Are you fit to dive?
Diving is becoming increasingly popular and has recently experienced not only quantitative but also a considerable qualitative change. Through the development of Technical Diving with sophisticated equipment in combination with the use of mixed gases, one can reach considerably longer bottom times and greater depths. In the group of scuba divers there now is an almost balanced sex ratio. The age limits have clearly shifted in both directions – down to a young age in children’s diving from 8 years up to old age diving in people over 70 or even 80 years. Due to the positive effect of reduced gravity underwater, diving is also used as a therapeutic method.
This implies an increase in the number of disabled and chronically ill divers. These factors confront the supervising physician with medically borderline situations. The trend towards ever more remote diving destinations, often combined with inadequate emergency health care and logistics, emphasizes the importance of a detailed medical screening for sports divers. Special problems associated with diving can occur in remote waters. Often, people decide spontaneously that they want to dive after seeing the underwater life as a snorkeller. A thorough dive medical examination is sometimes either not possible or sadly not required at all.
Usually, a dive centre will forward a questionnaire to the diver as a self-declaration of the medical history and will let it pass when a diver negates all questions. A possibly fatal mistake, as a self-declaration does neither substitute a medical check-up nor does it necessarily meet the truth. Another important fact is that the diver, who signed the declaration "to be healthy herewith", releases the dive centre of its liability in case of an accident. He might even loose his own insurance coverage. The dive centre should refer the diver to a doctor who is familiar with the specific aspects of diving, even if the diver negates all items in the medical questionnaire.
We highly recommend taking the effort to get checked by a doctor who is familiar with the medical aspects of diving rather than taking the easiest solution to see the next available doctor in the neighbourhood.
In most countries, there are no legal provisions for the screening of sports divers, in contrary to the professional divers and hyperbaric workers (principle of the employer’s liability insurance for professional divers). Only the demand of diving associations and dive centres puts a certain amount of pressure on the divers to undergo a dive medical examination.
The annual maintenance of the regulator or the maintenance of the tank every two years is of course left to an expert and the costs are paid without complaint. The diver’s attitude often change drastically when it comes to the own “health check”. As divers prefer to save time and money, "courtesy signatures" are not unheard of.
An often quoted dictum in my clinic is: "If I died down there, I could not imagine a more glorious death". But unfortunately, it is not that simple and glorious. We have a buddy on our side, who we could endanger by evoking a potentially harmful and dangerous emergency situation triggered by our own health problems underwater.
Furthermore, very few dive accidents end in a pleasant death under water, but lead to considerable distress. Even considering a serious DCS, a diver seldom dies of a decompression sickness, but is more likely to travel home in a wheelchair.
Most divers think themselves safe after a goodwill investigation or even after a questionable signature: "I have a doc’s signature on my dive-medical, nothing can go wrong any more". Wrong! A lack of medical knowledge with regard to the diving-related physiological aspects often leads to non-critical or to supercritical restrictions, which don’t make sense at all. It should be emphasized, however, that even a thoroughly done examination leading to an unrestricted certificate is not a free ticket for foolish behaviour in the water.
In principle, any licensed doctor with the appropriate knowledge can do a dive-medical examination, if he/she is familiar with the physical realities of diving and sports medicine. One can find a trained specialist for diving and hyperbaric medicine in one’s close area on the website of each society.
