Diver dies after being rescued in Jupiter

[archer1960]

For a 5'9" (me), the "normal weight" would be in the range of 125 to 168 lbs. So, my 156-lb weight (with 30" waist) is getting closer to an overnight guy. Something doesn't sound right.

If you look into it, BMI charts are only (reasonably) accurate and useful for people who are NOT physically active, and were never intended to be a measure of fitness for active people. Some one who does a lot of weight lifting will have a higher muscle mass for a given overall weight and may be pushing the limits of the normal section even if their body fat percentage is quite low. The same is often true for runners. Unfortunately, BMI charts are applied far outside of their designed area, and are largely useless for many people.

 

[boulderjohn]

International Journal of Obesity - Abstract of article: Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012

From the abstract:

Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005–2012 National Health and Nutrition Examination Survey. Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race-by-BMI interaction, but there was a significant gender-by-BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74 936 678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.​

 

[CuzzA]

International Journal of Obesity - Abstract of article: Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005-2012

From the abstract:

Our objective was to examine cardiometabolic health misclassifications given standard BMI categories. Participants (N=40 420) were individuals aged 18+ in the nationally representative 2005–2012 National Health and Nutrition Examination Survey. Using the blood pressure, triglyceride, cholesterol, glucose, insulin resistance and C-reactive protein data, population frequencies/percentages of metabolically healthy versus unhealthy individuals were stratified by BMI. Nearly half of overweight individuals, 29% of obese individuals and even 16% of obesity type 2/3 individuals were metabolically healthy. Moreover, over 30% of normal weight individuals were cardiometabolically unhealthy. There was no significant race-by-BMI interaction, but there was a significant gender-by-BMI interaction, F(4,64)=3.812, P=0.008. Using BMI categories as the main indicator of health, an estimated 74 936 678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy. Policymakers should consider the unintended consequences of relying solely on BMI, and researchers should seek to improve diagnostic tools related to weight and cardiometabolic health.​

In other words the best calculator is a mirror. And for everything else, labs. But even bad cholesterol alone isn't terrible. Stress and bad cholesterol is. Stress hardens artery walls making them easier for the bad stuff to stick to it. I'm paraphrasing a couple heart doctors I've talked to. Basically, try to look good and be happy.

 

[Storker]

One lesson learnt for me here is to not jump into the water when the sea condition is rough or I don't feel well at the time.

I'm probably (more than) stretching the rules for A&I, but my immediate reaction to this was "no sh!t, Sherlock!" I've called more than one dive even before splashing because I've deemed the conditions to rough for me to handle, or my condition not compatible with diving. Even back when I was a pretty fresh AOWD. I'm a little shocked that I seem to be unique in that respect (but then I'm generally pretty naïve...)

 

[Diving Dubai]

BMI as I understand (open to correction) was originated as a means provide a guide for medical drug administration.

BMI has been refined using different calculations for men and women and defining if you are athletic or not.

A better judge is obviously body composition where muscle mass, fatty tissue mass and bone mass are all taken into account. At teh end of the day each person knows what sort of shape they are in, we might deny it to ourselves, but in reality we all know if we should get into better shape or not.

None of this counts. Whether He'd been a top line athlete or not, I wouldn't have allowed him on one of my boats, purely because of the risk he posed.

In the event of an incident we could not have recovered him. This is born out by the "facts" in this case where a number of boats needed to provide assistance.

While agencies differ slightly, they all teach that in the even t of a diving incident you get the causality onto the boat or the shore ASAP so you can start CPR and O2 administration. The sooner you start the better. And while in this case you don't know that if had been possible to give immediate CPR the victim would have survived. It's a fair guess that being in the water for 30 mins pretty much prevented their recovery.

People make a big thing of it being their own responsibility. While they may think so it's not always true. Families often demand closure which may mean they take out a legal case against the operator.

A case in point was Death of Lex Warner in 2012.

Mr Warner crossed the dive deck in full gear (rebreather, Deco and bailout cylinders) while wearing his fins. He slipped and fell.

He was asked if he was okay, it was suggested he not dive, but he insisted he was okay and dived. Things went wrong at 88m and he died from an internal abdominal injury.

After the investigation which identified a lack of risk assessment for fully dressed divers cross teh deck, even though PADI and BSAC identify it as a risk (and the diver would have known) The widow launched a legal action - which was unsuccessful. At teh end of the day the diver in this case was responsible for his own actions and decisions but his family still wanted to "make someone pay"

This is why operators need to take precautions for their and their customers benefit

Marine Accident Investigation Branch Accident Report

Legal New report of dismissed case

 

[bilsant]

Deep condolences to friends and family. I hope Mr. Ley (the "Mr." earned by his choice of public service), was enjoying being in the water up til the last moment. So far as I've read, nobody knows much of anything as to the cause of death, and while some have focused their speculative discussion on his weight and condition, there are a variety of problems that can leave someone unresponsive on the surface. Sadly, knowing what I do about most Medical Examiner offices in Florida, official cause of death in this case will probably be "drowning".

While not as big as the diver in question, I'm a pretty big guy...and have reflected hard upon that when coming up a ladder wearing doubles on a sporty day. From your comments here, some here would be put off by diving with me. Some here have been out with me and we all did quite fine and were comfortable with each other the entire time.

Everyone who dives makes a decision to take some level of risk to achieve a level of enjoyment. I suspect the diver was aware of his condition and options, and chose to dive understanding that we are all usually responsible for our outcomes.

For myself...as I've told every buddy since my Rescue Class: If I'm offshore, unresponsive, and show no breathing or pulse, if you can't get me back on the boat all at once, it's ok to make multiple trips.

 

[joe10540]

This thread has looked at his size as the issue and some people have said they wouldn't allow him on their boat because of it but isn't that discrimination and against the law? I'm a big guy myself and by the numbers morbidly obease I'm 6'1" and 330lbs but I have run marathons and am signed up to run a 100mile race in January, my BP is usually 116/70 with a heart rate in the 60's my cholesterol is under 200 and I have no blood sugar issues. I would be extremely upset if someone told me I was too fat to dive from their boat especially since medically other than my appearance you would be hard pressed to find anything wrong with me based off my test results. Yes there are people who are overweight and have no business diving but this guy was running triathlons he must have had some base of fitness.

Maybe we should consider other options until there are autopsy reports with solid evidence. Maybe it was medical but not directly related to his weight. Maybe he had an electrolyte imbalance that caused a heart attack or had an aneurysm that ruptured.

 

[Diving Dubai]

I take your point. But consider this.

A commercial boat has a duty of care for its passengers. In the event of an incident they need to be able to give you the best assistance?

If they couldn't, then the question would be asked "why did you accept his money and let them on the boat knowing you couldn't cope?"

I'm 6'2", and only 180lb. I couldn't get you on the boat without a good deal of assistance, whereas I can get a 200lb person on board. If you passed away because I couldn't give you timely assistance, but I know that if I had of got you on board quicker I'd have saved you, how do I deal with that?

So now, I have a choice, do I refuse you and risk being accused of discrimination, or do I say I'm not allowed to hire female DM's because they're not strong enough? Do I need to equip the boat with extra gear or people? If so who pays the cost? Is it passed on equally to all or do I add a surcharge to those who need it? Do I put the crew in a position where they might injure themselves on a recovery opening my self up to further issues?

In the short term I go with the stance that I can't accommodate a larger person, the risks outweigh the returns.

This isn't about discrimination, just about assessing the risks and planning appropriately.

 

[joe10540]

I take your point. But consider this.

A commercial boat has a duty of care for its passengers. In the event of an incident they need to be able to give you the best assistance?

If they couldn't, then the question would be asked "why did you accept his money and let them on the boat knowing you couldn't cope?"

I'm 6'2", and only 180lb. I couldn't get you on the boat without a good deal of assistance, whereas I can get a 200lb person on board. If you passed away because I couldn't give you timely assistance, but I know that if I had of got you on board quicker I'd have saved you, how do I deal with that?

So now, I have a choice, do I refuse you and risk being accused of discrimination, or do I say I'm not allowed to hire female DM's because they're not strong enough? Do I need to equip the boat with extra gear or people? If so who pays the cost? Is it passed on equally to all or do I add a surcharge to those who need it? Do I put the crew in a position where they might injure themselves on a recovery opening my self up to further issues?

In the short term I go with the stance that I can't accommodate a larger person, the risks outweigh the returns.

This isn't about discrimination, just about assessing the risks and planning appropriately.

Having a long spine board on the boat would allow for someone to be boarded in the water and hauled up over the dive platform by one person but if needed a rope could be fastened to one end and pulled by two or three. I understand the fear of how would I get someone back on the boat but there is always a way to get someone aboard. If you genuinely believe that you couldn't do it then perhaps re-evaluate your emergency procedures. Adrenaline can give people the strength to lift cars off of people but you don't think you can drag someone up over the side of a dive platform? If they are already dead/dying how much worse will some scrapes and bruises from boarding them be?

 

[Diving Dubai]

Yes I agree, there is always a way.

My question remains (playing devils advocate). To what lengths should I need to go, in order to accommodate a minority? Do I need to invest in extra safety equipment, do I have to buy extra large BCD's?

Or can I just say no as the $80 I'm going to get from someone fir a trip isn't worth the extra hassle and expense and let them take their custom elsewhere?