Compulsory Recreational Dive Medicals

Questions relating to medical issues and treatment. Where possible and appropriate, we will request comment from qualified and reputable NZ-based diving doctors. If your query relates to a personal medical issue, we recommend you contact your GP or relevant medical specialist.

Compulsory Recreational Dive Medicals

Postby djwazzo » Tue Feb 12, 2013 12:36 am

We have had an enquiry at the NZUA office regarding compulsory (voluntary) dive medicals and whether the industry should adopt the worldwide practice of self-assessment forms?

Do you think this put off new divers with the additional cost or is it still a welcome safety net to ensure medical issues are flagged before participation?

Let me know what you think?

Shane
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Re: Compulsory Recreational Dive Medicals

Postby ChuckyBob » Tue Feb 12, 2013 8:20 am

Im a bit confused.

How can it be compulsory and voluntary?

Done we already have medicals when we do open water?

I did one for OW and also for Advanced Nitrox/Deco Procedures.

I recall the first doctor I went to told me I couldnt dive because I have asthma. I just went to another.

I think this proves 2 points.
1st Doctors dont know everything
2nd. If you really want to do something you will do it regardless of what some one says.

I think the only service dive medicals provide is bubbles covering for the dive shops/instructors.
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Re: Compulsory Recreational Dive Medicals

Postby divepirate » Tue Feb 12, 2013 9:04 am

Shane.
I would have to agree with bob here.

And at the same time extend the topic.

The question which is probably being out out there by the regulators relates to whether the 'fit to dive' should be a regular check.

Firstly to reiterate what bob says.. If you want to do it badly enough you will make it happen, by choosing other persons to write you up as healthy.

And more importantly will it make a difference at all, or is it regulation for regulations sake?

Specifically, will it capture those that have their own compressors, have their own gear, and don't need to ever go into a dive shop for anything.
Will it capture those that travel to New Zealand and dive.
Will it cover those doing 'dangerous' or inappropriate courses.

It seems that this is something that could be made into yet another thing which could create stumbling blocks and additional 'certifications' in a sport that is becoming less and less of a 'first choice' for the sportsmanship dollar.

And will it accomplish anything in the long term, would it have saved a number of divers in the lake (no ill intent ment by this reference), or any other diver who has been adversely affected by any dive or dives that they have done.
Is the long term cost to the sport worth the gamble that would be made for the sake of the one or two people who pass away every 5 years due to a medical condition that may or may not be picked up by tests conducted by a gp.

The same could be said for those who drive a car, (a medical for anyone who drives - every 2 years).
We allow people to drive cars in any state of medical disorder, who can not only kill themselves but others as well.

25 years ago I went to a doctor who said that I was asthmatic, I have never had an attack, and have never needed inhalers etc.
Sometimes even the professionals get it wrong!
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Re: Compulsory Recreational Dive Medicals

Postby djwazzo » Tue Feb 12, 2013 9:19 am

Hi Guys,

Just quickly.

There is no legislation that requires recreational divers to undergo medical examination prior to enrolling in a dive course. The NZ dive industry voluntarily enforces the medical requirement as a safety measure which historically came from the NZUA/CMAS training days.

Another issues is there is no distinction between commercial and recreational medicals, which is very different to other countries. Perhaps a reduced medical (with reduced cost) could be a middle ground?

NZUA are also in the final stages of medical software programme which means non-diving doctors can conduct the recreational medical examination and will give them a structured pro-forma and checklist to work through. This was an initiative that was started a few years back to reduce the burden for prospective divers.

The question is whether it puts off prospective divers with the added cost and what the safety merits are with a pre-course medical.

Hope this helps explain a bit.

S
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Re: Compulsory Recreational Dive Medicals

Postby binklebonk » Tue Feb 12, 2013 10:16 am

I'll PM Simon Mitchell or GregV and see if one of them has time to answer this otherwise this will be the usual 'echo chamber' of well intentioned misunderstandings.

1st Doctors dont know everything


Show me a doctor that has claimed the contrary!

Science, if it did know everything it would stop.
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Re: Compulsory Recreational Dive Medicals

Postby rambaldi » Tue Feb 12, 2013 10:26 am

In the past I have done two dive medicals, one here before my advanced and one years ago before my OW in South Africa. The medical in SA was insignificant and didn't really accomplish much. The one here was a little more in depth but as I don't have anything that would cause trouble with diving ended up effectively being a waste of time. If people were accurate in their self assessments then I think we could bypass the formality but cases like this one: http://www.divenewzealand.com/upimg/nor ... inding.pdf still happen so they seem to be a necessity.
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Re: Compulsory Recreational Dive Medicals

Postby Gregv » Tue Feb 12, 2013 2:18 pm

djwazzo wrote:We have had an enquiry at the NZUA office regarding compulsory (voluntary) dive medicals and whether the industry should adopt the worldwide practice of self-assessment forms?

Do you think this put off new divers with the additional cost or is it still a welcome safety net to ensure medical issues are flagged before participation?

Shane


Got a PM asking for a comment on this.

I'm not quite clear on the issue here. The NZ industry generally already uses self assessment forms (usually the RSTC form) plus medical review by 'a doctor'. Most docs who complete these forms have no formal diving medicine training, or may have done a 30 hour course some years ago, which is a whole other subject in itself. Is the question relating to JUST using the questionnaire, or referring for diving medical review those who answer positively to any question ? There are a number of complicating factors regarding WHEN you should get people to complete these forms and what you do with the positives, which anyone who has worked in the industry will attest to.

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Re: Compulsory Recreational Dive Medicals

Postby divepirate » Tue Feb 12, 2013 5:08 pm

One has to ask the question ..
why is this being highlighted as an issue?

and
will a change reduce the number of 'accidents' significantly?

If not, will the adoption of legislation just create another cost for divers on top of regular tank testing, servicing etc.

Forum poll will be raised on this subject.
see here; http://scubadive.net.nz/viewtopic.php?f=141&t=5152
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Re: Compulsory Recreational Dive Medicals

Postby ChuckyBob » Tue Feb 12, 2013 10:34 pm

divepirate wrote:One has to ask the question ..
why is this being highlighted as an issue?


Why indeed?
Have NZUA got nothing better to worry them selves about??

How about the fact we have to do a hydro every 2nd year when other counties do it every 5 years.

What about the shit we have to go through to get a tank SP LAB'd. If its good enough for the UK why isnt it good enough for here?

How about we cant use normal tanks for nitrox/ O2 use? Why is that? What sense does it make?

How about what NZUA is doing about the MSCDB cert. When I got mine there was talk about getting the boat length extended to 7 meters or a max amount of divers. That was 10 years ago. Still the same rules apply and the same talk goes on. Has any thing done about that?
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Re: Compulsory Recreational Dive Medicals

Postby djwazzo » Tue Feb 12, 2013 11:39 pm

SM will be in the loop - he's the medical advisor on this. But he input is very welcome here. However we were looking for general divers opinions on the matter.

Rambaldi - yes good point and exactly the issue, if you could guarantee honesty in the form then it would be a perfect world. The question is, would there be a higher incident rate if the medical was not undertaken.

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.

Pirate - Why is the issue raised -well someone feels strongly in the industry on it so its worth discussion. We all want to see more people diving so its worth gauging the diving publics opinion.

Chuckybob - negative comments not helpful. If you wish to raise issue with tank testing please do in another thread. You are welcome to assist NZUA to try and change ERMA regs if you feel so strongly about it. Personally I also think it's a pain and unnecessary cost.
MSCDB, yes there is a couple of people working away at it, but its trying to change legislation and working with a bureaucracy. Again if you want to effect change, we'd welcome your assistance in doing so.
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Re: Compulsory Recreational Dive Medicals

Postby binklebonk » Wed Feb 13, 2013 8:41 am

djwazzo wrote:.....we were looking for general divers opinions on the matter.......


I have to ask why you want the opinions of non expert divers.

This should be evidence driven, not based on opinion. What do the experts think?

If the concern is coming from shops worried that the extra cost will impact sales of courses and gear, then that's not a concern I share.

A medical may put off some but with the poor retention rates of divers (any recent figures on this?) it may only put off some of those who wouldn't be diving a year after their OW anyway.
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Re: Compulsory Recreational Dive Medicals

Postby ChuckyBob » Wed Feb 13, 2013 9:01 am

Shane, Sorry if my questions come across negative. But they are honest questions.

I dont understand what is broke with the current medical situation for new divers so I dont understand why NZUA want to try and fix it.

But I do see other areas that are broke and seemingly nothing is been done about it. These are the types of concerns that people on this forum are more worried about than what costs a new diver may be subject to ( we are all past that stage).
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Re: Compulsory Recreational Dive Medicals

Postby Gregv » Wed Feb 13, 2013 9:16 am

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?

Greg v

Ref:
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.
Last edited by Gregv on Wed Feb 13, 2013 10:54 am, edited 1 time in total.
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Re: Compulsory Recreational Dive Medicals

Postby djwazzo » Wed Feb 13, 2013 10:54 am

Chucky - yes valid. But start a new thread on it and discussion welcome. Medical issue - just looking for general options in addition to other sources. This forum is one medium to explore them.

Binkle - I would assume there are instructors/shops etc on this forum so hopefully get their opinion. However general divers opinions matter given they have gone through this. Obviously the medical did not put them off as they done a course!! Just another area where the dive industry can look to try and retain/culture divers. A healthier industry = better diving for everyone in NZ.

Greg - yes agree with your comments and know the research as have been working on a report on it recently. You can also include the wider issue of tourist divers and their medical sign off. But its the same worldwide. A better framework for reducing incidents would be recurring medicals and with ageing divers (given the stats), but that is recognised worldwide but no-one making any rules around it. You could look at club structures round the world and that they require a self assessment every year, perhaps the NZ clubs should also adopt this and dive operators ask for a self assessment form when they check the C-Cards.


Good to have open discussion anyway.

NZUA aren't pushing this issue, an enquiry has been made and our software is coming to fruition so its relevant to have some dialogue on the matter.
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Re: Compulsory Recreational Dive Medicals

Postby ChuckyBob » Wed Feb 13, 2013 11:05 am

Do charter operators look at cert cards? I havent shown a cert card to any operator since I started diving.

Will charters ask to see a yearly/ 5 yearly medical cert?
Will they turn people away if they dont have it?
Will they risk prosecution if they let someone dive with out one and that person dies due to a medical issue?
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