whole different level of responsibility that includes assuming risk for the student, not the other way around.

I know that, as a recent AOW graduate, there are stressors in the water galore and it is comforting to have a reliable, credentialed instructor in the water to help you through them. If I even had any idea that my instructor had a history of epilepsy, I know that would add a whole new set of stressors to my experience. Not only would I be worrying about myself, I now have the added concern that my instructor could hit it any moment (whether or not they feel there is a likelihood of it happening), and I don't need that stress in a learning environment.

As a student, I would not be comfortable with this.

As a dive buddy with proper preparation beforehand, I might. But not as a student.

 

[DevonDiver]

Epilepsy in Diving....

mmmm....jacuzi

 

[Crowley]

Okay I would like to contribute to this discussion by way of example - a former colleague of mine was invovled in the rescue of a diver who had an epileptic fit in (fortunately) shallow water and - somewhat ironically - during his Rescue Course. It turns out he'd lied about his epilepsy on the medical forms because he didn't think it would be a problem. Later we discovered he had had previous attacks whilst driving a car, a motorcycle, and also whilst skiing. That man is alive today because of the quick thinking of a well trained instructor and was subsequently banned from all dive shops in the area (he tried at at least two more outifts after his accident).

Now - obviously I'm not suggesting that anybody here would be as dishonest as this man but for the sake of all parties concerned, if a person who wishes to dive has epilepsy then please ensure they have the highest possible medical clearance available, and please do not be offended if that person is not accepted for training - even with that clearance.

As I have remarked on several posts before: we are diving instructors, not doctors. At the very least, most instructors know that an epileptic fit underwater = very bad news. I have some more advanced training and there are guidelines available from DAN (I don't have them to hand right now) but it requires, I am sure, several years without seizures and I think one article suggests that if a person with a history of epilepsy is cleared to drive a car, then they should be cleared to dive.

It's a tough call to make - and unfortunately, for me personally and speaking as a full time instructor, I could not accept a person with a history of epilepsy for training, or diving under my guidance, even if medically cleared to do so. We know little enough about the condition itself and there's zero to nothing in terms of data about the effect of pressure / nitrogen absorption / narcosis on a person prone to epilepsy. I will be extra blunt and say that I don't necessarily trust that a doctor has given the correct medical opinion if they *do* certify somebody to dive.

I know we'd all like it to be proven otherwise but I hope everybody understands my point of view. I simply cannot afford to take that risk. Am always happy to discuss this stuff offline and via PM if necessary.

Safe diving,

C.

 

[seafox69]

Recently a customer (already certified to dive) walked into our store and indicated an interest in becoming a DM then Instructor. After talking with her about a plan of action for more than 30 minutes... she dropped the "oh, by the way... I have epilepsy, caused by brain cancer." Not something I hear from a leadership candidate everyday.

So I started some hard research and luckily DAN (in the New March/April Issue of Alert Diver) has an article about Diving with Epilepsy (see page 22 of the magazine.)

DAN, I think most all of us agree is a leading (if not primary) leading authority on Dive related research. They start the article with "Epilepsy is perhaps one of the few worldwide diseases that most medical professionals agree is an absolute contraindication to safe diving."

The key words here are "perhaps" and "most." Both leaving room for interpretation and the possibility that diving with epilepsy is possible. They didn't help me any further by concluding the article with "The only real truth in the matter is that absolutes can be invalid. As Les Luthiers, a comedy-musical group from Argentina, said "absolute truth does not exist, and that is absolutely true."

So to get to my point... DAN is now using ambiguous and irrelevant quotes to help us determine what is safe and what isn't? I can only assume by the final conclusion made in the quote.. that epilepsy is not an absolute contraindication for diving according to DAN.

So my final question in this discussion is for anyone out there. Is it safe for epileptics to dive? They legallly drive cars in many places. This I believe is far more dangerous than diving. If they have a seizure underwater, they are likely only to harm themselves. If they have a seizure on a highway, they could wipe out 20 cars and take numerous lives and cause untold numbers of injuries?

If a doctor signs off that she is fit to dive (and instruct)... would you as a shop owner hire her? Would you as a student want her to teach you? Would you as an Agency approve her Instructor rating?

I'm asking all these questions hoping for some straight answers. She was a super nice girl and I want to help her... but I also want to have as many opinions as possible to help us come to a rational decision... both for her, her family, our store and her potential students.

Anyone out there diving with epilepsy... I'd especially appreciate hearing from you...

Safe and Happy Diving to All...

A few years ago I was teaching a class and one of my students was an epileptic. He had gotten another doctor, not his regular physician who knew about the epilepsy, to sign off on his form and say that he could take the dive class. Well, guess what! While doing his 3rd dive in the class, on the class' first boat dive and after already doing 2 beach dives, he had a full grand mal seizure, and I ended up rescuing him from 25' while he was in the middle of the seizure and had already spit out his regulator and fully seized. It took him almost 2 hours before he could even speak relatively succintly and he was taken to a hospital and kept overnight. It turned out that he had previously had a seizure while driving his car and crashed into a MacDonald's restaurant and had been on medication since then(which he forgot to take the night before the dive. So the boat had to return to the harbor and no one got certified as no dives were complted that day.

So, my answer to diving and epilepsy is a big NO! I don't care what a doctor has to say as he will not be there when I have to rescue his patient. There are lots of other sports that will be a lot safer for the person with epilepsy.

 

[allunderwater]

As one person mentioned, epilepsy has many forms. Not all of them involve blackouts. The kind most typically known are Grand Mal seizures. This kind of seizure involves the spasming of most, if not all muscles in the body and a loss of consciousness. There are also absence seizures. These typically don't involve the muscles spasms, but they still do typically involve a loss of consciousness. These both usually involve a type of epilepsy called general-complex, affecting broad areas of the brain.

Both of these kinds of seizures are dangerous, though the absence seizures are significantly less so. I can't offer that much insight as to whether it's safe, many good reasons and arguments are posted above.

However there is also a kind of epilepsy that is called simple-partial epilepsy. This type of seizures usually involves a localized incidence of "cross-wiring", often times it won't have a loss of consciousness involved. There is a huge amount of stigma that is associated with epilepsy because people automatically think that this means grand mal seizures. That's not the case. When neurologists are determining whether it is safe for a person to drive, what they will test for is whether there is a point during a seizure episode during which the patient loses consciousness. This is done, not by the perception of the patient, but by testing with an EEG, with wires all over the patient's head. If someone does lose consciousness during the multiple hour long, sleep deprivation test, they will not be able to drive.

For my brother, who has simple-partial epilepsy, what occurs is a contraction of the right arm and the right leg. Consciousness is never lost and the ability to communicate is maintained. His neurologist signed off on allowing him to dive for these reasons.

To the person who stated that "Diving is a privilege, not a right", please remember that this statement implies that someone has done something wrong to lose that privilege. I think that was out of place. People with disabilities have not done something wrong. People who are irresponsible with the lives of others on the other hand, that is another matter. The kid who lied about having epilepsy, didn't take his meds, & then had a grand-mal while diving was certainly the latter. But please make sure that you are educated before lumping everyone with any kind of epilepsy and want to dive into the category of "irresponsible with other people's lives" category.