Diving is a physically demanding sport that can place a diver in dangerous situations or result in a delay in access to health care due to the nature of the sport: several meters of water often separate the diver from first aid and 'safety', and the possibility of drowning is increased if a person is incapacitated due to a medical condition under the water. Due to this it is important to establish any medical conditions that might place a diver at increased risk. One needs to establish to what extent they pose a risk so that both the diver and medical doctor can make an informed decision on the eligibility and safety of participating in diving.
What are they looking for?
A medical doctor is looking for any conditions that might place you at risk of an adverse event under water or after resurfacing. They will try to establish the risk of a condition impacting your ability to dive safely. They are looking for conditions that could increase the risk of
- decompression sickness
- pulmonary overinflation syndrome (air trapping) with subsequent arterial gas embolisms.
- Any condition that could lead to loss of consciousness and thus increase the risk of drowning.
- Any adverse events related to immersion and cold stress
- the ability to deal with the mental and physical demands of possible emergencies under water.
- Other medical conditions that may lead to diving being dangerous for a particular individual.
Organ systems that will be evaluated are:
Any condition or neurological impairment that can impair a diver's ability to exercise are of concern. There is also a concern of conditions that come and go as they can often mask neurological decompression sickness. Any condition that could lead to a seizure, especially underwater, also needs to be established. If there are any concerns your doctor might refer you for further assessment by a specialist or for further investigations to establish the extent of your risks. You will also be screened by your doctor to establish your mental capacity and emotional make up to ensure that you will be able to dive safely and deal with any problems that may occur.
Your doctor needs to establish that you have no conditions that would prevent you achieving the required exertional performance needed to dive safely. The major concern here is any condition that can lead to cardiac ischaemia and possibly a heart attack. Your doctor may need to do formalized stress testing and an ECG to check for any signs of ischaemic changes in the cardiovascular system and all individuals older then 40 need to undergo risk assessment for coronary artery disease.
Your doctor needs to establish if you have any conditions that may lead to a pneumothorax (collapsed lung with air in the chest) occurring, or any process that impairs airflow which may lead to pulmonary overinflation and a possible stroke due to an air embolism. Both these conditions may be catastrophic under water. Conditions that could result in these include Asthma, COPD, structural diseases and any previous lung disease to name a few. Many respiratory diseases can also impair physical performance levels rendering an individual unable to meet the requirements for diving.
To ensure your safety, you will require a chest x-ray and you may also need spirometry (air flow testing). It may also be necessary to perform formal exercise testing to establish the effect of any disease on your exercise performance.
Any chronic disease might impair a diver's exercise performance and needs to be investigated. Conditions that cause increased reflux or gas trapping and can lead to vomiting which can be extremely dangerous underwater. Hernias are also a concern due to the increase in pressure underwater and the distance between medical help and many diving locations should a complication arise. They may need to be repaired prior to diving.
Diabetes can also be of concern due to episodes of low blood sugar that can affect the level of consciousness of a diver. If you suffer from this your doctor will need to review the extent of your condition and establish what risk this poses to you for diving.
A thorough exam of your ear, nose and throat will need to be done as your ability to equalize pressures and withstand the pressure of the water is particularly important. If you have any problems in this area the build up of pressure associated with diving can be extremely painful and can lead to rupture of certain structures.
In light of the above-mentioned points, if a person is fit and healthy then diving is a relatively safe and extremely enjoyable sport. This medical is designed to ensure that it is done safely and that any foreseeable problems are anticipated and avoided as much as possible.
For further information, medical practitioners that are part of the Divers Alert Network (DAN) can be reached on this number in South Africa: +27 11 242 0380