Engagement and Productivity

Over the last decade and a half, “employee/work engagement” and “productivity” have risen as hot, linked buzzwords in the business community. Though definitions and measures of “higher productivity,” “better performance,” “lower turnover,” “better quality” and similar concepts differ, studies consistently find higher engagement correlated with them. Studies also find it correlated with a positive customer experiences. In other words, “engaged” workers do more, better.

What Does “Engagement” Mean?

Schaufeli (2013) acknowledges that “work engagement” and “employee engagement” are used interchangeably, but they have slightly different meanings. Simplified, “work engagement” may be defined as being mentally and emotionally connected to work goals and performance in a manner that motivates the person to further both, beyond expected minimums. “Employee engagement” is work engagement, plus an emotional commitment to the organization for or within which the person works that motivates furthering the organization’s reputation and interests beyond expected minimums. It’s important to note that “engagement” is not “satisfaction,” “happiness,” or “workaholism,” which can be high without engagement.

Rising Importance

Measuring individual worker productivity is increasingly difficult as “knowledge-based” services make up more of the economy. In many countries, as many as half of all workers create and use intellectual property rather than physical property, making conventional productivity measuring methods obsolete and unreliable. Impraise, a management software company, notes that “knowledge-based employees simply can’t be measured by the output of their productivity.”

Engagement behaviors, however, can be observed and measured, and their effects can be seen on the bottom line. For this reason, more and more businesses concern themselves with encouraging and measuring engagement behaviors and overall results.

The Takeaways

Much of the dive industry falls in the knowledge/service domain, making engagement central to increasing and sustaining productivity. Creating engagement is complex, with entire courses on how to do so, but experts seem to agree on a few common themes:

  1. Communicate regularly and personally. Frequent one-on-one communication with the dive operation manager/owner should increase engagement. Focus on purpose and how each person’s purpose fits in with it. They also need to know and see specifically how their efforts make a difference.
  2. Quality is often more important than quantity. This especially includes instruction. Beyond the more important safety issues, well-trained divers are more likely to invest in gear, travel and more training, and more likely to refer friends. So, training fewer divers well in a given time is likely more productive from a business perspective than training more divers poorly in the same interval.
  3. Dive businesses thrive on customer experience. Diving is all about customer experience, especially in training and travel. Engagement and customer experience tend to go hand in hand. Engaged employees and instructional staff have a passion for what they do and with whom they work that contributes to this.
  4. Trust. Knowledge-economy workers need relative autonomy and responsibility for managing their own productivity. This doesn’t mean ignoring what dive center staff does, but providing guidance and goals that allows them to get their work done without micromanagement.
  5. Results over effort. Recognize when people work hard and for long hours, but for most tasks focus on doing the right things well over simply staying busy. Reward innovation that saves money/time, expands services or improves customer experiences.

Adapted from the 4th Quarter 2018 edition of The Undersea Journal®, written by Karl Shreeves.

Teaching Diving is Teaching Life

As early as the 1950s, scientific research began demonstrating that sports have significant benefits. Early research focused on physical activity in team sports, but today, research is broader and looks at mental as well as physical changes. It also looks beyond team sports to include adventure/extreme sports like mountain biking, kayaking, base jumping, and (of course) scuba. The latest findings suggest that sports that give an adrenaline rush develop skills that apply to everyday life.

Life Lessons: Confidence, Self-Reliance, Self-Control

Adventure sports tend to be more individual and have a perceived higher degree of risk than competitive team sports. This helps participants learn to rely on themselves as they stretch beyond their comfort zones, which builds confidence. But, many adventure sports (including diving) have strong teamwork aspects, which develops socialization and cooperative interaction skills much as do team sports. Anecdotal and research evidence finds that adventure-sport participants tend to be calmer, more confident, mentally stronger, more self-disciplined and better able to handle stress situations. One study found that extreme sport participants who experience fear and close calls not only exhibited more ability to manage fear, but also more humility.

Connected to the Environment

Unlike field/stadium team sports, which are usually played on constructed ball fields, stadiums and parks, adventure sports take participants into the environment because almost all of them require relatively natural settings. The benefit of this is that adventure-sport participants tend to develop a positive, protective relationship with the environment because their activities are integrated with it rather than separated from it. This social benefit, many argue, develops learners who are environmentally aware and sensitive, which is important because our collective future depends upon our relationship with the environment.

Old Dogs Do Learn New Tricks

Physical activity is known to benefit our health in our senior years, and now it seems that suitable mental challenges prevent – and in some ways can reverse – mental decline. Studies find that older adults who keep learning new skills tend to stay more active and enjoy better cognitive and memory performance. But, research finds that this learning must be challenging with demands on both thinking and memory. Most adventure sports require new skills, planning, assessing conditions and social interaction, making them good fits for the purpose of helping slow mental decline in older adults, as well as providing physical activity. The limiting factor for seniors is the ability to meet the physical requirements of a given adventure sport.

The Takeaways

Of all adventure sports, diving is probably open to the widest range of age, culture, physical abilities and other demographic characteristics. It is likely the adventure sport with the widest access for senior participants. These characteristics make diving suited to offering benefits to divergent markets with differing, specialized interests and needs.

  1. You’re not just “teaching scuba.” You’re teaching skills that have broad personal applications. This can be a useful message when presenting learn-to-dive opportunities to different groups as well as individuals.
  2. Market these “extra” benefits. Especially with institutions like youth, senior and environmental groups, it is exactly these developmental and environmental connections that add a reason to participate in diving or allow you to offer it to their members.
  3. Target the “nonteamers.” Scuba will appeal to many people who can’t or don’t want to participate in team sports, yet offer many of the same benefits.
  4. Target the “teamers,” too. Diving will also appeal to people who do like team sports. Scuba gives such groups something more individual in nature that they can do together, with some distinct challenges and benefits.
  5. Continue education. Senior divers may feel like they “just” want to be PADI® Open Water Divers, but continuing education offers new, deeper mental challenges, socialization and physical activity – all associated with benefits for older adults.

References

  • Association for Psychological Science (2013) Learning new skills keeps an aging mind sharp. (psychologicalscience.org/news/releases/learning-new-skills-keeps-an-aging-mind-sharp.html)
  • English Outdoor Council. Values and benefits of outdoor education, training and recreation. (englishoutdoorcouncil.org/Values_and_benefits.htm)
  • Adventure sports. (learn.healthpro.com/adventure-sports/)
  • Mathis, B. (2017) What are the benefits of adventure sports? (livestrong.com/article/149821-what-are-the-benefits-of-adventure-sports/)
  • OMG Lifestyle (2017) Major health benefits of adventure sports. (omglifestyle.co.uk/major-health-benefits-adventure-sports/)
  • Scott, K. (2015) The surprising benefits of extreme sports. (coach.nine.com.au/2015/10/19/13/34/the-surprising-benefits-of-extreme-sports)
  • Smart Health Shop (2018) Surprising mental benefits of doing extreme sports. (blog.smarthealthshop.com/2018/04/10/surprising-mental-benefits-of-doing-extreme-sports/)
  • org. The health benefits of sport and physical activity.(sportanddev.org/en/learn-more/health/health-benefits-sport-and-physical-activity)
  • Vitelli, R (2012) Can lifelong learning help as we age? (psychologytoday.com/us/blog/media-spotlight/201210/can-lifelong-learning-help-we-age)
  • The Wellness Seeker, Extreme sports benefits and health promotion. (thewellnessseeker.com/extreme-sports-benefits-health-promotion/)

A version of this article originally appeared in the 4th Quarter 2018 edition of The Undersea Journal®.

Meeting CPR and First Aid Requirements for PADI Courses

Some PADI® courses require first aid and CPR training within the past 24 months. You know that Emergency First Response® Primary and Secondary Care courses meet the requirements.

How do you determine what other courses qualify when a diver presents you with first aid and CPR qualifications from another organization?

Follow these steps:

  • Verify that the CPR and first aid training included student skill practice and demonstration of CPR and first aid techniques in person with a qualified instructor. A course that lacks this does not qualify, such as online only courses or self-study programs via any other media.
  • Check that the training taken meets current international emergency care guidelines as defined by the various resuscitation councils. For further information on layperson CPR and first aid training, visit the following ILCOR (International Liaison Committee on Resuscitation) Association websites:

American Heart Association

Australian Resuscitation Council

European Resuscitation Council

Heart and Stroke Foundation of Canada

New Zealand Resuscitation Council

  • For PADI Divemaster candidates, include a copy of that CPR and first aid course completion documentation along with the Divemaster Application to avoid unnecessary processing delays. Documentation must be from the qualifying CPR/first aid organization. Certificates or completion documents provided by third parties that are not directly sanctioned CPR/first aid organizations are unacceptable. Look at the name of the CPR/first aid organization for whom the instructor is authorized to teach and ensure it matches with the name on the certification.

If you’re unsure, contact a Regional Training Consultant at your PADI Regional Headquarters for clarification before accepting documentation provided by the student or candidate for course requirements.

The Heroic – But Failed – Rescue

Written by Al Hornsby

What do the following scenarios have in common?

  1. A certified diver surfaces near shore, gets swept onto rocks by the swell and spends several minutes submerged, regulator out of his mouth. The dive guide risks his life to reach the diver and tow him back to the boat. The deckhand quickly begins CPR and continues until reaching the marina, just minutes away. Unfortunately, the diver does not regain consciousness.
  2. A certified diver suffers a catastrophic injury at more than 30 metres/100 feet and becomes unresponsive. A nearby divemaster spots the incident and attempts to bring the heavily weighted, incapacitated diver to the surface, fighting a heavy swell and strong current. Reaching exhaustion, the buoyant divemaster loses contact with the victim before reaching the surface. The victim is found on the bottom deceased after a subsequent search.
  3. An instructor is asked by three certified divers to take them on a popular local dive. After non-eventful familiarization dives to confirm their skills, the instructor takes them on the requested dive. During the dive, at about 21 metres/70 feet, one of the divers indicates a regulator problem and begins rapidly heading to the surface. The instructor rushes to assist, slows the ascent and gets the diver up safely, then sorts out the regulator problem (which turns out to be imagined). The two other buddies, however, stay down and continue the dive. As the instructor takes the diver back down, the others pass them ascending rapidly with one completely out of gas. Upon reaching the surface, the out-of-gas diver begins to cough and panic. The instructor, who surfaced with the first diver immediately, manually inflates the victim’s BCD, and he floats high in the rough water, but nonetheless shortly loses consciousness. With a strong current carrying the group, by the time the boat and additional rescuers arrive, the victim has been unresponsive for an extended period. The diver is declared dead by EMS. The instructor who was attending him and the other divers throughout the several-hour ordeal ends up hospitalized for extreme exhaustion.

In all these (real) scenarios, there are various commonalities:

  1. The difference between what would/could have been a heroic rescue, at significant personal risk to the dive pro, and the diver fatality was heartbreakingly small.
  2. In the three situations, some combination of various errors and/or omissions could be alleged: an improper briefing/warning; improper rescue technique; improper rescue breaths; lack of available O2; etc.
  3. In addition to those common aspects, all three situations also resulted in the dive pro being sued, and all the cases resulted in negative verdicts or out‑of‑court settlements.

These, like any serious dive accident, were tragedies – for the victims, for the victims’ families and for the dive pros involved. Unfortunately in each, otherwise excellent, conscientious behavior and dive supervision had – or could be alleged to have had – small discrepancies that could be used in a lawsuit to attack the pros’ performance and/or response to the emergency.

Here’s a quick list of rescue-related issues to always stay current on and to use in a dive emergency to maximize the chances of success, but also to reduce the likelihood of a lawsuit that could reasonably allege that your conduct fell below accepted professional standards:

  1. Always provide a proper dive briefing, describing emergency and diver separation procedures and any special risks of the dive.
  2. Have operational, emergency O2 available, with all dive pros and applicable boat crew knowing where it is located and how to administer it, as well as being familiar with the dive boat/operation’s overall emergency plan and procedures.
  3. Stay current on and use the inwater, rescue-breath protocols you’ve learned, including when to give breaths, how frequently, when to remove the victim’s equipment, etc.
  4. Stay current on and use proper CPR protocols, including the sequencing and pace of inflations and compressions. Keep in mind that these processes have standards placed by dive and lifeguarding bodies, plus are supported by medical research and/or consensus of various sorts. These standards are mostly global, but there are a few that differ somewhat by region, so be aware of what is expected in your area. There are plenty of “experts” out there willing to allege that a nonstandard approach led to, or contributed to, a fatality: “If not but for the nonstandard, improper performance. . .”

Unfortunately, diving has risks that can never be fully eliminated, and the possibility of an incident occurring always exists. Stay prepared and vigilant, and ready to respond, using the procedures and protocols learned during your training. There will always be incidents that don’t have happy outcomes despite heroic, appropriate, individual efforts by dive professionals who do everything “by the book.” But even with real, human limitations, realize that diver rescues and assists occur every day, and the vast majority end without serious injury to the victim. Be and stay prepared for diver emergencies, but also be confident. What you know to do works and usually makes a difference.

Learning from the Statistics

Three Ways to Increase Diver Safety

Written by DAN Staff

Dive incident statistics show both improvements in diver safety and areas where divers may need more help. The DAN Annual Diving Report provides information about the most frequent causes of injury among divers. Dive professionals can learn from these statistics and continue to improve diver safety by reinforcing training concepts that encourage divers to follow safe diving practices. Knowing how to avoid common issues can reduce their chances of being involved in dive incidents.

Weighting

Overweighting is a common problem and a difficult issue to tackle. You may weight students correctly in class, but can’t control how they weight themselves after certification. Besides making a point to remind students that they should always use the correct amount of weight, you could address the issue with additional training, such as a PADI Peak Performancy Buoyancy course, or offer to help divers figure out proper weighting anytime the have an equipment change or just need a tune-up. Overweighting is a significant hazard to both new and experienced divers. Emphasize the need to develop good weighting habits to not only increase safety, but to also to add to their comfort and enjoyment in the water.

Buoyancy Control

With practice, every student should be able to attain neutral buoyancy and horizontal trim before finishing a course. You’re well aware that the inability to control buoyancy during ascent or descent can cause serious injury or death. Not being able to maintain their position or minimize drag in the water can cause new divers to become unaware of their depth or cause collisions with dangerous objects. It can also decrease visibility when they stir up the bottom and cause them to become exhausted due to excessive finning through the water. Focus on mastery of proper buoyancy techniques and encourage lots of practice in your courses. Keeping your students comfortably in control and happily finning through the water throughout their initial training will make them less likely to run into issues post-certification.

Checklists

The mandated use of checklists in aerospace, health care and other areas has significantly decreased the number of incidents and accidents in those industries. The same trend is coming into focus in diving. Whether you use the premade checklists from PADI materials or create your own, using a checklist is an excellent way to ensure that you have everything you need to run a class, board a vessel or get in the water, especially when managing multiple students and assistants. Checklists are an excellent resource for reducing errors. They should serve as reminders of key points rather than just to-do lists. Role model checklist use and encourage students to carry and use checklists for all their dives.

For more information about incident statistics, visit DAN.org.

How Cold is Too Cold?

Written by DAN Staff

Whether you use a dry suit, a thick wet suit and/or warm thoughts to stay warm in cool water, it’s important to know how cold is too cold. Diving on a blustery winter morning can be fun, but pushing your body and your exposure protection to their limits can lead to serious consequences. Help your new divers and customers avoid putting themselves in harm’s way with guidance about how to stay comfortable underwater.

Letting one’s core temperature drop too low, leading to hypothermia or a near-hypothermic state, can affect dexterity, decision-making and the body’s ability to offgas. Because one of the first symptoms of serious hypothermia is diminished awareness, many individuals fail to recognize the symptoms until another diver draws attention to them. Know what to look for in yourself and your students to reduce the risk of mild hypothermia escalating into a life-threatening issue.

What is Hypothermia?

Hypothermia is a drop in core body temperature. It can obviously occur in the arctic, but can also happen in warm tropical waters if divers have inadequate exposure protection and a long enough exposure. The condition is of particular concern for people lost at sea and those diving in extreme conditions.

A typical adult maintains a core body temperature of about 37°C/98.6°F. When this core temperature drops below 35°C/95°F, hypothermia begins to set in, and the body’s function begins to be impaired. To keep the vital organs warm, the body will shunt blood to the core. The initial symptoms of hypothermia include shivering, loss of coordination, dizziness, nausea and feelings of hunger. If the core temperature is allowed to continue dropping, at 30°C/86°F many people will stop shivering and their pupils will dilate. At 27.8°C/82°F, muscles become rigid and a serious risk of cardiac complications arises. These symptoms worsen as the core temperature drops, so it’s vital that people suffering from hypothermia are taken to qualified medical care as rapidly as possible.

Learn to Beat the Cold

Hypothermia can be serious, but it’s not something a well-prepared diver should have to contend with in all but the most extreme situations. Plan ahead with appropriate exposure protection, heat sources and a well thought-out emergency action plan if things get a little too chilly. Bring hot water to make a warm drink or warm water to pour into your wet suit between dives to make yourself more comfortable on a day that’s more winter wonderland than diver’s paradise outside. If you or a student begins shivering, terminate the dive in a safe manner and take time to warm up. Consider whether anyone who was shivering will be warm enough for another dive. If not, come back on a warmer day – there’s no sense in putting anyone at risk.

For more information on safe cold-water diving practices, visit DAN.org/Health.

Be Distinctive!

Tips for Preparing a PADI Distinctive Specialty Outline

Teaching your own distinctive specialty course has never been so popular. Since introducing the Dedicated Master Scuba Diver™ rating and PADI Freediver program distinctive specialties, PADI Regional Headquarters are receiving many new distinctive specialty outlines. Here are a few pointers to keep in mind when developing a PADI distinctive specialty outline:

  • Take advantage of resources! Go to the Pros’ Site – Distinctive Specialty Course Templates for detailed information. Use the template provided as a guide when creating your outline.
  • Set learning objectives and performance requirements, then tell divers what they need to know and what they will do. Beyond information consistent to every dive, what learning objectives and performance requirements specifically relate to the distinctive course? Provide adequate information in the knowledge development section to educate the student diver in the subject matter and fulfill the learning objectives. Also provide sufficient information and descriptions of how to meet the performance requirements of the dives.
  • Stay standards-consistent. Follow ratios and supervision requirements from General Standards and Procedures for confined and open water sessions.
  • It’s all about the diving. Most outlines will be approved only if there are two to four required open water dives. Although there are a few distinctive specialties that may qualify for only one dive (for example, Pumpkin Carving, Easter Egg Collection and other unique specialty programs), and a few with no dives, the point of specialty diver courses is to introduce people to new areas of diving and increase their dive experience under supervision.
  • Identify why you qualify to teach. When you complete the Specialty Course Instructor Application (No. 10180), you must document your background and experience in the course subject matter on page three. Examples include your level of familiarity with a specific site (for example, logged dives on a specific wreck) or an educational background coupled with dive experience in the specific subject matter (for example, underwater archaeology or coral reef research).

EFR® Distinctive Specialties

You can submit an Emergency First Response distinctive specialty outline as well. Use the EFR dedicated application and specialty template for these subjects.

Freediver Distinctive Specialties

See related resources for the PADI Freediver program on the Pros’ Site and download the PADI Freediver Distinctive Specialty Course Application (No. 10338).

Take time to review PADI standardized specialty outlines for information on ratios, minimum age requirements, supervision, maximum depth limits and minimum dives required to meet performance requirements. This will help guide you in drafting this information for your course. If you need additional guidance on writing your distinctive specialty, please contact a Regional Training Consultant at your PADI Regional Headquarters.

Immersion Pulmonary Edema: What You Need to Know

Written by DAN Staff

As the number of divers of retirement age rises, dive safety researchers are increasingly interested in immersion pulmonary edema (IPE). Also called swimming-induced pulmonary edema (SIPE), the condition may occur in young and healthy swimmers and divers, but the risk increases with age and age-related health changes. While IPE can be fatal, divers who are able to recognize the symptoms early and exit the water often have good outcomes, and spontaneous resolution is common.

Here’s what you need to know about IPE:

What is it?

IPE is the accumulation of fluid in the air sacs of the lungs (alveoli) caused by immersion in water. The condition occurs when the pressure in the alveoli is less than that of the fluid pressure in the surrounding capillaries, which causes fluid to seep into the alveoli. Some fluid in the alveoli is normal, but when too much of that fluid is present it can obstruct breathing and cause chest pain, frothy pink sputum and dyspnea (difficulty breathing).

IPE symptoms typically begin to improve immediately after exiting the water, but the condition can cause serious complications, and advanced medical interventions are necessary in some cases.

What are the risk factors?

There are several risk factors that, when combined with immersion, can increase the likelihood of IPE. Exposure to cold water will exacerbate the shunting of fluids to the chest. High blood pressure, overhydration, heart conditions such as left-ventricular hypertrophy, and some genetic predispositions may increase the risk. High-intensity exercise and elevated work to breathe, which may occur with a poorly performing regulator or an inappropriate gas at a deep depth, can also increase the likelihood of IPE by disturbing the fluid balance in the lungs.

Divers can reduce risk by using appropriate thermal protection, avoiding extreme effort in the water, maintaining physical fitness and addressing any potential health-related risk factors before getting in the water.

How should you respond?

If you or your student divers experience symptoms of IPE during a dive, it’s imperative to end the dive as quickly as possible. If symptoms are mild, make a relaxed ascent. However, if symptoms are quickly worsening or are interfering with the ability to breathe, make a direct ascent, get out of the water and seek help.

A diver with symptoms of IPE should breathe 100 percent oxygen and be immediately transported to qualified medical care regardless of whether or not symptoms are improving. It’s possible that the symptoms may have been caused by an underlying cardiac issue that must be addressed by a physician. IPE is likely to reoccur if relevant risk factors are not identified and addressed.

For more information on IPE or safe diving practices, visit DAN.org/Health.

5 Tips for PADI Divemasters Looking to Become Instructors

Written by Guy Corsellis, PADI Regional Training Consultant for East Thailand

I recently received recognition for 20 years as a PADI Professional – a proud moment for me. Now, as a PADI Regional Training Consultant, I look back at two decades in the industry and am grateful for the journey I have been on. It has been a passion that becomes a wonderful career.

Prior to this role, as a Course Director, most of my career has been focused on instructor level training, which brings me to my question – have you thought about becoming a PADI Instructor?

Getting this ticket truly allows you to travel the world and meet some incredible industry colleagues. It is still the dream job for young and/or innovative people. If you feel comfortable helping others, if you love the ocean as much as I do and if you’re ready to be a student for life, you will have a bright future as a PADI Instructor.

Once you have decided to take this step, please allow me to share of few tips on how to become successful.

  1. Remain humble and stay positive. Being positive and optimistic and smiling by default, will motivate and inspire others around you. You will touch the lives of so many as a PADI Instructor, so make sure it’s a positive memory you leave them with. Be more than a role model – be a mentor. Remember, that the PADI system of diver education is student-centered. So display proper attitude at all times and leave your ego at the door.
  2. Persevere and expand your knowledge. Stay updated on new diving techniques, advancements in technology and equipment changes. Continue your own education and be a student yourself. That will help you understand how your students may feel under your tuition. Consider enrolling in programs that make you a stronger ambassador to the underwater environment. Divers today want to learn from those who care about something bigger than themselves.
  3. Be punctual, organized and adaptable. People depend on your choices. You are there to show our future divers proper attitude. Arrive early for classroom or confined sessions. Make sure everything is set up and ready to go when your divers arrive. Accept that logistics in your PADI Dive Centre do change and are dependent on many factors. Dive Center owners need flexible instructors that know how to adapt to unexpected situations or when under pressure.
  4. Be sociable and available. It is important to spend time with your diver students. Not just in a classroom or in the water, but during surface intervals and breaks. Remember that sociable and professional often go hand in hand (more on professionalism later). Take and make the time to have lunch with your divers. Your body and brain need food to perform at an optimum. Lunch with your students is the perfect moment in time to share experiences with your divers and become friends. At the end of the day don’t run home when the clock strikes 5:00pm, take the time to debrief and listen to your student’s needs.
  5. Be professional. You will be judged against expectations and standards. Your image and competence is important. Respect your students and pay attention to how you communicate with them. Be committed, courteous and supportive. We all learn differently, so listen to their needs.

I strongly believe that these few tips will help you to have a long and successful career. If you’re currently a part-time Divemaster, it may be a challenge for you to leave behind another career that you’re attached too. I made the choice to become a full time Instructor some time ago and never regretted it. Change is positive.

With the right attitude becoming a PADI Instructor will be a life changing event. Get out there and visit a PADI IDC or CDC near youand earn the most sought-after credential in the diving industry.

Best of success!

View the PADI Open Water Scuba Instructor landing page for more information and to research your next steps.

Diving with a Patent Foramen Ovale (PFO)

Written by DAN Staff

Patent Foramen Ovale (PFO) is a perennial topic of interest to divers as indicated by DAN Medical Services fielding dozens of PFO-related calls every year. This is understandable based on the fact that the heart is a complex and critically important organ, and more than a quarter of all adults have a PFO. With uncertainty about the condition’s implications, and divers’ desire to reduce risk in the water, some amount of consternation is entirely reasonable.

As a dive professional who experiences greater frequency of exposure to decompression stress and may rely on fitness to dive to make a living, it’s especially important to understand how a PFO could affect your work and health.

Take a moment to improve your understanding of the condition, and learn how it could affect your risks and your students’ risks while diving.

What is a PFO?

A PFO is an opening in the wall separating the upper chambers of the heart – the left and right atria. The opening is a remnant of a flap valve present in developing fetuses that shunts oxygenated blood from the mother directly from one atrium to the other. In most cases this flap closes permanently after birth, but in as many as 27 percent of adults, this flap never shuts completely. The defect is relatively benign and rarely detected. It typically poses little or no risk to otherwise healthy adults in the normal course of life.

What are the risks?

Complications from a PFO are rare in otherwise healthy adults. Most people with a PFO will never be diagnosed with or experience complications from the condition. For divers, however, PFOs can present problems because of the inert-gas bubbles that arise following dives. Gas bubbles that occur in venous blood after a dive can potentially pass through a PFO of adequate size and bypass the pulmonary filter (the lungs), which may cause decompression illness (DCI).

This hazard is the source of much of the concern surrounding PFOs, but people with a PFO can reduce their risk through behavioral or surgical modification. Practical risk-management strategies for cardiac defects exist, but each case is unique. If you are diagnosed with a PFO, your physician will help you determine the best course of action and risk-management practices.

Should I get tested for a PFO?

PFOs are typically identified by injecting a small quantity of bubbles into a vein and monitoring the bubbles’ travel through the heart using contrast echocardiography. During the test, the patients will be asked to sniff or perform a Valsalva maneuver to attempt to open a PFO, should one exist, and allow blood to travel directly from the right to the left atrium. There are a few ways this test can be performed, but all are invasive and are not considered the first step in managing a potential PFO, particularly if you have never had DCI.

For most divers, it is not worth the risk or expense to get tested for a PFO. Many divers with a PFO will never experience DCI, let alone DCI that might have resulted from bubbles shunted through a PFO. If you experience serious neurological DCI or repeated instances of cutaneous decompression sickness, however, discuss your options with a qualified physician.

For more information about PFOs, visit DAN.org/Health.