why i do not train kids!lpt/pwrpnt/kids.pdf · powerpoint presentation author: larry...
TRANSCRIPT
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Why I Do NOT Train Kids!
Larry “Harris” Taylor, Ph.D.
[email protected] Biochemist & Scuba Instructor
University of Michigan
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Risk
Benefit
Risk NEVER = 0
8 Benefit NEVER =
Everyone has a different evaluation
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“There is a nation out there
of small people
And
They are NOT like us!”
Child Psychiatrist
University of Michigan
Private Conversation
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Children do NOT
Think
Emote
Respond
Play As Adults
Act
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Caterpillars are NOT small butterflies
Children are NOT small adults
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Soap Box Warning!
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The concept of
Physically
Mentally
Psychologically
MATURE
Youngster
Oxymoron
Economic Predation
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“The
It Won’t Happen to me!
Syndrome”
Somers (1976), U of MI
Q. Are Divers being informed of risk?
A. No!
Morgan (1995) , WI Sea Grant
Study Commissioned by NSF
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The Lesson of History
Decisions based on “need to increase funding”
Often sacrifice
the best interests of the participants
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Denial of risks
can be
Very COSTLY
The Lesson of History
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End Soap Box Warning
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Concerns:
Legal
Medical
Risks
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Legal Issues
Civil
Criminal
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Legal Concerns: Civil
Denial of risk is
NOT a strong defense
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Denial of Risk
Declining Standards:
Gift from C-Card Vendors
To
Attorneys
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Legal Concerns: Criminal
Some jurisdictions MAY limit activity:
“It shall be unlawful for any person
17 years of age or younger
to engage in skin or scuba diving
Unless accompanied
by a person 21 years of age or older”
Ohio DNR
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Medical Matters
Psychological
Physiological
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“It has NOT been proved that …”
Insert ANYTHING here
Related to the “Kid’s In Diving” Topic
No Documented Studies
Demonstrating
Diving Is Harmful to Kids!
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Research that
would answer concerns:
Costly
Involves Decades
Medically Unethical
There NEVER will be!
‘cause
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Psychology
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Personality
SOME post-DCS sport divers
Show
“negative” personality shifts:
Paranoia
Depression
Dysfunctional behavior
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23 recreational divers:
14 (60%) Mood Disorders 1 yr post incident
Sutherland, et. al. (1987)
Mostly Anecdotal
Or
Commercial/Deep diving
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Change in personality
SUGGESTS
Change in brain structure
Q. Is this reason to NOT train kids?
A. It is in MY kids
NOT because of history, but
Consequences severe
Unknown dose-response curve
Risk to personality development UNKNOWN
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Concrete Thinking
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Concrete Thinking
Communication must be specific
Operations limited to defined parameters
There may be knowledge of fact
Without understanding
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Your Computer Has Crashed
No one can hear your scream
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“The appropriate response
to a life-threatening situation …
is not to burst into tears”
Carl Edmonds, MD (1996)
Coping
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Concrete Thinking
Characteristic of 7 –12 yr olds
Concrete thinkers cannot:
Consider hypothesis
Consider multiple possibilities in scenario
Systematically solve a problem
Use combinatorial logic
Transition Out of Concrete NOT until age 15-17
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The Ice & Snow Of Little River
Water 100 o F Warmer Than The Air
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Mother Nature
Rules!
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is the ability to function
beyond the concrete
SOMETIMES
the difference
between tragedy and
an awesome day of diving
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Crisis Requires Flexibility
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Concrete Thinking
Contraindication to:
Scuba Diving
Piloting a plane
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“Adolescents who begin puberty
earlier than peers appear
at greater risk for participating
in a variety of health-endangering activities”
Donald Orr & Gary Ingersoll (1995)
Puberty Onset & Risk
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Commenting on Australian
lowering age of training to 14 years old:
“Off loading the responsibility to parents
who have no practical knowledge
of the risks of scuba diving
was a reprehensible act”
Carl Edmonds, MD (1996)
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Physiology
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Equalization
Essential to diving
Failure:
Ruptured Ear Drum
Hearing loss
Vertigo
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Equalization
“The (Valsalva) manoeuvre
is difficult
for children to perform” S.E. Strangerup, MD. (1998)
Kid Adult
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“Only 6 % of children with
negative middle ear pressure after
flight managed a
successful Valsalva”
S.E. Strangerup, MD. (1998)
Equalization
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“a poor ability to equilibrate negative pressure
is a fundamental deficit
of Eustachian tube function”
(in children under 12 years of age)
Anita Bylander-Goth, MD, Ph.D.
Cecilia Stenstrom, MD, Ph.D. (1998)
Equalization
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Concern
Combination
Small, horizontal Eustachian tubes
Equalization difficulty
Poor Instruction
Forceful Valsalva
SUGGESTS
Increased risk for ear barotraumas
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PFO’s
Present in 10-30 % Adults
Forceful Valsalva
Bubbles can move thru opening
Into arterial circulation
APPEARS TO BE
Correlation between
PFO and cerebral DCS
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Concern
Difficulty equalizing ear pressure
PFO correlation to Cerebral DCS
Young tissue more likely injured
SUGGESTS
Increased risk to CNS damage
Younger at greater risk
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How much Risk?
Too much for ME
To assume!
Most likely will be
determined
by a jury
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Skeletal System
Changes in pO2
alter skeletal soft tissue formation
CONCERN:
The effect on
developing tissue is unknown
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Pulmonary System
Air passages narrower
in comparison to cavity space
SUGGESTS
Increased risk to barotraumas
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Children Are Easily Chilled
Easily Solved:
Shorter Individual Exposures
Thermal Protection Garments
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Chlorinated Pools
“frequent swimming in “polluted water”
(rivers and chlorinated pools)
before the age of 15 significantly
increased risk of melanoma”
Nelmans, et. Al. (1994)
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“Decompression Fatigue”
Divers on Oxygen Enriched Air “Feel Better”
Theory:
Inert gas movement in and out of cell
is the source of fatigue
CONCERN
“mechanical stress” on kid cells unknown
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Oxygen “Bad Stuff”
Highly Reactive Oxygen Species
Increase in pO2 increases right side of equation
Problems occur whenever
“Bad Stuff” overwhelms body defenses
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Concern
Highly Reactive Oxygen Species:
Powerful mutagens
Profound metabolic mediators
Effect, if any, on
development is unknown
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Recommendations
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SPUMS
recommendation:
Minimum age
for training = 16
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“It is incumbent on physicians
performing examinations
on adolescent divers
to be somewhat overcautious”
Mark Dembert, MD, MPH
Julian Keith, MD
US Navy Physicians
Am J. Diseases of Children (1987)
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Recommendations
“Rigorous standards should be applied
to pediatric applicants …
higher minimum age requirements
(should be) be considered”
Dembert & Keith
Scuba Divers and Physicians
Sports Medicine (1986)
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waiting ‘till
child can drive family’s
most expensive car to the training site
Consider
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Adolescence, like pregnancy
is a survivable,
temporary situation
&
Perhaps, in the long-term,
it’s best to abstain from diving
until the condition is past.
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Participation
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“Primitive Brain”
We are land critters
We do NOT breathe water
Primitive brain needs TIME to adapt
To water environment
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“Quantum Point”
Student exits water with Cheshire Cat grin
Grin reflects:
Comfort
Accomplishment
Mastery of environment
b-endorphins
D fos (?)
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“I get high
By
Going down”
Barefoot Man
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Quantum Point
NEVER
LESS THAN
16 hours pool time
100 minutes open water
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Adaptation
The shorter the training,
The further from “quantum point”
The less likely to adapt
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Consider
Masks, fins snorkel
are the mainstay
Child: Swimming & Skin diving
Adolescent: Skin Diving
Young Adult: Scuba
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Let The
Endorphins
Flow!
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“I have covered too many
father-child double fatalities
to buy into
decreasing the age”
(of scuba training) Jim Caruso, MD
US Navy DMO
DAN Fatality Consultant
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Choose Wisely
The Risk is NEVER zero
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Dive Long
And
Prosper!