Mailing List Archive

Mailing List: techdiver

Message Display

On 5/1/98 1:36 PM, wwm@sa*.ne* wrote:

>In speaking to a friend of mine who advises insurance carriers I learned
>that some new requirements may be coming down on the tech diving
>industry.
>
>It seems that given the shocking record of accidents and fatalities of
>late one means of diminishing some of the risk may be to require Stess
>testing in conjunction with PFO and oxygen tolerance testing.
>
>In my opinion it is very wise to perform these tests regardless of
>whether they are a requirement or not.  The commercial diving industry
>considers this form of testing to be a mandatory prerequisite. Tell me
>why we shouldn't follow suit?
>
>Bill

Bill -

I was going to respond to this when Dan Volker first posted the idea of 
mandatory PFO screenings.  In principal, it's a very good idea -- 
especially for any kind of decompression diving -- but lets put a 
practical framework on the PFO issue:  

First, based on DAN statistics, PFOs are present in an estimated 10%-15% 
of the population

Second, diagnosing one requires -- at a minimum -- an echocardiogram with 
contrast (aka a bubble echo) which costs approximately $1,000.00.  (I 
know -- I just had one done.)

Third, even bubble echoes will not diagnose small PFO shunts because of 
interference from the rib cage. (This was surprise info from my 
cardiologist while the bubble echo was being performed.) To truly rule 
out a PFO, you have to get an endotrachial bubble echocardiogram in which 
a miniturized echo device is actually lowered down your throat to produce 
an internal picture of blood flow through the heart.  I didn't look into 
the cost of this procedure, but since it involves intubation and 
anesthesia, I think it's safe to say that it won't be simple or cheap. Do 
you know of anyone who's taken it this far? 

That said -- it you can afford it or have medical insurance that will 
pick up the tab, it's not a bad idea. I though it was important to do 
before starting mix dives and squeeked mine through my PPO insurance, but 
it wasn't easy.  As for Ox tolerance testing -- not sure it would show us 
much since the ox tox threshold varies so much from day to day and dive 
to dive even in the same individual.

Perhaps rather than make it mandatory, a bubble echo should be strongly 
recommended by the tech certification agencies and this recommendation 
should be backed up with a full and medically graphic description of what 
can happen to a diver with an undiagnosed PFO on a deco dive. Think of it 
as an informed consent -- "we're recommending this procedure; it's your 
choice not to get it; but this is what can happen if you don't" -- with 
that, some divers will have the procedure done and those who don't will 
at least have made a decision based on a clear sense of the risks and 
benefits.  (Personally, I think the risks of most diving are underplayed 
in order to increase the market, but that's another issue.)

Based on the info you've posted in the past and the DAN accident reports 
I've read, it seems like the vast majority of scuba accidents and 
injuries are earned -- from improper training, poor equipment 
configuration, bad gas planning, diving beyond limits, etc. -- and not 
from unearned causes like undiagnosed PFOs. Certainly that much is 
obvious about West Palm. It seems to me that we'd save lives and reduce 
risks more by setting higher training and equipment standards -- as you 
and George have been doing all along -- than by requiring expensive 
medical testing.

Just my $.04 -- Sorry about the length of the response -- it was a good 
question! 



Best Regards --

Bill

--
Send mail for the `techdiver' mailing list to `techdiver@aquanaut.com'.
Send subscribe/unsubscribe requests to `techdiver-request@aquanaut.com'.

Navigate by Author: [Previous] [Next] [Author Search Index]
Navigate by Subject: [Previous] [Next] [Subject Search Index]

[Send Reply] [Send Message with New Topic]

[Search Selection] [Mailing List Home] [Home]