New medical system

The major UK diving organisations have now adopted the new medical system. The background to this change is described below:

For years members have been required to undergo routine medicals in an effort to maintain the safety of diving in the UK. The system has worked well and it is rare for a medical condition to cause an incident directly. The most common reasons for mishap underwater are human error and equipment malfunction.

The current system has faults. The medicals are rarely performed by doctors with diving medicine expertise, and have little predictive value for the future. You are really being certified fit to dive immediately after being seen by the doctor, and the best guess is that you probably will not run into problems for the next 1, 3 or 5 years depending on the type of certificate issued. A frequent complaint from members has been the considerable variation of the cost of the medical.

Dr Stephen Glen, a member of the UKSDMC, and his colleagues (Steven White and Dr James Douglas, Fort William) studied the safety of diving medicals with the full participation of the Scottish Sub Aqua Club (SSAC) members, around 3000 members. In this study it was found that the questionnaire part of the form was the most useful way of screening members to see if further assessment was required. The routine medical examination added little and SSAC members, whose answers to the questionnaire identified problems, could then be seen by diving doctors, and benefit from more appropriate assessment including specialist investigation if required. The results of the study were put forward for consideration by the UKSDMC after publication in the British Journal of Sports Medicine (click here to see the article abstract) resulting in the UKSDMC recommending the existing Sports Diving Medical be changed to take account of this evidence.

The proposed new system will work as follows:

• A newly designed Medical Declaration Form has to be completed annually on renewal of membership. The Form is a legal document and the signed declaration confirms that the answers are truthful.
• If the response to all questions on the Medical Declaration Form are answered 'No' The Form can be signed and is to be held by the SAA Club/BS-AC Branch until the following year.
• The member should retain a copy of the form with their qualification book.
• If the response to any of the questions on the Medical Declaration Form is 'Yes' or the diver has a query on any of the questions If the member has not previously seen a medical referee and has answered 'Yes' or has a query on any question on the Medical Declaration Form, the member should not sign the form but telephone their local Medical Referee for advice.

1. From a telephone enquiry, the Medical Referee may only need to endorse this form on the diver's behalf. The diver will need to send the form to the Referee in a stamped self-addressed envelope for endorsement by them (no charge is made) and return to the diver. The original of the self-declaration form should be handed to the Diving Officer and is to be held by the SAA Club/BS-AC Branch until the following year and the diver should retain a copy with their Qualification Record Logbook for reference purposes.

2. If the medical referee advises further assessment and needs to see a diver for assessment, then this will be performed at he member's expense although this will only be required in a minority of cases. Such assessment may include physical examination, or specialist investigations such as breathing tests or heart scans for example. The expense, over and above the initial consultation fee (British Medical Association guidelines suggested £61.50 as an initial consultation cost in 2000) is a matter between the Medical Referee and the member concerned. If you are found fit to dive, the Referee will give you a Certificate of Fitness to Dive and complete the Medical Referee section of the Self-Declaration Form. The Self-Declaration Form completed by the Referee together with a copy of the Certificate of Fitness to Dive issued by the Referee should be handed to the Diving Officer to be held by the SAA Club/BS-AC Branch until the following year. The diver should retain the original of the Certificate of Fitness to Dive with a copy of the self-declaration form with their Qualification Record Logbook for reference purposes.

3. For members holding a current Certificate of Fitness to Dive signed by a Medical Referee, a copy should accompany the annual Medical Declaration Form.

Certificates of Fitness to Dive

1. The member should retain the original Certificate of Fitness to Dive because its period of validity may span a number of years, and hence the period covered by a number of annual Medical Declaration Forms.

2. The Certificate of Fitness to Dive will have a validity period stated on it. If this extends beyond the next membership renewal date, a further copy should be attached to the Medical self-declaration form, which accompanies the next membership renewal.

3. Once the Certificate of Fitness to Dive expires, it also invalidates any Medical Declaration Form.

4. The medical referee will maintain member confidentiality at all times, and the only information released to the diving organisations will be a Certificate of Fitness to Dive. Details of the medical conditions will not be released.

5. The final court of appeal for members is the UK Sport Diving Medical Committee comprising the medical advisors to BSAC, SAA and SSAC. A set of medical standards is published and updated by the committee. This can be found on the UKSDMC website along with reviews of recent diving medicine research.

This proposed new system has been approved by the insurance and legal advisors to BS-AC, SAA and SSAC. It effectively removes the need for compulsory medical examinations but the UKSDMC and diving organisations recognise that some members may prefer to undergo medical assessment for personal reasons. This is entirely acceptable. The safety of the new system will be monitored closely in conjunction with analysis of the incident reports.

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