This issue of eMedRef provides information to clinicians on the pathophysiology, diagnostics, and education for scuba clearance to dive

Koehn, Michael

University of Missouri: MOspace

Scuba Clearance to Dive Page 1 of 3    6.16.09 Scuba Clearance To Dive Background 1. General information  o SCUBA-self contained breathing apparatus 2. Web sites  o Diver's Alert Network (DAN)   www.diversalertnetwork.org o Professional Association of Diving Instructors   www.padi.com o National Association of Underwater Instructors   www.naui.org o World Recreational Scuba Training Council   www.wrstc.com o ScubaDoc's Diving Medicine   www.scuba-doc.com 3. Demographic information:  o www.padi.com/scuba/about-padi/PADI-statistics/default.aspx   538,782 Entry Level Certifications for 2008  393,704 Continuing Education Certifications for 2008  Median Age for Men was 30 during 2002-2008  Median Age for Women was 27 during 2002-2008  Men: 65-67% during 2002-2008  Women: 33-35% during 2002-2008 4. Pre-existing condition information  o www.diversalertnetwork.org/medical/report/2007DANDivingReport.pdf   Project Dive Exploration collected data on 1,181 divers, 3,062 dive series, and 15,056 dives in 2005  Chronic allergies 15%  Hypertension 8%  Ear/sinus problems 6%  Psychiatric, ear/sinus surgery, back surgery, and heart disease 2% each  Diabetes <2%  Pathophysiology 1. Pathology  o Multifactorial   Direct trauma  Exacerbation of pre-existing condition o Environmental   Barotrauma  Decompression Sickness (DCS) o Physical   Envenomation  Trauma  Musculoskeletal injury o Heat/cold - medical effects of exposure o Underwater   Drowning Scuba Clearance to Dive Page 2 of 3    6.16.09 2. Incidence  o Project Dive Exploration from 2007 DAN Diving Report   95% of dives are uneventful  <3% of dives involved difficulty equalizing middle ear pressure  <0.5% vertigo, seasickness, or headache  2.8 cases of DCS per 10,000 dives o DAN fielded 5,645 calls from around the world from 4/6/2006 to 12/31/2006   29.2% of all calls fielded by DAN in 2006 involved questions regarding Fitness to Dive  11.3% DCS  6.8% Middle ear barotrauma  5.5% Trauma or infection  4.9% possible DCS  3% Envenomation  2.2% Pulmonary barotrauma 3. Morbidity  o DAN fielded 1,301 case-related calls from 4/6/2006 to 12/31/2006   29.2% of calls was for information on fitness to dive  29.2% of calls was for non-specific information   65% of cases were male  Age distribution was 43 +12 years  Medical history recorded in 514 cases  52 had prior Cardiovascular condition  20 had prior DCS  10 had prior Psychiatric condition  9 had prior Respiratory condition  6 had prior Neurological condition  4 had Diabetes 4. Mortality  o 167 deaths in 2005 (most recent data available) o 55 of these fatalities were evaluated by a coroner o 51% of deaths were due to drowning o 16% of deaths were due to acute heart condition o 15% of deaths were due to asphyxia o Demographic information   89 recreational divers from US and Canada  82% of males were older than 40   Median 50 years old  80 % of females were older than 40   Median 43 years old  Predominant conditions were hypertension and heart disease  Other conditions include asthma, diabetes, back pain, kidney disease, prostate cancer, and hemochromatosis  Diagnostics 1. Fitness to dive 2. Disqualifications 3. Neurological 4. HEENT Scuba Clearance to Dive Page 3 of 3    6.16.09 5. Respiratory 6. Cardiovascular 7. Gastrointestinal 8. Musculoskeletal 9. Genitourinary 10. Hematology 11. Endocrine 12. Dermatology 13. Heat stress/heat stroke   Patient Education 1. www.diversalertnetwork.org 2. www.padi.com 3. www.naui.org 4. www.wrstc.com 5. www.scuba-doc.com  References 1. Freiberger J. DOs and DON'Ts-Defining Medical Fitness to Dive. Alert Diver. 2007: January/February 2. Freiberger J. DOs and DON'Ts-Defining Medical Fitness to Dive, Part II. Alert Diver. 2007: September/October. 3. Freiberger J. DOs and DON'Ts-Defining Medical Fitness to Dive, Part III. Alert Diver. 2009: January/February. 4. Pollock NW, Uguccioni DM, Dear GdeL, eds. Diabetes and recreational diving: guidelines for the future. Proceedings of the UHMS/DAN 2005 June 19 Workshop. Durham, NC: Divers Alert Network; 2005.  5. Greer H. How Your Diving Fitness Can Be Affected By Your Central Nervous System. Alert Diver. 1999: May/June. 6. Caruso J. Cardiovascular Fitness and Diving. Alert Diver. 1999: July/August. 7. Butler Jr. FK. DAN Answers Diver's Most-Asked Questions About Their Eyes. Alert Diver. 1998: May/June. 8. Uguccioni DM, Moon R, Taylor MB. Dan Explores Fitness and Diving Issues for Women. Alert Diver. 1999: January/February. 9. Chimiak J. Fitness Issues for Divers With Musculoskeletal Problems-Part I. Alert Diver. 2001: February. 10. Chimiak J. Fitness Issues for Divers With Musculoskeletal Problems-Part I. Alert Diver. 2002: March. 11. Gowen L. Medications for Depression and Fitness to Dive. Alert Diver. 2005: May/June. 12. Bennett PB, Cronje FJ, Campbell E, (with Marroni A, Pollock NW). Assessment of Diving Medical Fitness for SCUBA Divers and Instructors. Best Publishing: Flagstaff, AZ. 2006; 241pp. 13. Dear G, Dovenbarger J. Diving and the Body Systems. Alert Diver. 1999: September/October.  Author:  Michael Koehn, MD, University of Nevada Reno FPRP  Editor:  Carol Scott, MD, University of Nevada Reno FPRP 

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University of Missouri: MOspace