Probably one of the most important documents in recreational and technical diving has been revised.
The 'Medical Statement' form' is currently used by the majority of divers undertaking training. It was first published in 1989.
The Process
The initial impetus for working on a new medical came from the realisation in 2017 that the first RSTC Diving Medical would soon be approaching 30 years of age. It was reasoned that it needed reviewing as medical thinking must have moved on in that time. After discussions with the UHMS Diving Committee, it was decided that the most effective way to move forward would be to create a small, independent committee of top international experts in diving medicine to do the bulk of the work, and then to get the input of bodies such as UHMS and DAN once the new system had a solid initial draft.
PADI took the initiative to host the committee and Mark Caney, PADI Worldwide’s Industry Relations and Training Executive worked with Julie Taylor Sanders, PADI International Training Executive, to discuss how this project could be taken forward for the benefit of the entire recreational and technical diving industry.
The two executives worked together and smoothly organised the entire project to ensure that there was consensus, with Mark Caney chairing the meetings. Neither Mark nor Julie contributed to the medical input, instead they ensured that the whole process moved forward efficiently.
You can appreciate the challenges associated with gathering and coordinating this international group of diving medical experts and facilitating this remarkable collaboration. Dr Nick Bird
Nick Bird observed "I cannot sing the praises of Mark and Julie enough. The pair made it very clear this is not a PADI form - they were very explicit about that. They had the professionalism and capacity to coordinate the group, and keep us together and on task. You can appreciate the challenges associated with gathering and coordinating this international group of diving medical experts and facilitating this remarkable collaboration."
The new document has had input from several sources and was extensively reviewed by Divers Alert Network (DAN), the Hyperbaric Medicine Division at the University of California, and the Undersea & Hyperbaric Medical Society (UHMS). It has been endorsed by DAN, RSTC (Recreational Scuba Training Council), RSTC Europe, UHMS and the WRSTC (World Recreational Scuba Training Council).
The whole process has taken approximately three years.
The WRSTC has endorsed the use of the Diver Medical Participant Questionnaire as an open source document to all recreational diver training organizations in its membership
The Team
The 'Diver Medical Screen Committee' (DMSC) is made up of a team of internationally respected diving medicine experts; Dr Nick Bird, Dr Oliver Firth, (the late) Professor Tony Frew, Dr Alessandro Marroni, Professor Simon Mitchell, Associate Professor Neal Pollock and Dr Adel Taher.
Each person has a wealth of expertise in this medical field, and because they all come from suitably different backgrounds, every one has a unique perspective on the Medical Declaration Form. A good example of this is Dr Adel Taher.
Dr Adel heads up the Sharm-el-Sheikh Hyperbaric Unit, in Egypt. Before the Arab Spring, this was probably the busiest chamber in the world when it came to treating sick divers. Dr Adel's surgery was always busy - I write this from personal experience having worked in the resort as a professional scuba diving instructor. At the start of every course, certain paperwork needs to be filled in, including a Medical Statement. It was quite normal that at least one student in the class would need to get a medical, and I would regularly visit the chamber with these students before I could start teaching. Adel or one of the other diving doctors in attendance would conduct the relevant medical, and in most instances sign off the student as 'fit to dive'. When I was working in Sharm, Adel and his team would typically have at least 50 people attend his surgery each week for a diving medical.
The Work
DMSC member Nick Bird stated "The team took an evidence-based approach to identifying medical issues that are known to cause diving associated injuries and deaths. Our focus was to enhance the specificity of questions related to these issues, especially the cardiovascular system, in order to effect more appropriate medical referrals. The newly revised screening questionnaire has 10 questions, where its predecessor had 34.
We understood the need to create a document that could do a better job screening those medical issues truly associated with diving injuries, whilst at the same time, minimize unnecessary and avoidable referrals. The reduction to 10 screening questions simplifies the process for the diver, while the inclusion of up to seven additional question blocks for any ‘yes’ answers, enables a more thoughtful evaluation of the diver’s medical history and potential need for referral. As such, and unlike the current form, not all initial ‘yes’ answers require a medical examination.
If you look at the current form it says 'Have you ever had or do you currently have back or spinal injury?' The new form says 'I have had back problems'. The diver then goes to Box F where they read the following. 'I have / have had: recurrent back problems in the last six months that limit my everyday activity, back or spinal surgery in the last 12 months'. This means that someone who hurt their back years ago, or who has occasional back ache does not need to be referred for a medical.
We all were focused on the need to make this work for the diving industry. Dr Nick Bird
We deliberately separated the 'Medical Statement' questionnaire from the 'physician guidance' document. This format will enable guidance recommendation updates on a more timely basis as new information becomes available.
Dr Alessandro Marroni arranged for field testing - we had two versions out there before we finalised the current format.
I am very proud of the result and am honored to have been included in this international collaboration of volunteer diving medical experts. We all were focused on the need to make this work for the diving industry. We have now created a living document. We now want to see how it works. It is certainly a big improvement on the current documentation."
COVID-19
The new documents were ready to go earlier this year. In light of the COVID-19 crisis, the DMSC team reviewed everything. It should be noted that clinical guidance related to COVID-19 is changing as we learn more about this disease and the potential effects on organ systems like the lungs, heart and kidneys. The medical declaration form now has an additional statement, 'I have been diagnosed with COVID-19'. The physician guidance has also been edited to include further information about coronavirus.
Living Document
The shift to a 'living form' with more frequent updating is particularly important to ensure that the documentation reflects current perspectives. Dr Neal Pollock
The medical declaration form and the notes for physicians are both 'living documents'. This means that in the future they will be updated as necessary. The medical declaration form has been translated into 26 languages and the notes for physicians is available in seven languages.
Dr Neal Pollock confirmed that "the process to update such an entrenched tool was challenging, but important. There were a number of elements that sorely needed revision, and many more that benefitted from the effort. The shift to a 'living form' with more frequent updating is particularly important to ensure that the documentation reflects current perspectives."
The UHMS is kindly hosting these important documents. It means that dive professionals know that the most up to date version of these forms will always be found on the UHMS website.
To access these forms, simply follow the 'References and further reading' link below.
