Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I have always tried to make sure that when I go on group holidays
then the ground rules are established. Especially when diving in exotic
locations. Like the Hurricane said "It's my work and I do it for pay" and
they can't afford my rates to call me back from leave. I also make it
clear that I shall not be in any way abstinent during my holiday and
anybody seeking my advice, like in any other social gambit, will have to
take me as they find me.
And you cannot be said to have any "duty of care", except in life-
threatening emergency, to clients of another business who have volunteered
to put themselves through risks which one hopes they have sought to
calculate and suitably insure.
Having said that you do have a duty of self-protection both as to
your professional reputation and your relationships with your fellows.
You can't walk away but it may be acceptable to call somebody
stupid/clumsy (personal experience, giving and receiving).
So to the scenarios:
1) Designate a single toilet, well-marked, for use by the victims.
This will prevent spread of infection. Emphasise hand washing. Periodic
inspection for rose spots or signs of peritonism may reassure you. And
rehydration. If you've been on the boat for a few days when people get
ill then complain bitterly to the charter company and write to "Dive".
2) This wound will be contaminated both by foreign bodies (sand and
broken coral) and by coral toxins. It should not be treated by primary
closure but cleaned and rested, with elevation and antibiotics, until it
heals by secondary intention or facilities are available for debridement.
3) Passenger A is the author of his/her own downfall and bears the
consequences of their own actions. It is their decision, not yours,
whether to curtail the expedition and the fact that you have not been able
to medicate them means that they take this decision with a clear head. If
they're insured then that's their losses taken care of. Passengers B-Q
should check their own policies and prepare claims.
What! A full week and no answers to Trisha's quiz? Well, it might be
because there is a question missing:
As all scuba diving doctors know, as soon as the boat has pulled out
of port for its seven-day "reefs and wrecks" tour, the captain will ask if
there are any medics on board.
Do you:
a. explain that the 'Dr' on your passport was a PhD in ancient
history
b. keep quiet
c. say you did once do a St John's course, though you didn't bother
completing the certificate.
It's a Personal Thing
I have always tried to make sure that when I go on group holidays
then the ground rules are established. Especially when diving in exotic
locations. Like the Hurricane said "It's my work and I do it for pay" and
they can't afford my rates to call me back from leave. I also make it
clear that I shall not be in any way abstinent during my holiday and
anybody seeking my advice, like in any other social gambit, will have to
take me as they find me.
And you cannot be said to have any "duty of care", except in life-
threatening emergency, to clients of another business who have volunteered
to put themselves through risks which one hopes they have sought to
calculate and suitably insure.
Having said that you do have a duty of self-protection both as to
your professional reputation and your relationships with your fellows.
You can't walk away but it may be acceptable to call somebody
stupid/clumsy (personal experience, giving and receiving).
So to the scenarios:
1) Designate a single toilet, well-marked, for use by the victims.
This will prevent spread of infection. Emphasise hand washing. Periodic
inspection for rose spots or signs of peritonism may reassure you. And
rehydration. If you've been on the boat for a few days when people get
ill then complain bitterly to the charter company and write to "Dive".
2) This wound will be contaminated both by foreign bodies (sand and
broken coral) and by coral toxins. It should not be treated by primary
closure but cleaned and rested, with elevation and antibiotics, until it
heals by secondary intention or facilities are available for debridement.
3) Passenger A is the author of his/her own downfall and bears the
consequences of their own actions. It is their decision, not yours,
whether to curtail the expedition and the fact that you have not been able
to medicate them means that they take this decision with a clear head. If
they're insured then that's their losses taken care of. Passengers B-Q
should check their own policies and prepare claims.
Yours sincerely
Nick Jefferies
Competing interests:
None declared
Competing interests: No competing interests