The oxygen tolerance test is not a reliable reference except for a given
day. Call the Navy and they will tell you that.

Also in a chamber most people will tolerate oxygen much better than in the
water. Thus you would need a wet pot to make it even near valid.

On Pfo testing not practical and too expensive and as you pointed out it
does not even give you a whole picture . Would I recommend it yes require it
no. There is insufficient history to make it mandatory.

Your insurance sources are much different than mine. Our has no intention of
doing these things.

IANTD already requires stress management drills in training at all levels
from open water thro trimix. We are adding in some timed skills (for some
research I was involved in while the diving officer at the UM RSMAS many
years ago. ) I believe Bill like like all IANTD students completed some of
these in both his mix and cave courses with me. We have added in a general
fitness swim, and the new (I use them a lot already) Time skill and swimming
events will be filtered into the programs this tear. This will include at
instructor renewal time instructors will have to get a notarized statement
that they have completed a set of fitness skills before renewal.
We are putting these things in place as we have been since the inception of
IANTD  because we thought it was prudent not because it is an insurance
requirement. Nor will it become an insurance requirement with our carrier.

I also would recommend that anyone doing serious diving teck or otherwise do
the stress physcial and a VO2 max test just to know their own base line and
what if anything they need to do to maximize their capability as divers.
Tom
-----Original Message-----
From: Bill Wolk <billwolk@ea*.ne*>
To: wwm@sa*.ne* <wwm@sa*.ne*>; Cavers List <cavers@ca*.co*>
Cc: Techdiver List <techdiver@aquanaut.com>
Date: Saturday, May 02, 1998 9:19 PM
Subject: Re: New Requirements


>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
>

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