I am glad that we spun this thread off (from the A&I discussion of the Cozumel fatality) because it has produced some informative discussion. Based on some of the comments I have several reactions, in no particular order of importance:
Several posters have referred to the 'PADI form'. While that may be the form that PADI makes available on their website, and carries a PADI logo, it is useful to keep in mind that the form is actually (clearly stated on the form at the top) the RSTC - Recreational Scuba Training Council (
United States Council - WRSTC) form. So, if any SB user wishes to 'suggest' that the form should be changed, the RSTC would be the best point of contact. I happen to agree with one such post, that the form should be updated to include non-physician primary care providers such as PAs and FNPs. I have been presented with forms signed off by both types of providers, and have accepted them without reservation, even though the form specifies 'physician'. I cannot speak for other Instructors or dive operators.
In the US, RSTC members include PADI, SDI, PDIC, SSI and RAID. Notably missing from the list is NAUI, NASE and SEI. It would be good to hear from Instructors / operators working through those agencies, regarding the standards for medical clearance that those agencies apply.
The 'process' of obtaining a diver statement regarding their health, is intended - as the RSTC form indicates - to protect the diver (formatting added for emphasis):
The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in dive activities.
Diving is associated with certain risks, it can be a strenuous activity, and some individuals wishing to pursue diving may not be aware of how their physical condition may increase their risks. (Of course, all of us on SB are fully aware of any and all risks that we face when diving, so that statement really applies to 'those other divers'.) The form really is for the benefit of the diver - by providing a checklist and a decision tree. If you answer 'Yes', you should seek the opinion of an independent, informed 3rd party - a medical provider. Like it or not, very few (actually, I think NONE) of us are absolutely objective in assessing our own fitness to dive. We may be able to make a valid assessment, but we are not entirely objective, even when we are right. The Medical Statement is not intended to be intrusive, although some may choose to view it that way.
The process also involves risk mitigation for dive professionals and operators. It really is a matter of liability, on two levels. The first is straightforward - if someone dies while diving, the most common reaction among family and friends is NOT - 'Wow, at least that's some consolation, they died doing what they loved.' Rather, it is, 'Who is to blame for this needless tragedy?' And, the process of assigning blame, remarkably, seems to routinely exclude the victim. There have been high profile examples of this in recent years (
Wes Skiles' Widow Looking For 25 Million from Lamartek). But, there is a 2nd level. Dive professionals may be put at risk by a medical event suffered by a diver they are guiding. For example, a diver has a history of TIAs (transient ischemic attacks) associated with transient loss of consciousness, which would qualify as a Severe Risk according to the form. But, they are on vacation at a beautiful Caribbean destination, say Grand Turk, and their group is set to do an exciting wall dive - they will swim down through the Tunnels, and come out over the edge of the wall (where the bottom is several thousand feet below). The diver writes 'No' on the Medical Statement next to the question : 'Blackouts or fainting (full/partial loss of consciousness)', so they can do the dive with the group. The diver suffers a neurological event during the dive, become unresponsive and begins sinking down into the abyss (they were negatively buoyant to begin with, but were also a '45'er', and their finning was actually keeping them at a constant depth; they stopped finning as a result of the event, and started sinking). The DM leading the dive sees that they have started descending, and is faced with a dilemma, to descend and try to catch her, or not. The DM decides to try, but the unresponsive diver is well below them by the time they see there is a problem. The DM finally catches the diver, at 300 ft. At this point, the DMs air supply is quite low, and they are unable to make a normal ascent, with the unresponsive diver, to the surface. They try, but go out of air at 110 feet, release the victim, head for the surface, suffer a severe DCS hit, from which they recover but with residual paralysis. The family of the deceased diver looks to sue the dive operation and the DM for failure to provide a reasonable Duty of Care.
The Medical Statement is by no mean foolproof. Just because you have signed a statement and answered 'No' to all the questions does not mean that you will
not have a medical event while diving. Rather, it seeks to make divers aware, in advance, of potential risks and provides a process for assessing those risks - evaluation by a 3rd party - where the diver may be able to identify potential issues (answering 'Yes' to a question). That 3rd party does not have to be a diver! The Medical Statement provides information to the provider to help them determine whether their patient may have Severe Risk or Relative Risk, and whether the risk can be considered temporary or not, as far as diving goes. In the example above, a diver without the history of TIAs, who honestly answered 'No' might have a first time neurological event. Nonetheless, the Medical Statement 'process' is intended to pre-identify substantive risks, and mitigate them,
to the extent possible.
Any diver is free to answer 'No' to any and all statements on the form, even if s/he knows an answer to be 'Yes'. If that is what you choose to do, that is your decision. Hopefully, you - AND your family / friends / loved ones, since you may no longer be in a position to consciously care - will be willing to accept the possible consequences of your choice. You might think about also asking others that may be affected - e.g. dive professionals and operators - about what they think of your decision.
