Hot Button Topics – Balancing Diver Privacy, Safety, and Institutional Risk

Charlie Lawton, Virginia Aquarium

A Dive Safety Officer will naturally come in contact with divers’ medical information. Medical information can come formally from medical-history questionnaires associated with a dive physical exam or information collected for emergencies. It can also come informally through diver disclosure. Some information may be subject to privacy, employment, medical-record, or institutional requirements, so how medical information is collected and handled can create liability concerns.

That said, on some level the DSO must understand a diver’s fitness to dive. Asking or understanding too little can mean missing something that affects how safe a dive is conducted.

A medical questionnaire is a great example of this and was recently discussed on the ADPA listserv. Some institutions have the DSO review a diver’s answers directly. Others keep the DSO out of it entirely, so the DSO only knows whether or not the doctor cleared the diver to dive.

A DSO’s review could be important when the level of diving expertise of the physician is unknown. But taking on that review also puts a level of responsibility in the hands of the DSO. Adding further complication, it was pointed out that when conducting an agency-sanctioned course, a review by the instructor may be required. In those cases, some level of review of medical information may be unavoidable.

Emergency information works differently. Allergies, medications, and existing conditions need to be easily accessible to find in an emergency, not filed away and hard to access. Some Programs handle this by posting it at the dive locker, tagging it to gear, or keeping it on a slate near the diving location. That accessibility is the point, but it comes with a cost. The more visible the information is, the more it becomes something the whole team is aware of, whether or not that was ever the intent.

Other programs shift the responsibility to the diver instead. Medical ID bands, along with Medical-ID features built into many phones and smartwatches, let a diver carry their own emergency information and control what is included. These tools can allow EMS to access information directly without the dive program having to collect, store, or post it. They may not be a complete solution in every environment, however, particularly if a device is unavailable, or inaccessible during an emergency.

The most complex example of this has no form and no process at all. A diver mentions something in passing. A teammate overhears a conversation. The DSO notices behavior or an apparent limitation that may raise a concern about a diver’s fitness to dive. Or, something gets repeated secondhand until it reaches the DSO without ever having been formally disclosed. None of this requires the DSO to have asked a single question or received a formal medical disclosure. But once a DSO has information that may affect diver safety, they have a responsibility to act. The question is: how is that medical information managed and to what extent can they act on it?

What is clear is that DSOs should engage with institutional resources outside of the dive program (HR, legal counsel, occupational health, risk management etc.…) to understand the rules and expectations that apply locally to diver medical information. The balance will be different for every institution’s circumstances.

If you are unsure how to approach these subjects with your team, the ADPA community is a valuable place to compare practices, identify questions, and learn how other programs have approached them.

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