Those who want to explore the underwater world must be fit to do so.
Scuba diving and freediving both require a minimum of physical fitness and health.
Before you can strap on your fins and breathe compressed air underwater, a scuba diving medical checkup is recommended. In other cases, it might even be mandatory.
Find out more about the general fitness and health requirements, as well as what a diving medical is and why we need it.
What is a Diving Medical Checkup
The Diving Medical or diving medical fitness examination, is an assessment of an individual’s capability to participate in diving activities. During the checkup, lung and heart function, as well as medical history, and psychological and other physiological aspects are examined. Divers should renew their Diving medical regularly to ensure they can dive safely.
If you are a scuba diver, chances are high that you were required to provide this medical examination confirmation before starting your Open Water Diver course.
During the checkup, the physician will test and examine several important functions to evaluate your fitness.
These often include:
- Medical history
- Complete physical exam, with emphasis on neurological and otological components
- Urinalysis
- Any further tests deemed necessary by the physician
For divers over the age of 40, as well as in the case of high-risk profiles, the following tests become necessary:
- Chest x-ray
- Resting EKG & exercise EKG
- Assessment of coronary artery disease using Multiple-Risk-Factor Assessment (age, lipid profile, blood pressure, diabetic screening, smoking)
The Diving Medical used to be required everywhere before a person could dive.
DAN and aquaMed still recommend this, however, in recent years most scuba training organizations have adopted the Scuba Medical Questionnaire are a valid replacement.
What do you do during a Diving Medical Examination?
During a Diving Medical, a physician conducts a lung (spirometry) and heart test (EKK), hearing test, visual test, urine analysis, short fitness test, and examines your medical history. If certain preconditions exist like chronic diseases, additional tests will be performed.
Conditions that may disqualify you from diving
The following conditions must be checked and cleared by a trained physician and could potentially disqualify you from diving activities:
- Severe cases of asthma
- Pregnancy
- Vertigo including Meniere’s Disease
- Substance abuse, including alcohol
- Diabetes mellitus
- Recent surgeries, especially ocular, pulmonary, or cardiac
- Episodic loss of consciousness
- Inadequate fitness and exercise tolerance
- Head injury with sequelae
- Chronic pulmonary disease, including radiographic evidence of pulmonary blebs, bullae, or cysts
- Psychiatric disorders including claustrophobia, suicidal ideation, psychosis, anxiety states, and untreated depression
- Recurring neurologic disorders, including transient ischemic attacks
- Severe hypertension
- Stapedectomy or middle ear reconstructive surgery
- Abnormalities of the tympanic membrane, such as perforation, presence of a monomeric membrane, or inability to auto-inflate the middle ears
- Hematologic disorders including coagulopathies
- Evidence of coronary artery disease or high risk for coronary artery disease
- Atrial septal defects
- Significant valvular heart disease
- Significant cardiac rhythm or conduction abnormalities
- Implanted cardiac pacemakers and cardiac defibrillators
If you have a medical history of one of the following conditions, they might disqualify you from diving activities:
- History of spontaneous or traumatic pneumothorax
- History of seizure, stroke, or a fixed neurological deficit
- History of neurological decompression illness with residual deficit
- History of intracranial aneurysm, other vascular malformation, or intracranial hemorrhage
Please note that the existence of one of the above conditions does not automatically prevent you from diving (with a few exceptions).
For example, you may be able to dive with asthma if you have a light case only, and enjoying a glass of wine occasionally is not the same as “substance abuse”.
Therefore, it is important to talk to a doctor and get a Diving Medical checkup to clear up any questions.
How long does a Diving Medical usually take?
A Diving Medical on a healthy individual can be completed within 30-40 minutes including testing and examination. If preconditions or a complicated medical history exist, the assessment may be significantly longer and last 1-3 hours.
Diving Medical vs Scuba Medical Questionnaire
Historically, the Diving Medical was required to participate in any diving activities and the scuba medical questionnaire is technically part of it. However, scuba training agencies usually accept divers simply filling out the questionnaire instead of getting the full examination, as long as all questions are answered with “no”.
Therefore, you can usually get by with answering the questions on the paper.
However, if you answer “yes” to any of them, this will require you to get a full examination.
This usually brings up questions such as “I had a surgery on my hand 7 years ago. Is this relevant for the question whether I had any surgeries before?”
As you can see, this is one of the examples in which you can probably evaluate yourself whether this past surgery affects you today.
If the problem was fixed and you haven’t had any issues for years, it is safe to assume they won’t arise underwater.
However, if that surgery affects your ability to carry your scuba tank or perform basic diving skills, it might very well be an issue.
Apply common sense and don’t hesitate to consult your physician if you are unsure.
Diving Medical for Children
A Diving Medical is required for all children under the age of 15 in order to participate in diving activities.
If you want to dive with your kids, they need to get a checkup from a physician.
The assessment determines whether they are ready and developed enough to dive and is required for all children’s diving courses.
Example Diver Medical Questionnaire
You can find an example Diver Medical Questionnaire by the UHMS (Undersea & Hyperbaric Medical Society) here.
Some questions you might be asked, include:
- Have you had problems with your lungs, breathing, heart and/or blood affecting your normal physical or mental performance?
- Are you over 45 years of age?
- Have you had problems with your eyes, ears, or nasal passages/sinuses?
- Have you had back problems, hernia, ulcers, or diabetes?
- Have you lost consciousness, had migraine headaches, seizures, stroke, significant head injury, or suffer from persistent neurologic injury or disease?
There are some more questions you will be asked but they all aim at determining your overall diving fitness.
Information for physicians
If you are a physician or medical provider looking to offer Diving Medical assessments, check out the provided info of reputable hyperbaric and sports-related medicine societies.
For example, use the recreational diving medical screening system of the UHMS (Undersea & Hyperbaric Medical Society), as well as further training courses before offering such services.
It helps to be a certified diver in order to understand the requirements and challenges of diving medicine.
You can find several studies and whitepapers on diving medical fitness examinations on PubMed.
Conclusion
The Diving Medical is an important assessment of your overall diving fitness and should be taken by every serious diver.
During the examination, a physician will evaluate your capability to dive and participate in underwater and other hyperbaric activities.
While it is possible to replace the Diving Medical by simply filling out the Medical Questionnaire (and answering “no” to all questions), every diver should get a full checkup at least once when they start to dive.
Read our guide on scuba diving fitness to get more tips on improving your overall readiness for diving.
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Always dive with friends and happy bubbles. 
Cheers
Julius