The Role of Competition Medic in 2015 and Beyond
I wouldn't want the job I can tell you. Even after 5 years at medical school, 2 years of general medicine and surgery, and a couple of years of specialist training in Anaesthetics (that’s Anaesthesiology for all you yanks out there) and Emergency Medicine, I’d feel myself woefully ill-equipped to swim out to the platform and take into my hands the life of someone crazy (sane?) enough to do what we’re doing.
You couldn't pay me enough. Even before you've considered the problem of professional registration and insurance, even before you've factored into the equation the terrible guilt you'd feel if something went wrong involving one of your friends, there are those three little words: Low Resource Setting. Even the most highly qualified emergency physician, easily able to handle a penetrating trauma to the chest in the controlled environment of their native emergency room would quail, I’d wager, at the thought of handling a big lung-squeeze without access to imaging, suction, BIPAP or a chest drain, 400 miles from the nearest hospital.
The new AIDA rules have gone a long way towards highlighting this fact, and now specify, not only a list of equipment that must be provided as a minimum, but also the minimum qualifications required of the medic at world record-status competitions. But is it enough?
We’re used to putting our trust in doctors. Particularly the heroes we see on programs like ER, House and Gray’s Anatomy. To a lot of us, they’re superhuman, capable of amazing feats of healing and resurrection. The reality, though, is that doctors are just ordinary people working as part of a team; usually in a well equipped, well resourced and familiar environment. Quite apart from the fact that miracles like you see on TV just really don’t happen - even in hospital - take a doctor out of that setting and without the proper training, the vast majority of them, I reckon, would go to pieces.
Low resource settings require a totally different mindset. You can’t order tests, you can’t make the same interventions you would do in a hospital. A lot of the time you can’t even get the patient in the position you’d like - on a table, for example. Then there’s the issue of fitness to dive. Still very little is really known about the phenomena of blackout and lung-squeeze. No objective tests with a high enough sensitivity have yet been developed. Asking, for example, a doctor like me in their 4th year of work to assess an athlete’s fitness to dive in a low-resource setting is a bit like asking a car mechanic to service a space-probe in zero gravity with nothing but a screwdriver and a roll of copper wire. Sure they’ll have some relevant knowledge, a bit of experience, and will probably be able to make some guesses more educated than your average Joe, but, unless they’ve got some specialist training, we’ll be kidding ourselves if we call that “as safe as it can be”.
Clearly we have to make compromises. Even the most highly sponsored and well-attended competition could hardly afford to equip a fully-functioning operating theatre and a team of specialty staff, especially in locations as remote as Dahab and Dean’s Blue hole. The onus is on the medic, therefore, to ensure that they’re up to date with the latest in freediving research and are qualified and prepared to operate in a low-resource setting.
I think it’s worth us taking a long look beyond our “qualified medical doctors” to the nurses, firefighters and paramedics who, with the right work beforehand might be much better equipped for the emergency role. Final responsibility lies with the organisers to ensure that they approach only suitably qualified and experienced people, and are clear about who’s providing what sort of equipment. It’s worth considering, too, that the skills required in an emergency situation are completely different from those that will produce the best fitness to dive decisions. Could it be that, as the new rules suggest, 2 individuals are really required to ensure the highest standards of safety? The right people are out there, and anyone with a bit of medical training can equip and develop themselves for the role, but we should all expect it to take time, commitment and motivation. Full praise to those brave individuals who are willing to take on the job, and good luck to competition organisers in assembling the safety teams of the future.