djwazzo wrote:Greg - its regarding the doctor part. Say it costs $200 to get a doctors cert, thats an extra burden on prospective students which could be a hindrance when encouraging more people to take up the sport. The statistics on ageing incident stats are huge worldwide, so the argument for checkups is valid but this is focussed on the entry route for new divers.
I am perhaps a little out of the loop on recent diving industry policy developments, but recreational diving medical assessments have generally been aroud the $50 mark. If the assessment involves audiometry and spirometry, and a more complete physical exam (more keeping with the occupational diving medical assessment), then $200-300 including the tests is more the norm, but uncommonly requested or done for recreational divers in my experience.
Agreed that divers in NZ are generally assessed at entry, and then may not be reassessed for the next 30 years. That issue has been raised a number of times over the years, but given these assessments are done almost completely in the private sector, where the diver pays for all assessments and investigations, resistance to a 5 year medical cycle or similar has been high when raised in the past.
The mortality stats while diving (including snorkeling) are not what I would call huge, espeically compared to other activities like driving a car, or engaging in other outdoor activities. Denoble et al 2008 found a 16.4/100,000 annualised death rate in insured DAN members. This has been compared to jogging in one of Simon M's papers (13/100,000 joggers died from heart attacks in one study). I think road deaths in NZ run around 10/100,000 road users annually. We're not talking dead divers washing up on beaches across the country. And a significant proportion of the Australasian numbers come from snorkelers on the Barrier Reef (primarily old people with significant pre-exisiting medical conditions).
The way I see it, we're not going to significantly lower the mortality rate in NZ divers via diving medical assessments. For example, the vast majority of cardiac events (something like 25% of the total diving mortality rate from memory) are not able to be predicted on a general medical exam. Aviation has a good medical safety record, but even that rigorous system of medical screening of pilots cannot reduce the risk of medical incapacitation to zero, and the costs to participants in that industry are several orders of magnitude higher. I suspect few divers in NZ would support switching to a medical certification system in line with that of the CAA.
The issue of veracity when completing the questionnaire is something that cannot be easily detected if a person's intention is to dive despite a known medical problem - with or without an assessment by a diving doc. The bigger question I think is what do you do with positive responses to the questionnaire you are using (assuming the system being discussed uses one). The risk assessment and acceptance model of diving medical assessment requires good information about a person's condition, and a careful discussion of the subsequent risks. A questionnaire only model, while cheaper to implement by dispensing with the expensive physician, makes this difficult to reliably achieve. A sensitive questionnaire that reduces risk of medical incapacitation will necessarily pick up a bunch of people who are actually low risk. A questionnaire that minimises false positive pickups will be so insensitive as to miss a few that should have been screened out for valid medical reasons. That is where the diving medical assessment I think is needed. Problem is, these questionnaires are often done at 0800 on a busy Saturday at the jetty, boat leaves at 0830, punter A marks yes to (pick your condition, Type 1 diabetes, Asthma, Claustrophobia, whatever). I've been called for an opinion in just this situation a number of times. The RSTC questionnaire is not ideal for use in this scenario and there has been talk for years on developing a short, but sensitive medical questionnaire for this kind of use. Divers are not going to embrace a system of medical clearance that costs them money, even if it is in their best interest - that's just not how people think. Of course when the 55 yo obese smoker with known angina carks it on Operator X's dive charter boat while struggling to put on his wetsuit, the coroner will come back with 'you should be medically screening all these guys to prevent further similar incidents'. I think what we have at the moment is something in the middle that pleases no one completely, but it must be pretty close to good enough?
Denoble PJ, Pollock NW, Vaithiyanathan P, Caruso JL, Dovenbarger JA, Vann RD. Scuba injury death rate among insured DAN members. Diving Hyperbaric Med 2008; 38:182-188.
Mitchell S, Bove A. Medical screening of recreational divers for cardiovascular disease: consensus discussion at the Divers Alert Network Fatality Workshop.Undersea Hyperb Med. 38(4):289-296;2011.