An accident too much !!!

In 2008, we initiated a retrospective analysis of the cases of pulmonary overpressure occurred in training during the course of Exercise Without Tip (CSR), motivated by our experience and especially recent work on the study of causes of death in diving showing cases consecutive to a CSR, which for us at the time, was already an unacceptable cause. We then published in the newsletter of the "Society of Physiology and Underwater Medicine and Hyperbaric French Language" the results of this study. The conclusion was final: " Despite a low incidence, thoracic barotrauma remains unacceptable by its circumstances of occurrence and potential severity. A divers sensitization on the risky behaviors, but especially a better planning of the dives and a questioning of CSR should limit the number and severity of barotrauma. »

At the time, we then informed the vice-president of the FFESSM and the president of the National Technical Commission of this study. His response was to tell us that the subject is controversial only because some have made it controversial and that the idea of ​​a moratorium is totally unthinkable, that this suggestion stems from a great ignorance of the federal apparatus. However, we would have “the chance” to be informed of the conclusions of the FFESSM study group working on this subject.

A few months later, the medical reporter of the FFESSM considers that the accident risk is the same to any exercise done in training. Moreover, it is claimed that this exercise probably prevented pulmonary overpressures during real air failures. It is therefore important to keep it.

Let's just remember that other federations like the FSGT in France or the Lifras in Belgium took the decision to suspend this practice following a number of unacceptable accidents. His educational interest was declared almost null. In parallel, not teaching CSR did not result in a hecatomb related to poor management of air outages.

In 2009, the team of Dr. Tino Balestra publishes in a international scientific journal, a study that reinforces the arguments for a increased risk pulmonary overpressure with this type of practice.The same year, during a meeting of the CTN, the rapporteur of the FFESSM working group concludes that there is no no medical reason to question this practice.

In 2010, following the occurrence of new incidents, we published, with the referents of the diving in the armies, the national technical adviser of the diving to the Civil Security and the director of formation of the National Institute of the Professional Diving, a open letter evoking the dangers of CSR.

Nothing changes in the formations in France. Some even explain to us that he is preferable that there is a problem with a candidate when this exercise is done with a very competent coaching, all necessary safety measures and in a secure environment, rather than when alone, in a situation of driving 4 L2 just trained.

In 2013, Francis Le Guen, diver and renowned journalist, ask me about the risks inherent in this practice in a Scubaparte sequence for Scuba People.

2014 in the filing a criminal complaint following sequelae following a serious barotrauma during a CSR is made impossible for facts considered as prescribed.

In the same year, on the occasion of seated under the aegis of the Préfet Maritime, the former Secretary General of the FFESSM bounces following my words and sums up perfectly the argument in favor of stopping of this technique:

1. In France, this exercise is only imposed by the FFESSM, at level 4 and at MF2. The FSGT does not practice this. The ANMP has set up, for its level 4, a draw between two tests, CSR or management of the ascent. The management of the feedback is systematically drawn by lot… and the CSR test exists on paper only to avoid the non-recognition of level 4 ANMP by the FFESSM.

1. A international exercise is not practiced.

1. There is no technical justification for its realization. The claim that this is to prevent the risk of pulmonary overpressure is not credible. Indeed, by way of example, this exercise is not required for level 3 diver and this does not bother anyone at the FFESSM. So why ask for it at level 4 of dive guide and at MF2? Because it is a historical reminiscence dating from 1957, when, with a material very different from that used today, it was envisaged that the instructor would need to give his diving suit to a student and that it reaches the surface alone. At the time, this exercise was already considered dangerous, but the choice had been made to maintain it out of necessity. Subsequently, it was upheld against all evidence.

1. Medical justification : Faced with a political will to maintain the exercise and despite a technical reality finding no justification, some federal doctors endorsed the justification of this exercise, which closed the technical debate ... on the grounds that medicine justified the thing. The minutes of CTN, available on the site of the FFESSM, where sits a representative of the medical commission are unambiguous on this point.

1. Political justification : The continuation of this exercise would make it possible block the entry into our territory of monitors from international organizations, who do not practice it. This is the only probable real reason, if not acceptable and valid.

1. A new deal : The repeated accidents, including deaths during training, made the FFESSM aware of the impossibility of being able to continue in this way. This is the meaning of the decision of the CTN of September 2014 which, in fact, recognizes the dangerousness of the exercise and its lack of technical justification, or even its uselessness apart from a simple technical demonstration. While it was believed that this exercise would be definitively abandoned, this topic was regularly put at the end of the meeting or not addressed due to lack of time, considering that other subjects were more worrying and that this issue should be integrated into a global look at diving training and certification. The subject of CSR was therefore not urgent or above all a priority. A working group was supposed to come up with a replacement test, something that has yet to be translated into practice… six months later. As a result, the RSEs were maintained for the 2014-2015 season for federal training and exams.

2014 is unfortunately marked by the death of a diver in Marseille during a CSR. This accident of more and too much, does not modify the position of the FFESSM. Thus, the 15 June 2015, the president of CTN threatens the regional technical commissions, who took the decision to cancel this test and to award him a mark of 10 / 20, to cancel the entire examination due to a procedural violation.

A few days later, a new serious accident occurs in northwestern France, in a candidate for MF2.

Given the seriousness of the facts, the president of the CTN finally makes the decision to request a precautionary measure immediate neutralization of the event to the President of the FFESSM.  He cancels on his own responsibility the CSR tests in the N4 and MF2 exams pending a decision by the National Steering Committee. This one must pronounce in 30 June 2015.

The CDN can quite to rule against CTN's decision, this one being only consultative. This would be the second time in a year that he would make such a decision, since he had decided in 2014, unilaterally and against the advice of the CNMP, National Medical and Prevention Commission, to give the possibility to any doctor to make a medical certificate of no contraindication to diving until level IV, while the evolution of diving practices and practitioners make this consultation more and more technical.

The story is therefore unfortunately perhaps not yet over, while it is obvious that CSR is a useless and dangerous exercise that must be prohibited in all diving training in France, and of course in all events. leading to the qualification of divers and teachers.

We are obviously at your disposal to discuss it in the interest of the diver.

Friendships.

Dr. Mathieu Coulange

Head of Department, Hyperbaric, Underwater and Maritime Medicine

Emergency Resuscitation Unit SAMU Hyperbarie (RUSH)

CHU Ste Marguerite