IN 428 – Medical Examiners of Divers

As you may be aware the UK Health & Safety Executive (HSE) is withdrawing from its internationally recognised scheme for the approval of non-UK based doctors to carry out annual diver medical examinations from the end of September 2001. HSE will continue to enhance its approval arrangements for doctors based in the UK.

IMCA’s Diving Division Management Committee, prompted by HSE’s withdrawal from this activity, agreed that IMCA should develop guidance on the requirements for doctors to undertake such periodic examinations covering:

• doctors’ qualifications/experience
• equipment needs
• key elements in the medical examination.

Unfortunately, with HSE’s withdrawal from the approval of non-UK based doctors, in the absence of any suitable international alternative, it is up to each diving contractor to identify doctors with such qualifications/facilities to perform annual medical examinations on divers. This note has been produced to assist IMCA contractor members to identify appropriately qualified doctors in their region.

The doctor (medical examiner) of divers must be able to determine whether or not a person is fit to undertake commercial offshore diving activities by means of an annual fitness to dive medical. The doctor also needs to be able to assess a diver’s fitness to return to diving after serious illness (including decompression illness) or accident, and should be able to give advice to any commercial diver, or to his supervisor, who may have concerns about fitness to dive because of some individual’s problem.

• Fully qualified medical practitioner
• A sound knowledge of diving medicine and hyperbaric physiology
• Knowledge of scope, nature and organisation of commercial offshore diving work.

In some geographical regions there will be specific requirements regarding qualifications etc. of the individuals permitted to carry out such medical examinations. In such regions the medical examiner would be expected to meet those requirements.

The doctor would have normally be expected to have attended a suitable diving medicine course in order to gain a sound knowledge in diving medicine, and be committed to keeping up with diving medicine developments. To this end it would be anticipated that the doctor would attend an appropriate refresher training course at suitable intervals, at least every five years. In order for the medical examiner of divers to achieve appropriate competence the initial course is likely to be in the order of 25 lecture hours and 3 hours practical.

A list of organisations which might offer suitable training is given in Annex 1. This list is not exhaustive – IMCA would be interested in learning of any organisations that might also offer suitable training.

The Joint Medical Subcommittee of ECHM (European Committee for Hyperbaric Medicine) and EDTC (European Diving Technology Committee) has prepared a note on ‘Training Standards for Diving and Hyperbaric Medical’ which provides some useful information on modules/topics to be covered in diving medicine training.

The doctor should have access to suitable facilities for examining divers and for carrying out testing in:

• audiometry
• electrocardiography
• spirometry
• exercise testing.

Access to radiology and clinical laboratory services is also required.
Equipment used needs to be calibrated and serviced in line with the manufacturers’ recommendations.

The medical examination should include examination in the following areas:

• morphology
• respiratory system
• cardio-vascular system
• exercise testing
• peripheral nervous system
• musculo-skeletal system
• ears
• vision
• dental
• urology
• integument
• radiology – as required
• haematology – as required.

Some guidance on medical examinations is available at Annex 2. This reproduces the UK Health & Safety Executive’s document MA1 ‘The medical examination and assessment of divers’. This is provided for information only so that readers can be aware of the contents of the diving medical examination standard required in the UK. It could be adapted for use in a member’s company with appropriate deletion of HSE references. At Annex 3 is a reproduction of the annual medical examination form used by HSE, with HSE references removed.

Alternative guidance is provided in the ‘Occupational Diving Operations Part 1: Standard Operational Practice’ Australian/New Zealand Standard, AS/NZS 2299: 1999, Appendix K). This sets out guidelines for carrying out medical examinations on occupational divers and those intending to undertake training for occupational diving. This document is available from:

Standards Australia

1 The Crescent, Homebush, NSW 2140, Australia

Standards New Zealand

Level 10, Radio New Zealand House, 155 The Terrace, Wellington 6001, New Zealand

• Europe

Courses complying with the ‘Training Objectives of Diving and Hyperbaric Medicine’ document prepared by the joint Medical Subcommittee of the European Committee for Hyperbaric Medicine (ECHM) and the European Diving Technology Committee (EDTC).

• • France
    • Navy

• • Netherlands
    
    • Navy

• • Norway
    
    • NUI
    • Navy

• • Sweden
    
    • Navy

• • UK
    
    • Institute of Naval Medicine, Alverstoke
    • Department of Environmental and Occupational Medicine, University Medical School, Aberdeen
    • Biomedical Seminars, Ewell, Surrey

• North America

• • Canada
    
    • DCIEM – Canadian Navy

• • USA
    
    • USN
    • NOAA (2 week course)

• Asia Pacific

• • Australia
    
    • Royal Australian Navy

• • New Zealand
    • Royal New Zealand Navy

• • Singapore
    
    • Singapore Navy

Link to 'The Medical Examination and Assessment of Divers' by Health and Safety Executive (HSE), UK

Link to Medical Examination / Assessment of Divers form