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AD 2015 Q4

This is the “not do” component. It is also somewhat harder to define. After all, who determines the duty to care and the non-compliance thereto in unique emergency situations? Still, this component is more likely to lead to a recovery of damages. Put differently, when you are under a legal duty to take reasonable care and you do not do it, then you could be held liable for damages that are directly caused by the breach of that duty. The key elements are “reasonable care” and “directly caused”. Let’s break that down, starting with directly caused. This means that the damages are linked directly to the failure to perform the reasonable duty. This is called a causal connection. In other words, there must be a connection between the duty not complied with and the damages. deep diving are so hazardous that it may well be better to only jeopardise the life of one individual rather than two. That is, of course, as long as no one is put at risk during the subsequent body recovery or rescue efforts! Well, as a qualified instructor and dive leader, I shall continue to teach and advocate the buddy system. I do not like the idea of diving alone anyway. I prefer to share the joys of diving with someone able to share the memories of the dive. To me, diving is, and remains, a team sport. Which introduces another consideration: How would the principle of duty to take care be applied to children who dive? Training agencies impose age and depth restrictions on children who enter the sport before the age of 14. Depending on the age and diving course, a child may be required to dive with an instructor or at least another adult dive buddy. If the adult were to get into trouble, the child would not be expected to meet the duty of care of another adult. He/she would be held to an age appropriate standard. What about all those waivers? As mentioned in the previous article, waivers define the boundaries of the self-imposed risk divers are willing to take by requiring that they acknowledge them. Waivers do not remove all the potential claims for negligence and non-compliance with a duty of care. As such, it is left to our courts to ultimately interpret the content of a waiver within the actual context of damage or injury.


STEPHEN FRINK Climbing a ladder while wearing heavy gear, for example, can cause pain, soreness and even numbness or tingling that might be confused for DCS. However, symptoms after a dive warrant prompt administration of oxygen and evaluation by a medical professional. 90 | FALL 2015

UNCERTAINTY A F T E R D I V I N G Case reports and recommendations A 53-year-old man was diving at a resort in the South Pacific. He was doing approximately four dives per day; all his dives were on air, and all were within his computer’s no-decompression limits. In the evening on the third day, approximately three hours after his last dive and a half hour after dinner, he began to experience severe abdominal pain. The pain radiated to his back, just below his right shoulder blade. He vomited several times, felt weak and needed help walking. Concerned about the possibility of severe decompression sickness (DCS), his friends called a taxi and rode with him to the local hospital. Some things about this diver’s symptoms and recent history suggest DCS, and most doctors would include it on their list of differential diagnoses. The evaluating physician in this case considered it, but he knew that other potential causes had to be eliminated first. After a cardiovascular emergency was ruled out, blood tests and ultrasound imaging of the diver’s abdomen revealed stones in the gallbladder that were causing acute inflammation. The diver underwent laparoscopic surgery and made a successful recovery. BY MARTY MCCAFFERTY, EMT-P, DMT SYMPTOMS OF DCS Books and articles about DCS usually include an extensive list of signs and symptoms. It is important to remember that none of the signs and symptoms in any such list is exclusive to DCS. Here are examples of some of the most common symptoms of DCS: • Headache • Lightheadedness and/or dizziness • Nausea • Joint and/or muscle aches • Fatigue, lethargy and/or generalized weakness As you can see, these symptoms can apply to a wide range of medical conditions, not just DCS. This can make diagnosing DCS a challenge. after surfacing she began to experience widespread but intense muscle pain. She could not find a comfortable position, and nothing seemed to offer relief. She called emergency medical services (EMS), which transported her to the local hospital. When discussing her medical history, the doctor found out that the woman had begun taking a statin medication to lower her cholesterol three weeks earlier. Muscle pain is a rare side effect of statins, and blood test results suggested that her pain was most likely due to the medication. However, the hyperbaric physician who was consulted did not want to dismiss the possibility of DCS and treated the diver in the chamber with a U.S. Navy Treatment Table 6 (TT6). The hyperbaric treatment had no effect on her symptoms, which confirmed that the muscle pain was probably due to the medication. Whenever you begin taking a medication, whether prescription or over-the-counter, make sure you familiarize yourself with the potential side effects. As this case illustrated, the side effects of some medications can mimic DCS. Medications can also affect your ability to function normally, regardless of whether you’re on land or underwater. Common seasickness medications, for example, come with advisories stating that they may cause drowsiness. Physicians trained in dive medicine typically recommend waiting at least 30 days after starting a new prescription medication before diving. Similarly, divers should always try nonprescription medications well in advance of diving so they will know how the drugs affect them. In addition to limiting the risk of disorienting or otherwise hazardous side effects at MEDICATIONS A 48-year-old woman completed a dive to 95 feet for 25 minutes on 32 percent nitrox. Approximately 10 hours STEPHEN FRINK ALERTDIVER.COM | 91

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