Overview of fitness to scuba dive

General practitioners can improve diver safety by screening for health conditions that can contribute to diving fatalities, and referring for formal diving medical assessment if appropriate, as outlined belowLippmann, 2020.

Assessment of fitness to dive is a complex area; it is recommended that clinicians seek advice from a practitioner trained in diving medicine (certified diving doctor) if there is doubt regarding a person’s fitness to dive. The guidance provided here is not exhaustive.

Assessment of fitness to dive should focus on identifying medical conditions that will put the diver at risk from the environmental hazards of diving. The environmental hazards in diving include:

All professional or occupational scuba divers in Australia are required to undergo regular examinations for medical fitness; these are described in the Australian Standard AS/NZS 22991.

Any doctor who performs formal diving medical assessments for occupational divers, or divers undertaking a scuba training course or dives over 30 metres, must have completed an approved training course in diving medicine. Details of approved courses and certified diving doctors are available on the South Pacific Underwater Medicine Society website.

General practitioners who have not undertaken an approved diving medicine training course cannot certify formal diving assessments. However, they may be asked to screen certain individuals to identify conditions that require referral to a certified diving doctor for formal assessment, including:

  • potential divers considering private recreational or resort dives shallower than 30 metres (dives over 30 metres automatically require assessment by a certified diving doctor)
  • established divers (both occupational and recreational) who have had a new diagnosis since gaining their diving qualification or undergoing their last assessment of fitness to dive.

Australian regulations require occupational divers to undergo annual assessment by a certified diving doctor, but a diver’s general practitioner needs to consider interval diagnoses to decide if the reassessment should be brought forward. Although recreational divers are not required to undergo regular assessment by a certified diving doctor, if the diver develops a new health problem, it is important that their general practitioner reconsiders whether they require a referral for a formal assessment.

Potential divers may present to their general practitioner for assistance in completing a screening medical questionnaire that was provided by a diving organisation before a resort dive. Alternatively, a questionnaire developed by the South Pacific Underwater Medicine Society (SPUMS) can be used by a general practitioner as the basis for screening—see Section B of the ‘Guidelines on medical risk assessment for recreational diving’ available to download on the SPUMS website. Questionnaires are not completely comprehensive, so it is important to take a thorough history, including review of past medical records if the person is not a regular patient of the practice, and perform a systems review to identify contraindications to diving, including age-related risk. Any diver 45 years or older (or 35 years or older if they have diabetes, or 30 years or older if they are a First Nations person) requires full cardiovascular risk assessment—see Cardiovascular disease risk estimationSouth Pacific Underwater Medicine Society (SPUMS), 2020.

Local certified diving doctors who can provide advice when considering referral can be found using the search function on the South Pacific Underwater Medicine Society website.

Note: Refer any patient in whom concerns are identified on screening to a certified diving doctor for full assessment.
1 Information is available from the Standards Australia website.Return