Dive Medical Examination
The Dive Medical is only to be conducted by a physician who has had the approved training to medically examine recreational divers.
The Dive Medical is basically an assessment of the ability of the diver to survive unexpected underwater or on-surface emergencies, and the risk of death, unconsciousness, impaired judgement, disorientation, impaired mobility, or decompression sickness that may be associated with diving with a particular condition or disorder.
As a general part of the examination, age factors and overall physical fitness are assessed, as well as vision function, ear nose and throat condition, hearing, dental condition, balance, blood pressure, lung function, musculo-skeletal function, and the gastro-intestinal tract.
A urine test will also be carried out to detect previously undiagnosed conditions including diabetes and pregnancy.
Any conditions or disorders highlighted as a result of the Medical Questionnaire will also be clinically assessed in terms of the risk that they pose to the diver, as will any medications currently being taken by the diver. The latter is particularly important in terms of decompression sickness risk, nitrogen narcosis, and the cardiovascular, respiratory or neurological side-effect risks associated with the medications being used in underwater and compressed air environments.
Certain medical conditions develop with age, and the physiological strain of regular diving can damage the body anyway, so a regular dive medical examination is recommended every 5 years for those under 30 years of age, every 3 years for those 30-50 years of age, and every year for divers over 50 years of age.
Dive Medical Requirements
The rules and requirements are slightly different for different classes of recreational divers:
Introductory or Resort Dives
Prior to diving you will be required to fill in a Medical Questionnaire given to you by the company you are diving with. If you answer YES to any question you will be referred to a qualified physician for a Dive Medical assessment that conforms to Australian Standard AS4005-1. You will not be allowed to dive until the Dive Medical has been carried out and you are certified as being fit to dive. Some dive companies require that all uncertified divers over 55 must produce a current Dive Medical Certificate.
Learn To Dive Courses & Referral Programs
All divers are required to have had, and to have passed, a Dive Medical that has been done in accordance with Australian Standards AS4005.1 - While a dive medical that conforms to AS4005.1 may be available in countries other than Australia, if the medical certificate does not state that the medical examination has been done in accordance with the Australian Standard, it will not be accepted.
Advanced Dive Courses
You are required to fill in a Medical Questionnaire. If you answer YES to any of the questions you will be required to undergo a medical assessment to Australian Standards AS4005-1. This includes Open Water Dive Courses and Rescue Diver Courses.
Dive Master Courses & Instructor Development Courses
An AS4005.1 dive medical assessment less than 12 months old is required. Even if you have had one, you may also be required to fill in a Medical Questionnaire. If you answer YES to any of the questions you will be required to undergo a medical assessment. If you are intending to work in the diving industry it will be an ASNZ2299 (the standard for occupational diving) dive medical. If you are NOT intending to work in the industry it will be an AS4005-1 dive medical.
Expedition Diving - Certified Divers
Prior to diving you may be asked to fill out a Medical Questionnaire, or to simply sign a waiver releasing the dive operator from liability. If you do answer YES to any question in the Questionairre you will be referred to a qualified physician for a medical assessment. Depending on the dive operator, this assessment may need to be AS4005-1 compliant, or it may simply be a release from your doctor saying that you are fit to dive. Regardless, you will not be allowed to dive until the medical assessment has been carried out and you are certified as being fit to dive. Please note that a qualified and experienced diver will be disqualified from diving immediately if a previously undisclosed medical condition becomes known to the diving supervisor or dive master while on board.
Overseas dive medicals or diver fitness certificates will NOT be accepted unless the assessment certificate clearly and specifically states that the Dive Medical was carried out to the Australian Standard AS4005.1.
The Dive Medical Questionnaire
Some medical conditions may directly preclude you from diving because of the condition itself, while others will stop you from being able to dive because of the medications giving to treat the condition. The dive company will provide you with a Dive Medical Questionnaire that must be completed prior to departure.
The Medical Questionnaire comprises a series of questions that will determine whether you have, or are, suffering from a range of conditions, or involved in any contra-indicated treatment regimes, that may impact on your fitness or suitability for diving.
If you indicate that you have suffered, or are suffering, from any of the conditions listed, or are taking any of the medications listed, you will be referred to a qualified physician for a Dive Medical that conforms to Australian Standard AS4005-1. The purpose of the Medical Questionnaire is to find out if you should be examined by your doctor before diving.
A positive response to a question does not necessarily automatically disqualify you completely from diving. It simply means that there is a pre-existing condition that may affect your safety while diving and you must seek the advice and assessment of a trained physician prior to diving. The assessment will involve weighing-up the pleasures to be had by diving against an increased risk of death or injury due to the medical condition.
The Medical Questionnaire will also ask some questions about your experience as a diver, and the conditions that you have previously dived under.
If you answer YES to any question, you will not be allowed to dive until the Dive Medical has been carried out and you are certified as being fit to dive.
Risk Factors
Severe Risks
A severe risk condition implies that an individual will be at a substantially elevated risk of serious injury or death compared with the general population, and should not dive. The principle conditions in this category are:
Asthma
Recent heart surgery
Serious lung or chest disease (particularly where surgery was involved)
Epilepsy, fitting, convulsions and seizures, or taking medications to prevent them
Diabetes requiring insulin.
Pneumothorax (collapsed lung) even after a surgical procedure designed to prevent recurrence
Any neurological abnormality where there is a significant probability of unconsciousness
Pregnancy
Relative Or Temporary Risks
The following conditions are termed a relative risk and will cause a moderate increase in risk, which in some instances may be acceptable. A physician is required to make a clinical assessment of the diver to decide whether diving is contraindicated for this category of medical problem.
Some of these medical problems may be temporary in nature, and the Dive Medical will determine if and when the diver can be considered fit to dive.
On the list of significant conditions that may disqualify you from diving pending a medical assessment are:
Breathing issues including frequent or severe attacks of hayfever or allergy, frequent colds, sinusitis or bronchitis
Behavioural health, mental or psychological problems (claustrophobia, agrophobia, active psychosis, panic attacks)
Recurring complicated migraine headaches whose symptoms or severity impair motor or cognitive function, neurologic manifestations, or taking medications to prevent them
Blackouts, fainting or partial loss of consciousness
Head injury with loss of consciousness in the past five years
Intracranial Tumor or Aneurysm
Frequent or severe motion sickness
Dysentery or dehydration requiring medical intervention
Past dive accidents or decompression sickness
Inability to perform moderate exercise
Clinically obese
Recurrent back problems, or back or spinal surgery
Back, arm or leg problems following surgery, injury or fracture
High blood pressure or taking medicination to control it
Heart attack, heart disease, angina, heart surgery or blood vessel surgery
Sinus surgery
Ear disease or surgery, recurrent ear problems, hearing loss, or ear-related problems effecting balance
Heamophelia, bleeding or other blood disorders
Hernia
Ulcers or ulcer surgery
Colostomy or ileostomy
Recreational drug use or alcoholism, or treatment for these in the past five years
Regularly taking prescription or non-prescription medications (With the exception of birth control or anti-malarial treatments)
Being over 45 years of age and having one or more of the following:
Currently smoke a pipe, cigars or cigarettes
Have a high cholesterol level
Have a family history of heart attack or stroke
Are currently receiving medical care
Have high blood pressure
Have diabetes mellitus, even if controlled by diet alone
It is far better to visit a physician whilst in Australia and obtain a valid dive medical certificate that complies with Australian Standards (AS4005.1), rather than show up for your live aboard dive trip and watch the boat depart without you because you weren’t prepared.
Cancelling The Right To Dive Anyway
Under the various state and federal legislations covering workplace health and safety in Australia, a dive operator (and their agents) has the power to exclude any diver from participating in diving activities, regardless of whether or not they are in possession of a current Dive Medical Certificate.
Such decisions are rare and would only be made in the event that a risk assessment determined that any diver's health, safety and well-being was significantly at risk if that person was allowed to dive, and is usually related to an incident, illness or condition that has occurred, or become apparent, subsequent to the Dive Medical being taken, or a “low level” medical condition identified by the Dive Medical examination that could become a significant risk to the diver’s well-being due to unusual conditions at the dive site.