Bill
I like your recommendation on warning and recommendation of PFo testing . I
will try to get that into the IANTD program but I would be opposed to
mandatory testing


Also on oxygen tolerance, a god way to avoid the need is to (let the slams
come) use eAN 80 on training dives begining at 30 feet. At this depth the
po2 is less than 1.6 and the diver has to drop to 33 feet to hit 1.6. That
is the whole reason why IANTD tables use EAN 80 and for the dives they were
designed for they have through thousands of dives been proven safe.

Tom Mount
-----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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