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Following on from last month’s thoughts regarding general diving fitness it is worth looking at a recent article from the SPUMS Journal in March this year by Des Gorman. Des is the Professor of Medicine and Head of Occupational Medicine at Auckland University. Many of these concepts are taken from his article.
When assessing a person’s fitness to dive and in particular looking at any specific medical condition, it is important to take a "functional" approach to the problem. One way to do this is to ask these four questions:
Will the condition impair the person’s ability to dive?
Will diving make the condition worse?
Will the condition compromise the person’s (or their buddy’s) safety?
Will the condition predispose to a diving related illness or injury?
If the answer is yes to any of these then the condition is important. If we consider insulin dependent diabetes as an example, the answers would be:
YES. Low blood sugar levels (hypoglycaemia) can impair judgement or even produce unexpected loss of conciousness. Many of the problems associated with diabetes may make diving physically difficult.
YES. The high metabolic demands (exercise and cold) of diving can produce unexpected hypoglycaemia.
YES. Obviously any loss of consciousness underwater will lead to drowning.
YES. Impaired judgement could arguably predispose to all diving related injuries and illnesses.
These 4 questions can very neatly be applied to any medical condition and used to help determine whether an individual should dive, and if they should how can they dive more safely. Club members with any chronic conditions could also ask these questions of themselves and see what answers they come up with. If they don’t know the answer, they should find out!
The other important concept in assessing diving fitness is the Physical Competency Test (PCT). Des uses the example of a diver with a previous fracture of the femur (thigh bone) which has been fixed with a pin. One could argue in theory that such an injury might predispose to decompression illness or further bone injury from dysbaric osteonecrosis. The real issue however relates to physical stamina and the ability to perform the tasks necessary to dive safely. This cannot be assessed in the doctor’s office but requires a PTC (eg putting on dive gear, swimming a certain distance, climbing up the boat or jetty ladder). These tests should be performed by the employer or diving instructor when required.
A club environment such as the UEC may allow some divers with chronic illness such as diabetes to dive by strict adherence to protocols and education of the club members on first aid etc. In fact evidence exists that diabetics diving in such a controlled fashion may do so safely and with acceptable rates of DCI and hypoglycaemia. More on this next month perhaps!
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