Am Fam Physician. 2001;63(11):2225-2226
What is recreational scuba diving?
Recreational scuba diving is defined as pleasure diving to a depth of up to 130 feet without decompression stops. Recreational scuba diving has become very popular in the past 20 years. There are almost 9 million certified divers in the United States alone.
Several scuba certifying agencies offer training for divers, from beginners to experts. Three of these agencies are the Professional Association of Diving Instructors (PADI), the National Association of Underwater Instructors (NAUI) and Scuba Schools International (SSI). Basic classes involve classroom instruction and training in a pool and in open water settings. The most popular courses last from 4 to 8 weeks.
What are the common medical problems of scuba diving?
The most common medical problems are simple “squeezes.” These can affect your middle ear or face mask during descent. Squeezes cause pain in your ears. The pain is caused by the difference in pressure between the air spaces of your ears and mask, and higher water pressure as you go deeper in the water. Squeezes that affect the inner ear or sinuses are less common.
Cuts, scrapes and other injuries to the arms and legs can be caused by contact with fish and other marine animals, certain species of coral and hazards such as exposed sharp metal on wrecks or fishing line.
Can I be seriously hurt while scuba diving?
Yes. The most dangerous medical problems are barotrauma to the lungs and decompression sickness, also called “the bends.”
Barotrauma occurs when you are rising to the surface of the water (ascent) and gas inside the lungs expands, hurting surrounding body tissues. In some divers, these lung injuries can be bad enough to cause lung collapse (pneumothorax). The injuries may also allow free air bubbles to escape into the blood stream. This is called arterial gas embolism. Arterial gas embolism often causes chest pain, breathing trouble and neurologic problems such as stroke.
Decompression sickness occurs during ascent and on the surface of the water. Inert nitrogen gas that is dissolved in body tissues and blood comes out of solution and forms bubbles in the blood. The bubbles can injure various body tissues and may block blood vessels. The most common signs of severe decompression sickness are dysfunction of the spinal cord, brain and lungs.
How common are medical problems in scuba diving?
Fortunately serious medical problems are not common in recreational scuba divers. While there are millions of dives each year in the United States, only about 90 deaths are reported each year worldwide. In addition, fewer than 1,000 divers worldwide require recompression therapy to treat severe dive-related health problems.
How can I lower my risk of medical problems?
Most severe dive-related injuries and deaths happen to beginning divers. To be safe, you must dive within the limits of your experience and level of training.
NEVER try any dive you're not comfortable with. During descent, you should gently equalize your ears and mask. At depth, never dive outside the parameters of the dive tables or your dive computer.
NEVER hold your breath while ascending. You should always ascend slowly while breathing normally.
Become familiar with the underwater area and its dangers. Learn which fish, coral and other hazards to avoid so that injuries do not occur.
NEVER panic underwater. If you become confused or afraid during a dive, stop, try to relax and think the problem through. You can also get help from your dive buddy or dive master.
What should I do in a scuba diving emergency?
If you or one of your dive buddies has had an accident while diving, or if you would like to discuss a potential diving-related health problem, call the Divers Alert Network (DAN) emergency telephone line (1-919-684-8111). DAN is located at Duke University Medical Center in Durham, N.C. Doctors, emergency medical technicians and nurses are available 24 hours a day to answer your questions. If needed, they will direct you to the nearest hyperbaric chamber or other appropriate medical facility. A hyperbaric chamber is a facility where they can place you under increased pressure, similar to being underwater. This can often help injury from arterial gas embolism or decompression sickness by shrinking bubbles and allowing them to pass through your blood vessels.
Where can I get more information about recreational scuba diving and dive medicine?
Several Web sites and e-mail addresses offer information about recreational scuba diving, dive medicine and dive-related health issues:
Scubamed, sponsored by Underwater Medicine Associates: http://www.scubamed.com
Diving Medicine Online: http://www.gulftel.com/~scubadoc
Undersea & Hyperbaric Medical Society: http://www.uhms.org
Association of Commercial Diving Educators: http://www.diveweb.com/acde/
National Association of Underwater Instructors: http://www.naui.org
Scuba Schools International: http://www.ssiusa.com