Medical Problems

Medical problems affecting diving

For those wishing to take up diving, there will usually be a self-certificated health questionnaire to complete. If any issues are identified then it is unwise to proceed to dive training without consulting a doctor, indeed in the UK it is against the law for dive schools to allow the student into the water without clearance from a doctor.

Medical problems and treatments can have an adverse effect on diving. Some conditions are so serious that the mere mention of them results in a doctor declining to sign a 'fit to dive' form. Other conditions, if mild, may only slightly increase the risk of diving and a doctor may sanction diving if the patient is fully informed about these increased risks. Other medical conditions may have little impact on diving and the student can proceed to diving.

So how can you find information about medical problems that may effect diving:
- your GP ( but remember that they have probably had little or no training in underwater medicine)
- a specialist dive doctor (but these are no available through the NHS)
- internet forums (but the advice may not be correct)
- diving medical textbooks (often written in medical language and may be out of date)
There are pros and cons of each method.

Many NHS GPs will no longer provide sport diving medical assessments or sign fitness to dive forms. This reflects their lack of training in underwater medicine and the high insurance premiums that they must pay if they wish to provide this service.

Diving Doctors

There are two lists of doctors that have undergone training in underwater medicine in the UK.

1) Health & Safety Executive Approved Medical Examiner of Divers (AMED.) They provide assessments for commercial divers working in UK waters but will often provide recreational diving medicals as well.
2) UK Diving Medical Committee (UKDMC) medical referee. They are the required doctors for BSAC & SAA members with medical problems. They will often also provide fitness to dive certificate for students of other training agencies.

There will almost certainly be a fee payable, which will vary depending on the complexity of the medical problems and to cover the doctor's expenses. You would be advised to check this fee before committing for a medical assessment.

Problems caused by diving

Ear barotrauma

This is the commonest diving injury and is caused by inadequate equalising of the ear spaces. Research has show that as high as 60% of students new to diving will suffer some degree of ear barotrauma (even though most do not report it to their instructor.) This may cause anything from a dull ache in the ears, muffled hearing, perforation of the ear drum (which may allow cold water into the middle part of the ear causing severe vertigo and vomiting.)
No specific treatment, just time (several weeks) will cure most cases of ear barotrauma, although occasionally skin grafting to repair a persistent perforation of the ear drum may be required.
See the video resource page  - Dr Edmond Kay's lecture on The Divers Ear - Under Pressure for more information.

Decompression Illness

Decompression illness occurs more frequently than most divers expect. Your training course should have taught you about why it happens and the symptoms to be concerned about. Simply put any new symptom developing in the 24 hours after a scuba dive should alert the diver to seek medical advice. As the diver is likely to have left the dive school / shop when these symptoms start they are probably not likely to be able to seek advice from their instructor etc. and will need to know how to seek help by themselves.

In the UK divers are encouraged to contact Diving & Hyperbaric Doctors directly:

- The British Hyperbaric Association helpline for England & Wales - 07831 151523
- Aberdeen Recompression Chamber for Scotland - 0345 4086008
Divers should know where their local Recompression Chamber is located and how to contact them (Google them!)

When abroad it is essential that divers have adequate insurance to cover the cost of treatment, often in the region of £30,000 for the chamber treatment alone. Search & Rescue costs, transportation costs, Emergency Department costs will all increase this amount significantly.
Access to treatment is often via Emergency Departments, but your insurance company may need informing prior to any expenditure.
International emergency telephone numbers are listed here.

Immersion Pulmonary Oedema

Immersion Pulmonary Oedema (IPO) is now being recognised as a significant cause of diving fatalities (most of those over the age of 50.) It presents as becoming short of breath underwater and can rapidly progress unless the diver is able to exit the water, receive 100% oxygen and medical treatment. Whilst it can happen to any age diver and being considered to being fit and healthy does not protect against it, there is an increased incidence in those with untreated high blood pressure and abnormal heart rhythms.

More information is available:
- Dr Peter Wilmshurst's lecture on the video resource page
- BSAC website - Diver Guidance on IPO

Ear Equalisation Problem Assessment

Ear equalisation problems are very common, often it is just a case of too little, too late, but anyone experiencing this should consult a doctor for assessment and advice.

More information is available:
- on the video resource page - Dr Edmond Kay's lecture The Diver's Ear- Under Pressure
- an article by John Francis, ENT specialist - click here

Other Medical Problems whilst Diving

Diving is rated as an extreme sport and injuries are not uncommon. If the rules are followed then many of the risks can be reduced but not completely prevented.
Many marine animals will bite you if you get too close and appear to be threatening them. The water is rarely clean and marine infections are possible. Injuries from touching coral are common. Fractured bones can occur from falls on dive boats whilst wearing scuba equipment.

So make sure that you have adequate insurance when diving abroad - standard holiday insurance may not cover the type of diving that you intend.