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.
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.
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STEPHEN FRINK<br />
Fatigue after diving is not uncommon, but<br />
significant fatigue may be a sign of DCS.<br />
depth, this recommendation also helps reduce the risk<br />
of confusing the medication’s side effects with DCS.<br />
MUSCULOSKELETAL SYMPTOMS<br />
Diagnosing DCS can be challenging: It is a relatively rare<br />
condition, there are no lab tests to confirm it or rule it out,<br />
and it shares signs and symptoms with many other illnesses<br />
and injuries. Divers who have pre-existing musculoskeletal<br />
issues such as spinal problems, arthritis or residual effects<br />
from previous trauma can be particularly susceptible<br />
to diagnostic uncertainty. The physical stresses and<br />
activities associated with diving and travel (e.g., carrying<br />
heavy equipment, enduring uncomfortable sleeping or<br />
travel accommodations, swimming against currents or<br />
experiencing boat rides in rough seas) can aggravate<br />
existing conditions. Strains, sprains and overuse injuries<br />
that occur in the absence of diving are relatively easy to<br />
diagnose. But when diving is involved, a doctor might<br />
reasonably decide to conduct a costly and time-consuming<br />
hyperbaric chamber treatment to be on the safe side.<br />
Musculoskeletal problems, whether pre-existing or<br />
not, can manifest as pain, numbness, loss of strength and/<br />
or reduction of mobility, all of which are also possible<br />
symptoms of DCS. The key to learning the true cause of<br />
such symptoms is a thorough review of the diver’s medical<br />
history and the circumstances surrounding the complaints.<br />
DAN Medical Services often receives calls from divers<br />
who have traveled to tropical or subtropical destinations<br />
and are experiencing a severe headache, multiple joint<br />
or muscle aches, abdominal pain, nausea and general<br />
malaise, often after a few days of diving. With no<br />
additional information it would be easy to conclude<br />
that these symptoms were the result of DCS. However,<br />
further inquiry often reveals a fever and diarrhea. This<br />
suggests a tropical disease rather than DCS. When such<br />
reports include a fever but not vomiting or diarrhea, this<br />
suggests dengue or another tropical virus. People with<br />
these symptoms may require prompt medical attention<br />
but not evacuation to a recompression facility.<br />
DIAGNOSIS BY EXCLUSION<br />
Diagnosing DCS is generally a process of ruling out other<br />
causes. It is imperative that we not discount the possibility<br />
of nondiving-related injuries or illnesses just because<br />
someone was diving. However, this is not to suggest we<br />
should discount the risk of DCS: When a person has been<br />
diving, DCS absolutely needs to be considered in the<br />
physician’s differential diagnosis.<br />
A 46-year-old male diver on a weeklong dive trip<br />
on a liveaboard vessel was doing four or five dives per<br />
day. All dives were within recommended recreational<br />
no-decompression limits. His deepest dive was to 115<br />
feet, which was his first dive on the third day. The next<br />
morning he complained of right shoulder discomfort.<br />
Five years earlier he had surgery on that shoulder to<br />
repair a torn rotator cuff. Since the surgery five years<br />
prior he had done more than 80 dives with no problems,<br />
but it was not uncommon for him to experience<br />
discomfort in that shoulder with exertion or certain<br />
activities. Usually he could find a position of comfort,<br />
apply ice and take ibuprofen to relieve the discomfort,<br />
but this time the symptoms were somewhat different<br />
and not as easily relieved.<br />
The diver’s companions believed that his symptoms<br />
were due to his previous medical history because they<br />
had all dived the same profile without any problems.<br />
When the diver finally reported his symptoms to the<br />
boat crew, they provided him with high-flow oxygen.<br />
Based on the fact that the symptoms were different<br />
from those the man typically experienced, the captain<br />
diverted the ship toward an island with a dive clinic.<br />
After breathing oxygen for approximately 30 minutes,<br />
the diver reported some improvement but not much. The<br />
ship arrived at the island 30 minutes later, and the diver<br />
was taken to the clinic. The physician on duty evaluated<br />
him and discovered that his right arm (his dominant<br />
arm) was significantly weaker than his left. He diagnosed<br />
DCS and treated the diver with a U.S. Navy TT6,<br />
which provided measurable improvement. Because the<br />
symptoms did not completely resolve, the doctor treated<br />
him again the next day with the shorter U.S. Navy TT5,<br />
which brought complete resolution of the symptoms.<br />
There is controversy regarding the potential for<br />
increased risk of DCS at the site of a previous injury.<br />
Little scientific data addressing that issue is available. But<br />
controversy notwithstanding, we know that when people<br />
with pre-existing musculoskeletal problems choose to dive,<br />
diagnostic confusion can result. If you or your dive buddy<br />
92 | FALL <strong>2015</strong>
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