Medical Questionnaires, Training Rules ...

Margo Peyton launched Kids' Sea Camp in 2000, providing an imaginative program for parents and grandparents to travel with their kids and get them certified in a safe environment, while the adults had plenty of time themselves to dive. Her highly regarded program, which has led to nearly 8500 youth certifications without an accident, has earned her accolades from the diving community, which has honored her many times for her contributions to our sport. A few months ago, Undercurrent asked our subscribers about their experience with having to respond to medical questions when they travel. Margo sent a long and thoughtful response that we want to share.

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I wanted to chime in on your recent article about the invasiveness of dive medical forms, which has certainly impacted my business. While I'm not sure if it's entirely a bad thing, my personal sense -- based on information I've gathered from my operators -- is that these changes are largely insurance-driven.

For instance, one operator in the Cayman Islands that I've worked with for over 10 years now enforces new ratios far beyond training agency standards: For all kids 16 and under who are not certified and are taking a course, it's a 1:1 ratio. I'm happy about the increased ratios.

For years, I've maintained a 1:2 ratio for kids 12 and under, even though some training agencies allow 1:2 with a loophole to add up to 2 more kids if they're 12 or older. This shift could impact the number of students being certified or even lead some dive shops to stop certifying kids altogether.

For my company, it's a significant impact on our Cayman Island events, as we travel with family groups and might have up to eight kids in a class -- previously requiring four instructors, but now potentially needing eight, due to their insurance restrictions. It's not necessarily a bad decision, as it will for sure keep kids much safer. I have struggled for years to impose a 1:2 ratio on my own. The backlash is always the additional cost and staff needed to meet my demand. Hence, I fly additional instructors with me around the globe on KSC trips to meet my own demands. This has financially impacted me for years, but child safety is not negotiable for me. I just wonder if the insurance companies' 1:1 demand will make it beyond the means of any dive shop to certify kids. Divers don't always equate higher pricing to better quality of service and safety when it comes to diving, and maybe that is something we all need to really consider, and, as consumers, ask better questions when booking dive trips.

Regarding the medical forms, Blackbird Caye in Belize uses the standard form provided to parents getting their kids certified or to adults diving there, as well as at Scuba St. Lucia. This form is given to the diver to share with their doctor: Diving Medical Guidance PDF (https://bit.ly/46Pc7s7). This set of forms is provided to anyone taking a PADI dive course and includes the medical form you discussed in your article: Medical Form PDF (https://bit.ly/3PqVT2d).

It was created for divers taking a course only, but many operators have adopted it to allow divers to dive at all.

There have been very strict and necessary mandates imposed on diving Belize's Blue Hole, not only by dive resorts but by the government, to prevent dive accidents. This medical form is now required by the resort for all divers. One can't even go to Blackbird Caye without this form completed. They want to ensure all divers are physically and mentally able to scuba dive before arrival.

I have mixed emotions about this, as adults should be responsible for ensuring they're fit to dive. But too many times, adult divers omit information that leads to accidents and sometimes death. Insurance companies are placing the onus on resorts to do everything possible to ensure they're only taking out approved divers. There's been extreme pressure on many resorts that carry dive insurance -- not only for their dive teams but also for guests -- to enforce tighter ratios and medical forms. This serves as a good guide for divers to choose safer dive operations. If you're fit and healthy and want to dive with an operator that's checking this information, asking for these forms, and verifying certification levels, it brings better peace of mind -- not only for me but for my clients as well -- to know safety is a priority.

Blackbird Caye in Belize will not take any diver to the Blue Hole who is not AOW certified. They also have a mandatory training dive to 130 feet for anyone wanting to dive the Blue Hole who is AOW certified. They do not allow kids under the age of 15 to dive the Blue Hole, and a Jr. AOW does not suffice. Kids must be 15, have an AOW certification, and dive with their parents. In my opinion, this is awesome! For this reason, I'm very happy working with Blackbird Caye, and I know there are other Belize dive operators doing similar things due to mandates and insurance requirements. This was a very needed implementation.

Being someone who has been diving Belize for 15 years, I remember when new divers and divers with zero experience with depth were just given weak briefings, suited up, and told they were doing a 130-foot dive at the Blue Hole. It was crazy, and on my own, I had to stand up and tell my adult divers that if they were not trained for that dive, not to do it. If they had not been certified for more than 60 feet and had zero experience with depth, they were to stay at 60-feet.

There were times I was mocked and called difficult, and instructors actually demeaned me for discouraging my divers from going beyond their comfort zone and training at the Blue Hole. That was one of the reasons I became an instructor and why I'm still in business with a flawless safety record. Those divers just didn't know. They were ill-informed and just trusted the operator and did not ask questions. When Belize mandated these changes, I was over-the-moon happy.

Scuba St. Lucia at Anse Chastanet also requires divers complete the medical forms, regardless of whether they are in a course or not. This is a great move. Over my 30-year diving career, I've read about and heard of too many preventable accidents. I don't necessarily believe people are lying about their health because they're intentionally hiding anything; I believe many just don't know or understand what's okay with diving and what isn't. I have to be responsible and ensure I'm reading all the medical forms and notes that I receive from divers and parents, and uphold my moral compass as well.

For example, I had a longtime client with a new diagnosis of onset of dementia (she did not volunteer it -- in fact, omitted it -- but I observed issues, and so did my team). She had dived with me for many years. The dementia was, in my opinion, advanced enough that, going forward, I felt diving was completely too dangerous. Her family submitted a medical form signed off on by a GYN. Obviously, that didn't work for me, and I do take the time to read and look up the signatures. I probably saved this woman's life by turning her down, against the wishes of some family members wanting her to have one more dive trip. I'm not a doctor, but good common sense is something I'm proud to have.

It's my wish that people educate themselves better with regard to the medications they're taking and the conditions they have when it comes to diving. My goal is to keep kids and families safe. The hardest part is keeping parents honest, especially when it comes to their kids. I've had parents sign kids up who have autism, severe ADHD, diabetes, and are on major medications that can cause a lot of issues with diving, and they put "NO" on all the medical forms -- and that's just with taking courses, so I don't know what's missed for divers just diving. Divers need to talk to their doctors about these medications, know what the mix of them and diving can do, and make informed decisions.

When it comes to children, I talk to them and ask them how they are doing, if they are excited or nervous or anxious, how they slept last night, and how they feel today. I have had answers that advised me that a child just got over pneumonia, or has asthma, or didn't sleep last night because their ADHD medication kept them up. I've been told ages that don't coordinate with the age and year written on a course form for Deep Diver or Jr. Open Water class. Kids are pretty honest, and, for the most part, tell you what's going on, so I make sure I ask.

Ben, I know you as a fair and informative dive source, and have read many of your articles over the years. Educating adults is where it all begins for me, along with my emphasis on keeping divers safe and educating them to be their best, well-informed selves.

(Last October, Forbes Magazine published this article about Margo's program https://bit.ly/40ljRhU)