Monday, July 10, 2006

Recommendations of the World Congress on Drowning

Appendices to Recommendations of the World Congress on Drowning
Amsterdam 26 – 28 June 2002
Overview recommendations task force Diving (breath hold, scuba and hose diving)

During the World Congress on Drowning, experts of the task force Breath hold, scuba
and hose diving have finalised a consensus document on a variety of topics.
It was agreed that
1. Well-constructed national regulations have been effective where enforced and
that any significant improvements in health and safety would arise only from a
more inclusive definition of working divers and a wider application of existing
procedures.
2. Self-regulation within the world-wide recreational diving industry continues to
be the practical route for further improvement but that there is a need to counter
a perception that there is a conflict between commercial interests and safety.
3. The training agencies comply with international quality assurance and control
procedures (QA/QC) such as the International Standard ISO 9000 series and
also encourage independent monitoring to assure the effective and safe use of
existing and new procedures.
4. Subsistence fishermen who are predominantly found in the poor countries
around the world, use equipment that is minimal and that their training,
regulations and medical support appear to be zero.
To improve diving-fishermen safety and reduce drowning there is a need to
collect data on accidents and drowning among representative samples of diving
fishermen around the world.
This should be followed up with international non-governmental organisations
(NGOs), other charities and appropriate UN development initiatives so that
existing academic societies, training organisations and others could deliver
suitable medical and diving advice and training for fishermen compatible with
the limits of available local resources.
5. The collection of diver morbidity and mortality data and the associated
contributory factors for each incident is a necessary first step in reducing
drowning incidents among divers. Also needed are the denominator data that
will allow the calculation of risk.
6. Recreational divers are free to dive when, where and how they like but the diver
also has an obligation to the public. Any underwater accident to a diver can put
buddy divers and rescuers at considerable risk.
7. Greater stringency is needed in the assessment of the physical, mental and
medical fitness of all who choose to dive. A single assessment of fitness for
diving at the beginning of diver training should not be considered valid
throughout the rest of the diver's life. Re-assessments are recommended at
intervals that may diminish with advancing years and re-assessment may also
be needed after illness or injury.
8. To give a medical opinion on a diver's fitness, the doctor should have prior
knowledge of the unique hazards faced by a diver. Whenever possible, the
medical assessment should be conducted by a doctor acknowledged as
competent in this special subject. It is recommended the training of diving
doctors, both for the medical examination of divers and also for the treatment of
medical emergencies in diving, complies with guidance such as that published
by the European Diving Technology Committee (EDTC) and the European
Committee for Hyperbaric Medicine (ECHM). Periodical revision training is
also important.
9. The mental, physical and medical standards of fitness in each category of
diving should be harmonised internationally.
10. Greater emphasis should be placed at all levels of training on the causation and
prevention of in-water fatalities.
11. After some 3 to 5 years without regular diving, the individual should be subject
to a formal re-assessment of competence before re-entering the water.
12. The policy of training children as young as 8 years old to dive should
emphasise the immaturity of mental outlook that many young persons may have
when an emergency occurs.
13. Emergency procedures should be consistent with a variety of equipment in a
variety of configurations.
14. Programs of refresher training should be established to maximise practical re-learning
and updating of basic emergency skills. This is needed particularly
after an individual's equipment has been modified.
15. Self-rescue and buddy-rescue procedures should be compatible with the
equipment used and the environmental conditions.
16. Training of rescuers should include the procedures for recovery of the victim
from the water into a boat and transfer of the patient from the deck of a boat to
a helicopter or some other emergency transport vehicle.
17. Hand signals and basic procedures used in diving emergencies, whether at
depth or on the surface, should be standardised and promoted through rescue
and diving agencies throughout the world.
18. Rescuers must be made aware that the treatment of drowning in a diver might
be complicated by other medical conditions such as carbon monoxide
poisoning, envenomation and omitted decompression arising from that same
dive.
19. National and international standards of medical care should be written for all
medical emergencies in diving by suitable academic bodies.
20. Drowning is mostly a diagnosis of exclusion and often is a presumptive
diagnosis based on purely circumstantial evidence. All diving-related deaths
should be thoroughly investigated, including a complete autopsy, evaluation of
the equipment and a review of the circumstances surrounding the fatality by
knowledgeable investigators with appropriate training and experience.
The post-mortem examination of a drowned diver should be conducted by a
pathologist who is knowledgeable about diving (or who is advised by a doctor
who is knowledgeable about diving).