Exclusions and Qualifications
Medical History and Physical Examination
of prospective divers, sports scuba divers, underwater photographers
diving instructors should include the pertinent aspects of present and
past history, review of systems and physical examination directed and
to specifically detect those conditions that place a person in jeopardy
for the following:
over pressure accidents
3). loss of
to mentally or physically handle the in-water environment.
sign a certificate stating he "can find no contra-indication to diving"
rather than "the diver is fit to dive".
- Age Related
why a person should not be allowed to dive are as follows:
to altered consciousness
the "natural evolution of Boyle's Law"
lead to erratic and irresponsible behavior.
pressure in the middle ear by auto-inflation. This may be due to a
problem such as polyps, nasal septal deviation or coryza in which case
the diver can be reevaluated after correction of the problem.
tympanic membrane. Until fully healed or successfully repaired with
Eustachian tube function, diving is contraindicated.
of the TM.
than myringoplasty (Type I)
- History of
is being debated. See below.
- History of
or partial laryngectomy
(posterior) involving the external canal is disqualifying. (Closed
is disqualifying, as well as surgical procedures designed to treat the
-remove before allowing to dive.
of the ear canal- disqualifying.
secondary to barotrauma
due to surgery (Cannot close for valsalva maneuver)
recently there have been good studies to show that stapedectomy is not
the risk that
Neck Surg 2001 Oct;125(4):356-60
stapedectomy: clinical experience and recommendations.
House JW, Toh
EH, Perez A.
Department, House Ear Clinic and Institute, 2100 West Third
CA 90057, USA.
does not appear to increase the risk of inner ear
scuba and sky divers. These activities may be pursued with
after stapes surgery, provided adequate eustachian tube
disorder: After head injury, disallow diving during that period of
time that the diver is at risk for seizures.
ischemic attacks) or CVA (Cerebral vascular accidents)
cord injury, disease or surgery with residual sequelae. This includes a
history of having had Type II neurological DCS with permanent
- A history
syncopal episodes, whether cardiovascular or neurogenic.
artery disease: Because of the need for cardiac reserve in an
emergency, the carrying of tanks, donning of equipment, swimming
a current represent significant stresses. A history of myocardial
is considered a disqualification for sport diving; there are unusual
of exceptional rehabilitation after dilations and revascularization
(particularly large right to left shunts), PFO
Hypertrophy: this can lead to sudden loss of consciousness.
Can lead to sudden loss of consciousness.
can dive but drugs that limit exercise response (beta blockers) need to
be evaluated. OK if person can reach 13 METS on the treadmill. *(See
with medications is disqualifying.
disqualifying ( can be cold or exercise induced).
with no symptoms and negative treadmill OK to dive if can
13 METS. *METS are multiples of resting O2 consumption. Eight to nine
equal 1 knot or 100 feet per minute swimming. (70% maximal). Thirteen
equal 40 ml./kg./minute.. One cannot swim at 1 knot so don't dive in an
environment requiring more. In currents of 7-8 knots, it's best to go
the flow. (p=KpV2).
aortic insufficiency with no left ventricular dysfunction can dive
stenosis are disqualified
with no symptoms such as chest pain, syncope, dyspnea can dive
right and left should be disqualifying.
is unassociated with other cardiac dysfunction
after the usual exercise evaluation
block are disqualifying
block can dive
block can dive with a normal thallium and angiogram test.
syndrome is disqualifiedSupraventricular tachycardia can dive 6 months
after the causes are removed
pneumothorax; A history of previous spontaneous pneumothorax
a high incidence of recurrence and the candidate must be advise against
compressed-gas diving.. A pneumothorax that occurs under water or in a
chamber can become a "tension" pneumothorax on ascent and be
life-threatening as the pleural cavity expands because of Boyle's Law.
pneumothoraces can be allowed to dive after appropriate clearance from
a diving physician, chest surgeon or pulmonary disease specialist.
cysts or blebs which can trap air and lead to local pulmonary
overpressure accident during decompression (Ascent).
in the active phases. May dive when the pulmonary functions have
to normal at rest. The mid-expiratory flow needs to return to baseline.
recommendations concerning diabetes
sickle cell anemia)
cell disease or trait: There is the remote possibility that the
diver will breathe a hypoxic mixture of gas or start the sickling
with exertion in cold water or with bubbles during
leading to sickling->hypoxia-> and a vicious cycle of more
sickling. (See section on endocrine
and metabolic problems. )
with prosthetic devices
of the jaw
with a history
of panic attacks
abuse, including alcohol
or intention to become pregnant*
Women and Diving)
externa or media
loss in one ear
(scotomata, CNS symptoms and stroke after diving)
can dive, including contacts
dive when completely healed (6 weeks).
can dive when healed (3 months).
if vision is not affected
who have migraine with any of the following should not dive: Aura,
of one of the senses, nausea and vomiting or photophobia.
can be cleared for diving following head injuries if they have no
24 hours or longer
2-24 hours and the person has been seizure free for 2 years
less than 2 hours and the person has a normal neurological workup.
- Person is
normal one year after experiencing 3-4 weeks of amnesia.
nine months after experiencing 2-3 weeks of amnesia.
6 months after amnesia for 1-2 weeks
6 weeks after momentary amnesia.
Seizures accompanying febrile episodes below the age of 6 with no
of abnormal neurological exams, seizures of longer than 15 minutes
or nonfebrile seizures in family members.
neurological or physical impairments. Successful disc surgery below
and uncomplicated, successful cervical disc surgery from an anterior
after 3 months.
cord) decompresion sickness with complete resolution of signs and
within 24 hours.
with complete resolution of signs and symptoms within 24 hours assuming
no complications from pulmonary considerations (Some say 3 months).
surgery (tumor or aneurysm) with no residuals or sequelae after 3
(with the approval of the surgeon)
Diabetes Mellitus: Insulin
dependent diabetics represent a gamut of severity; the more brittle
diabetic who should not dive and a less serious one which should not
increase the hypoglycemia risk enough to exclude diving. The
long-standing diabetic who has lost the normal defense mechanism
against hypoglycemia should not dive. Newer methods for testing
and steps to regulate blood sugar can eliminate the risk of
hypoglycemia. As diabetics are more prone to coronary disease, a good
and exercise testing when indicated, can reduce the risk for a heart
problem while diving.
Diagnoses potentially rendering the person incapable of performing the
exertional requirements necessary to meet the needs of diving. Formal
testing with a minimum criterion of *13 METS needed for qualification.
Patients with a thoracotomy can be certified for diving after thorough
evaluation by a thoracic surgeon knowledgeable of diving medicine.
with pulmonary barotrauma
may return to diving after no less than a three month wait and a
from a diving physician that there is no air trapping.
gastric outlet obstruction need to be evaluated prior to qualification.
obstruction is not disqualifying if the person is asymptomatic 6 months
after corrective surgery.
bowel is disqualifying until surgically repaired.
severe reflux, hiatal hernias, achalasia, gas bloat syndrome, (s/p
hernia repair) and gastric outlet obstruction are all disqualifying.
dive while fractures are healing and until acute inflammatory
of bone and joints subside.
necrosis is a contraindication.
stable paraplegics, scoliosis without respiratory limitation should be
able to dive.