Book Review |
Medical Assessment of Working Divers. Fitness to Dive Standards of European Diving Technology Committee. Edited by J
rg Wendling, David Elliott and Tor Nome. Published by European Diving Technology Committee, 2004. ISBN 3-952284-2-7. Price: £10. 216 pp.
The editors and authors of this recently published desktop handbook represent the powerhouse of European and North Sea diving expertise. They have joined together to produce a concise collection of guidance for medical examiners of divers, whether they be UK, Scandinavian or EU based. Whilst the handbook is aimed towards the harmonization of medical diving standards in Europe with reference to commercial divers, the general reader should not be put off: there is much in this compact manual which will be of relevance and interest to medical examiners of sport and recreational divers. The foundations of the handbook are that new medical fitness standards should be evidence based and relevant to contemporaneous clinical practice. The authors state that their main goal has been to abandon the rigid style of assessment and the associated pass–fail checklists. Instead, they aim to give the medical examiners of divers the competence to perform a differentiated assessment according to diving task-based criteria. For example a professional/commercial diver with a medical contraindication would be more likely to be disqualified than a recreational diver with the same relative contraindication.
The authors introduce principles of medical assessment that start with legal aspects and go on to include general criteria of fitness for commercial diving, the assessment procedure, frequency of assessments and, importantly, re-assessment after sickness, injury or decompression illness. The handbook is enriched by a range of valuable checklists and forms, which include in depth (sic) assessments of history (preliminary and periodical) and examination as well as record forms for annual medical assessments. There is a specific form to assist in the medical assessment of resumption of diving after temporary layoff. A succinct general guidelines section covers cardiovascular, respiratory, ENT, neurological and musculoskeletal contraindications with advice on conditions requiring ‘careful evaluation’ including the resumption of diving after decompression injury.
The extensive reference section is a working tool for diving medicine physicians. This is based on extensive earlier work whose purpose was to list comprehensively special circumstances relating to systems that have significant relevance to medical fitness to dive. The brief final section describes the various diving activities that necessitate the special medical assessment that divers require, reminding us of the occupational medicine roots of diving medicine—how health problems might impact adversely on working at depth, and how working at depth may in itself create medical problems leading to the diver being unfit to resume diving. Three important appendices include details of reliable tests of physical fitness (maximal and sub-maximal exercise stress tests), guidelines for medical training and recommendations on preventing dysbaric injuries. There is an extensive literature list together with a reference section which includes electronic references of relevant agencies and experts.
This is a portable and concise reference work for the busy medical examiner of divers. It will also provide invaluable background help for any medical practitioner who may be required to advise individuals who have questions concerning their health and diving activities. An extensive index will assist readers in finding what they want. Whilst this is neither a textbook of diving physiology nor a comprehensive account of hyperbaric medicine, it will be a valuable desk aid for all physicians who may have to consider medical fitness to dive. There are brief sections on a wide range of medical and surgical conditions which include a box detailing ‘absolute’, ‘relative’ or ‘no contraindications’. For example, in the section on hernias, absolute contraindications include hernias that are irreducible and painful, whilst a relative contraindication would be an asymptomatic hernia incipiens until repaired.
The International Marine Contractors Association provided a grant towards the publication of the manual ‘for the benefit of medical examiners worldwide’. This is undoubtedly reflected in the price tag of £10 which is a bargain and represents excellent value for money. For HSE-approved medical examiners of divers in the UK (and Europe) this is a book to buy, read and keep near at hand. For occupational physicians, general practitioners, diver medics and anyone else with an interest, this handbook should be within reach for reference whenever the medical fitness of a diver is under consideration.
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