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Medical Requirements for Diving
Medical Requirements for Diving
Issues Covered in this Section:
- Requirement of the Heart and Vascular System
- Lung Requirements
- Neurological and Psychiatric Requirements
- Earn, Nose, and Throat Requirements
- Other Diseases and Conditions and the Implications of Diving:
All divers must have medical clearance prior to being certified. Physicals should be repeated every two years if under the age of 40 or yearly if over 40. Experiencing a medical problem while at 30 meters sea water can be catastrophic. Even the most seemingly healthy individuals have died during scuba diving because of an unrecognized or an acknowledged health irregularity. Stress on the lungs, cardiovascular system, and muscles is substantial under the sea where atmospheric pressures and currents are tremendously increased. Lungs may collapse, intestines may pop, or the middle ear may rupture under the pressure. Sensory deprivation may lead to panic and drowning. Divers must be strong, healthy, and mentally stable in order to deal with these inherent dangers. A dive physician has many responsibilities to insure the health of the diver. The diver should always disclose any prior medical condition to the examining physician. Lack of disclosure may cause injury to the diver or bring harm to other members of the dive group.
No one less than 12 years of age should dive and a diver is considered old after the age of 40. Only very healthy people should consider diving over age 40. Gender is of no concern for divers, but body size can be a very important issue. Overweight or obese persons are more at risk for developing decompression illness (“the bends”). This is caused by excessive nitrogen gas retention by fatty tissues. Thin people suffer from hypothermia on occassion because of lack of insulation. Pregnant women should never dive, as the risk to the fetus is too great. There is no increased risk of shark attack in women who are menstruating. In fact, according to some experts, the rate is apparently lower.
Requirements of the Heart and Vascular System:
Cardiovascular health is of prime concern for divers. Hypertension (high blood pressure) should be monitored carefully. Blood pressure over 145/95 should preclude diving. If you have a previous history of heart disease you must receive full clearance from your cardiologist prior to diving. People who have had stents or even bypass surgery may dive only after receiving medical clearance. Uncontrolled heart disease would preclude you from diving. Bleeding disorders, such as previous hemorrhages, could be fatal when diving. Varicose veins cause no problem, but blood clots or previous blood clots in the deep veins of the legs (deep venous thrombosis) or the lungs (pulmonary embolism) will eliminate you from diving.
Up to 25 percent of the population is at an increased risk of developing compression illness from the presence of a patent foramen ovale. During your development in the uterus you had a hole in your heart that shunted blood away from your lungs because you were getting oxygen from your mother. Shortly after birth this opening closes in most people, but in many individuals the foramen ovale stays open. If you dive with an open (or patent) foramen ovale you are at an increased risk of having nitrogen or other inert gas bubbles, that form during a dive, pass from the right side of the heart to the left side of the heart. Without the hole, bubbles stay on the right side of the heart and are filtered out harmlessly in the lungs. If the bubbles pass to the left side of the heart they enter the arterial blood supply and are rapidly transported to all parts of the body. If they lodge in an artery feeding the brain a stroke or brain damage may occur. If they lodge elsewhere in the muscles or organs other local injury may occur. These conditions are known as Cerebral Arterial Gas Embolism (CAGE) and Acute Decompression Illness (DCI) respectively. An echocardiogram, performed by a skilled cardiac technician, may discover a patent foramen ovale and thus should be included in a diver’s first fitness-to-dive exam. The presence of a patent foramen ovale does not exclude you from diving but should limit the depth you dive and the length of time you dive and increase the interval between dives. Each of these precautions lessens your chance of developing dangerous nitrogen gas bubbles.
Lung disease is a very important subject to divers. Recent pneumonia or bronchitis should be cleared completely prior to diving. Asthmatics should be impeccably controlled. Many experts do not recommend diving with even the slightest history of asthma. An asthma attack underwater could be catastrophic. Smoking and diving do not mix. Tobacco contains a number of chemicals that can be harmful both short-term and long-term. Smoking causes stimulation of heart rate with occasional irregular beats and vascular spasms. Smoking also causes decreased endurance and poor physical fitness. If a person is prone to hyperventilation, generalized anxiety or panic disorder, he/she should notify the dive physician or instructor prior to embarking on the dive. Consider not diving.
Neurological and Phychiatric Requirements
An epileptic should be seizure-free for five years prior to diving. Migraine headaches may be precipitated by intense cold or exercise and may put a diver in danger. With migraine a diver may become disorientated, blinded, or even vomit under water, each of which could be extremely dangerous. A diver should be mentally healthy. Panic attacks underwater could endanger a diving group and if one has a history of panic attacks the diving instructor and physician should be alerted prior to diving. Strongly consider not diving.
Ear, Nose, and Throat Requirements
Injuries to the external, internal, or middle ear are the most common problems seen by dive physicians. Swimmer’s Ear can cause undue pressure and dizziness and must be treated and cleared prior to a dive. never dive with an active middle ear infection or a perforated eardrum. Middle ear problems threaten the integrity of the balance mechanism and can cause underwater disorientation. Allergies may lead to a disorder of the middle ear and should be very well controlled prior to diving. Any suggestion of congestion of the nasal passages or the middle ear due to allergies will invariably cause a problem at depth. Nasal congestion and swelling of the mucus membranes may be controlled with antihistamines or decongestants. However, most decongestants contain pseudoephedrine (Sudafed), which may increase blood pressure or cause nosebleeds, either of which could be dangerous for a diver.
Alcohol should never be consumed prior to driving. Studies have shown that 80 percent of adults who drown while diving have had alcohol before entering the water. Alcohol causes increased risk taking, dulled reactions, and a drop in body temperature with prolonged diving. There is also an increased incidence of vomiting after alcohol consumption. Do not drink alcohol for 24 hours before diving.