The major UK diving organisations adopted the medical self-declaration system some time ago. The background to this change is described below:
For years members had been required to undergo routine medicals in an effort to maintain the safety of diving in the UK. The system had 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 old system requiring routine medicals had its faults. The medicals were rarely performed by doctors with diving medicine expertise, and had little predictive value for the future. The diver was being certified fit to dive immediately after being seen by the doctor, and the best guess was that he or she would probably not run into problems for the next 1, 3 or 5 years depending on the type of certificate issued. A frequent complaint from members had been the considerable variation of the cost of the medical.
Dr Stephen Glen, a member of the UKDMC, and his colleagues (Steven White and Dr James Douglas at 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 UKDMC after publication in the British Journal of Sports Medicine. This resulted in the UKDMC recommending the existing Sports Diving Medical be changed to take account of this evidence. To access information about this and related articles please click on the document links below.
The Medical Self-Declaration Form was reviewed in 2013, 2014 and 2015 by the UK Diving Medical Committee, the proposed changes were put out for consultation on the Diving Doctors Forum, and to BSAC, SAA and SSAC, and it’s use trialed by SSAC. The new form was published in 2016. Please see “Frequently Asked Questions” (FAQ) for more detail.
The medical self-declaration system works as follows:
- The newly designed Medical Self-Declaration Form (2016) has to be completed annually on renewal of membership (to ensure there are no new medical issues). The Form is a legal document and the signed declaration confirms that the answers are truthful. If the diver has an in date medical or self-declaration form countersigned by a Medical Referee they need not get another signature until the previous ones runs out, they can photocopy the previous one and keep it with each year’s new self-declaration.
- If the response to all questions on the Medical Self-Declaration Form are answered ‘No’ the diver signs to confirm they are answering “No”, takes a copy of the form, hands the original form to their Diving Officer and this is to be held by the SAA Club/BSAC/SSAC Branch until the following year. The diver should retain a copy for their own records with their qualification book.
- If the response to any of the questions on the form is ‘Yes’ or the diver has a query on any of the questions, the diver should telephone or email their local Medical Referee for advice. The list of Referees is on the BSAC website and this website under the heading “Medical Referees”. The diver should download and complete the Medical Referee Form, which can be found on this website and the BSAC website. At the top of page 2, please give more detail about the questions to which a positive answer has been made and include any documentation that will help the Referee make a decision. Copies of hospital letters or an HSE medical certificate (if the diver has one) may be examples of these. The diver should also complete their details on Page 3, as this will be sent back to them.
From a telephone/email 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 (keeping a copy for themselves) with any supporting documentation of relevance and with a stamped self-addressed envelope so that Page 3 can be returned, endorsed by the Referee. If the diver is unsure what to send they can email or telephone the Referee for advice. A charge is made by the Referee for this, the level depending on the complexity of the issues under question. Please see FAQ for more detail if necessary. After countersignature Page 3 will be returned to the diver. To preserve confidentiality the Medical Referee will retain Pages 1 and 2, which contain medical information. Page 3 should be handed to the Diving Officer and is to be held by the SAA Club/BSAC/SSAC Branch until the following year and the diver should retain a copy with their Qualification Record Logbook for reference purposes.
If the Medical Referee advises further assessment and needs to see a diver for a medical, then this will be performed at the diver’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 is a matter between the Medical Referee and the diver concerned. This may vary as noted above depending on the complexity of the case. If you are found fit to dive, the Referee will supply a Certificate of Fitness to Dive, (the right hand side of the Medical Examination Document), a copy of which should be handed to the Diving Officer (the right hand side contains no medical information) to be held by the SAA Club/BSAC/SSAC Branch until the following year. The diver should retain the original of the Certificate of Fitness to Dive with a copy of Page 3 of the countersigned Medical Referee Form with their Qualification Record Logbook for reference purposes.
The diving medical referee may wish to get further advice from other diving medical experts. The referee can only do this with your written consent and if it is thought to be necessary will discuss this with you. The referee may either email or telephone another diving medical expert or post the query on the diving medicine forum which can only be accessesd by approved diving doctors and your information is posted anonymously with only the minimal information required to answer the query so you cannot be identified.
For members holding a current Certificate of Fitness to Dive signed by a Medical Referee, a copy should accompany the annual Medical Self-Declaration Form. The diver does not need to get a Medical Referee to resign the form each year, but only when the previous signature by the Referee expires (which may vary depending on the health problem, or may even be indefinately, unless there is a change in the diver’s health).
Certificates of Fitness to Dive
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 Self-Declaration Forms.
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.
Once the Certificate of Fitness to Dive expires, it also invalidates any Medical Self- Declaration Form.
The Medical Referee will maintain diver 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.
The final court of appeal for divers is the UK 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 UKDMC website (www.ukdmc.org) along with reviews of recent diving medicine research. If a diver does not agree with a Medical Referees decision they can appeal to the secretary of the UK Diving Medical Committee via the “Contact Us” page of this website or via the email address provided on the BSAC website.
This medical self-declaration system has been approved by the insurance and legal advisors to BSAC, SAA and SSAC. It effectively removes the need for compulsory medical examinations but the UKDMC and diving organisations recognise that some members may prefer to undergo medical assessment for personal reasons. This is entirely acceptable. The safety of this system continues to be monitored closely in conjunction with analysis of the incident reports. If you have your own private diving medical insurance you will need to contact your insurer to ascertain wheher they will accept a self-declaration form or require you to have a medical.