Post head surgery commercial/recreational diving

[Moti Gross]

Hello Scubaboard members,

perhaps someone in the community can assist me or point me in the right direction.

Being a veteran avid divemaster, with over 600 dives, I passed along that love of breathing O's from a tank to all my kids.

My youngest son, decided to make it his profession and became a certified diving instructor with thousands of dives under his belt. after a short reprieve travelling the world, he came back home and started to work as a commercial diver, doing underwater jobs.

A month ago, my son suffered a horrific incident where he was the victim of a terrorist attack, where he was repeatedly hit over the head with a hammer. His skull was fractured in three places. one of the fractures was a depressed skull fracture that required invasive surgery where the bone was lifted out, the brain dura was repaired and the skull reassembled and returned. subsequent CT's showed no damage or bleeding and we are all hopeful for a full and speedy recovery.

my question is, does anyone have an idea what limitations will there be on his return to diving? both commercial and recreational? Being a commercial diver requires all sorts of work, at different depths, and we're not sure who can advise on this.

I'd appreciate any thoughts, referrals, anything that can give us a lead.

To all you divers out there, Eat. Sleep. Dive.

thanks,

Moti G.

 

[Pedro Burrito]

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[Radoo]

This should really be discussed with his neurosurgeon who knows all the details. If there was any brain injury you are prone to have seizures so that’s quite a tricky one...

Hope your son makes a speedy and uneventful recovery.

 

[Duke Dive Medicine]

Moti, I'm sorry to hear that this happened to your son. I hope he continues to recover.

I agree with Radoo in that if he has had seizures, it could complicate his return to diving. However, if he recovers fully with no residual symptoms and is not at increased risk for injury in the area where he was struck, I don't see why he would not be able to go back to work. His company will (or should) ensure that he receives a thorough dive physical when he's ready to return.

Best regards,
DDM

 

[uncfnp]

Hello Moti. Sympathies to you and your son for the pain you both are enduring.

I am not a dive professional but since I do certify commercial drivers in the US there may be some similarities. After a tramatic brain injury, especially if penetrating or the dura is otherwise compromised, there is a higher risk for delayed seizure. Depending on the severity of the trama, the risk may decrease over time for up to 11 years or as with the most severe TBI the risk is life long.

As a recreational diver the assumption of risk is personal. However, as a commercial diver the risk is broader and I wonder if it may even be regulated by the industry or country.

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I hate to give bad news and again I am not an expert but it sees there may be a similar concern for commercial divers. I found this with a quick google search. For at least one commercial dive school in the US a penetrating head injury with surgery history is a disqualifier. Again, I do not know if this is universal or if it pertains to a diver already certified.

Also, there is a commercial diver forum that might give some insight as well.

Commercial Divers

 

[Duke Dive Medicine]

Thanks to my colleague from the lighter blue place across town for posting the above. The ADCI standards don't mention penetrating head trauma and it's those I'm most familiar with. They are reproduced below from the ADCI Consensus Standards Revision 6.2.

2.3.6 DISQUALIFYING CONDITIONS

A person having any of the following conditions, as determined by a physician’s examination, shall be disqualified from engaging in diving or other hyperbaric activities.

• 
  
• History of seizure disorder other than early childhood febrile conditions.
  
  
• Cystic, bullous or cavitary disease of the lungs, significant obstructive or restrictive lung disease and/or spontaneous pneumothorax.
  
  
• Chronic inability to equalize sinus and middle ear pressure.
  
  
• Significant central or peripheral nervous system disease or impairment.
  
  
• Chronic alcoholism, drug abuse or dependence or history of psychosis.
  
  
• Hemoglobinpathies associated with comorbidities.
  
  
• Any person engaged as a diver, or otherwise exposed to hyperbaric conditions, will have a medical evaluation following any
  
  non-diving injury or illness that requires any prescription medication, any surgical procedure or any hospitalization.
  
  
• Untreated or persistent/metastatic or other significant malignancies including those that require chemotherapy and/or radiation therapy unless five years after treatment with no evidence of recurrence.
  
  
• Hearing impairment in the better ear should be at least 40 dB average in the 500, 1000, and 2000 Hz frequencies.
  

• 
  
• Justa-articular osteonecrosis is disqualifying.

However, the International Marine Contractor's Association (IMCA) standards do mention a depressed skull fracture as disqualifying.

H7.
There are inherent dangers in diving if there has been significant brain damage or there is a risk of post traumatic epilepsy After head injury where there has been any of:

• 
  
• a depressed skull fracture;
  
  
• intracranial haematoma;
  
  
• unconsciousness or post traumatic amnesia greater than 30 minutes; or
  
  
• focal neurological signs
  there is a significant risk of post-traumatic epilepsy and the person should be rejected.

So, I stand corrected. He may not be medically cleared, depending on the criteria used. Apologies for any confusion.

Best regards,
DDM