The SPUMS Diving Medical 1
THE RECREATIONAL DIVING MEDICAL
Accepted by the Committee at its meeting on February 3rd 1991
Published March 1992
Revised February 1996
(Statement of Health for Recreational Diving replaced Certificate of Fitness to dive)
Reprinted December 1996
Revised May 1999
Reprinted December 1999
South Pacific Underwater Medicine Society
(Incorporated in Victoria) A0020660B
ABN 29 299 823 713
C/o Australian and New Zealand College of Anaesthetists
630 St Kilda Road
Melbourne,
Victoria 3004, Australia
It is suggested that members have the three pages of the medical form reproduced as the form which they use for their diving medical examinations. The Statement of Health for Recreational Diving on page 11 should be
reproduced and used as a certificate of fitness to dive.
2 The SPUMS Diving Medical
APPENDIX A
PRE-DIVING MEDICAL EXAMINATION FOR RECREATIONAL DIVING
A1 INTRODUCTION
The medical criteria discussed in this Appendix are relevant only to examination of individuals
considering entry-level recreational scuba diving and are addressed to registered medical practitioners. The
medical criteria discussed in this Appendix are in no way exhaustive. The trained personnel doing the medicals
are expected to use their own discretion. Criteria for medical examination of persons intending to train for
occupational diving are given in AS 2299.
The medical examination shall be conducted by a medical practitioner who has done an approved course
of training for medically examining candidates for recreational diving training. In the absence of a relevant
regulatory authority, the Board of Censors of the South Pacific Underwater Medicine Society Incorporated
(SPUMS) shall be the authority approving courses. Courses which have been approved at May 1999 are given
in Paragraph A 5.
NOTE
SPUMS publishes a list of SPUMS members who have received appropriate qualifications and who do
diving medicals. This list is posted on the SPUMS Website at http://www.SPUMS.org.au.
In the event of any difficulty in interpreting the Standards or if it is considered that the applicant may not
be suitable for diving, the candidate should be referred to a specialist diving physician, one who holds the
Diploma of Diving and Hyperbaric Medicine (DDHM) or an acceptable overseas equivalent, who may also, if
appropriate, refer to a specialist in the medical area under question, e.g. otologist, cardiologist, respiratory
physician, if such a specialist also has an appreciation of the requirements of compressed air diving.
The examination shall be carried out before the candidate first uses compressed air underwater.
Preferably it should be carried out prior to commencement of any training in case a decision of unfitness
disqualifies the candidate.
Results of the chest X-ray and specialist tests or opinion, if necessary, should be available at the time of
examination and shall be known before a certificate of fitness to dive is issued.
The record of examination shall be retained by the medical practitioner. A certificate of fitness, unfitness
or temporary unfitness pending further examination, to dive shall be forwarded directly to the diving school. A
typical medical form with the certificate at the end is shown in Appendix B. Any medical problems, likely to
influence the diver’s safety should be included in the section marked “Advice” on the fitness to dive certificate.
The training establishment shall hold a record of the date of certification of fitness to dive, and the name
and address of the medical practitioner who performed that examination.
A2 NEED FOR FITNESS CRITERIA
Although recreational diving may be undertaken in a relatively non-arduous fashion, survival of
unexpected emergencies underwater, or on the surface will depend upon training, mental stability, and
physical and medical fitness.
Physical fitness in not synonymous with fitness to dive. Any disorder which causes an increased risk of
sudden death, impaired consciousness, impaired judgement, risk of disorientation, impaired mobility, risk of
barotrauma and risk of decompression sickness may render a person unfit for scuba diving.
The SPUMS Diving Medical 3
Divers are exposed to pressures and related physiological changes which do not apply to persons
involved in other activities. Ambient pressure at 10 m depth in seawater is double that at the surface, and
pressure changes capable to causing tissue tearing in unvented lung regions can occur upon ascent from as
little as 1 m depth.
As diving is carried out in a non-respirable environment, any loss of consciousness is likely to result in
drowning.
Specific standards are therefore required. Certain conditions are absolute contraindications to diving.
(Some relative contraindications exist which may not permanently preclude diving.) If in the course of a
medical examination such risk factors are identified, the prospective diver must be told of the condition(s) and
informed as to the hazards and advisable restrictions associated with these conditions as regards diving.
A3 “CONDITIONAL” CERTIFICATES and ADVIS0RY NOTES
Conditional certificates should not be given. Advice with regard to limitations may be given to
the candidate and should be written on the medical certificate as advice only.
Limitations may be applied to depths in excess of 18 metres, or decompression requirements, as long as
these restrictions do not prevent the candidate from being certified according to the instructor organisation’s
requirement. Any restrictions relating to depth in excess of 18 m shall be provided in the “advice” section of the
medical certificate.
NOTE: As the greatest proportionate pressure changes occur in water close to the surface, certificates
restricting candidates to shallow water only, or interim certificates for “training dives only” are not allowable.
Severe pulmonary overpressure incidents have occurred in as little as 1 m of water.
A4 FITNESS CRITERIA
A4.1 General
The bodily systems outlined in Paragraph A4.2 to A4.14 should be evaluated from the diver’s history and
the medical examination. The Example Form and Medical Certificate given in Appendix B may be copied for
use by medical practitioners. The information and questions on the form shown in Appendix B shall form the
minimum content of any alternative form used for recording the medical examination.
A4.2 Age
The minimum age for entry level scuba diving should be 14 years. Children between the ages of 14 and
16 shall only be medically examined after consultation by the doctor with a parent or guardian to establish the
child’s physical and psychological maturity. Between the ages of 16 and 18 it is preferable to consult with a
parent or guardian before medically examining the child. No upper age limit applies provided that all medical
standards can be met.
The cardiovascular fitness and pulmonary reserves of persons over 45 years of age should be examined
carefully; emergency situations may demand a high degree of fitness. In addition, older divers have an
increased susceptibility to dysbaric illness and cardiac death. A reduction in decompression stress is
required with increasing age.
A4.3 General Fitness
Consideration must be given to the candidate having adequate reserves of physical fitness to cope with
unexpected demands inflicted by adverse weather or sea conditions, surfacing away from a boat, having to aid
a distressed buddy, or other emergencies.
A4.4 Obesity
Obesity may imply a lack of physical fitness and also represents a particular hazard to divers by causing
increased risk of decompression sickness. Reduction in decompression stress is required with obesity.
4 The SPUMS Diving Medical
A4.5 Vision
Although methods of using corrective lenses underwater are available, unaided vision should be
adequate to allow location of a dive boat or a diver’s buddy if a diver surfaces without mask and/or corrective
lenses. Corrected near-vision shall allow reading of gauges, timing devices and decompression tables. A risk
of corneal ulceration exists if non-permeable contact lenses are used.
A4.6 Ear, nose and throat
(a) Both tympanic membranes should be seen to be intact and mobile. The Eustachian tubes must be
patent.
(b) Any evidence of chronic outer or middle ear discharge may be cause for rejection.
(c) Any evidence of chronic or recurrent sinusitis, catarrh or severe allergic conditions of the respiratory
tract may be a cause for rejection.
(d) Any history of middle ear surgery (including tympanoplasty) should be referred for diving specialist
opinion before any decision is made.
(e) Audiometry. Baseline audiometric examinations should be done. The audiogram shall be conducted
at 500, 1,000, 2,000, 4,000, 6,000 and 8,000 Hz. An abnormal audiogram should be noted in the diver’s log
book. If there are any significant abnormalities in either audiometry or labyrinthine function the patient should
be referred to a diving specialist.
Hearing loss is not necessarily a contraindication to diving.
NOTE: The middle ears and sinuses will develop problems on descent unless the pressure in these
spaces equals ambient. There is no way of establishing the patency of sinus ostia by clinical examination.
However, patency of the Eustachian tubes, and so the ability to equalise the middle ear pressures, can be
established. Observation of the tympanic membranes while the patient holds his (or her) nose, shuts the
mouth and blows (Valsalva manoeuvre) will show entry of air to the middle ear by movement of the drum. The
Eustachian tube opening in the naso-pharynx is normally closed. Swallowing opens the ostium. Therefore, a
combination of a Valsalva and swallowing during the manoeuvre will give the best chance for air to travel up the
Eustachian tube. Another way of opening the Eustachian tube is to protrude and wriggle the jaw from side to
side while performing a Valsalva manoeuvre. Failure to auto-inflate a middle ear is an absolute bar to diving
until the person can auto-inflate.
A4.7 Dental
Dental fitness, dental plates and jaw function should be assessed for ease of retention of a diving
regulator or snorkel mouthpiece. Carious teeth, or teeth with incompletely filled caries are at risk of dental
barotrauma. Recent extractions can lead to air entering the tissues and causing subcutaneous emphysema.
A4.8 Central Nervous System
(a) A full examination of the central nervous system should show normal function. Any abnormalities
should be accurately documented for future reference.
(b) A candidate with a history of fits (apart from childhood febrile convulsions), or unexplained blackouts,
or a history of migraine requires further assessment.
(c) Candidates with a history of head injury involving significant unconsciousness or concussion
associated with repeated headaches, or intra-cranial surgery should be individually assessed by a neurologist.
(d) The Modified Sharpened Romberg test is useful in assessing vestibular and cerebellar function, and
should be tested as a baseline. This test is performed by having the candidate stand on a hard floor, barefoot,
with the feet, heel to toe, in a straight line, with arms crossed on the chest. When steady in this position the
eyes are closed. From the time the eyes are closed the ability to maintain balance is timed and recorded in
seconds, e.g. the number of seconds the position is maintained. If the candidate fails to maintain the position
for 60 seconds the test is repeated as often as necessary to establish a reproducible result. This is necessary
as there is a learning curve which is much assisted by the candidate relaxing.
The SPUMS Diving Medical 5
A4.9 Cardiovascular System
(a) A full examination of the CVS should be normal. There must be no evidence of heart disease or
arrhythmias. Any abnormalities should be fully investigated.
(b) The resting blood pressure should not exceed 150/95 mm Hg.
(c) Further cardiovascular assessment, including ECG, exercise ECG, or specialist opinion may be
indicated where any doubt concerning a candidate’s cardiac fitness for exercise exists. The exercise ECG may
be a valuable addition to the medical examination of all divers over the age of 45 and even those younger
where significant coronary risk factors are present. These factors include obesity, smoking, elevated serum
lipids and positive family history.
A4.10 Respiratory System
(a) A full history and examination should be normal. Any abnormal findings should be fully investigated.
Such investigations should include provocation testing if any doubt concerning the possibility of bronchial
hyperreactivity exists.
Particular attention must be paid to any condition that might cause retention and trapping of expanding
gas in any part of the lungs during decompression ( e.g. asthma).
(b) The following conditions may disqualify:
(i) Any chronic lung disease, past or present.
(ii) Any history of spontaneous pneumothorax, penetrating chest injuries, or open chest surgery.
(iii) Any fibrotic lesion of the lung that may cause generalised or localised lack of compliance in lung
tissue.
(iv)Any evidence of obstructive airways disease e.g. current asthma, chronic bronchitis, allergic
bronchospasm.
In cases of doubt, specialist medical opinion should be sought. Such opinion should include provocation
testing if any doubt concerning the possibility of bronchial hyperreactivity exists.
(c) A full plate postero-anterior chest X-ray shall be performed on all candidates who have a significant
past or present history of respiratory diseases, a family history of respiratory disease, abnormalities in the
respiratory system on clinical examination or an abnormal pulmonary function test (see A4.10 d). If there is no
history of cardio-respiratory disorders, a normal physical examination and normal lung function tests a chest
X-ray may not be required.
(d) Pulmonary Function Tests shall be measured by equipment capable of reading to 7 litres.
(i) All divers shall have a pulmonary function test to establish Forced Expiratory Volume at 1 second
(FEV1) and Forced Vital Capacity (FVC).
(ii) A FVC or FEV1 of more than 20 percent below predicted values and/or FEV1/FVC ratio of less
than 75 percent requires further assessment.
A4.11 Gastro-intestinal Tract
(a) A full history and examination should be normal. Any abnormal findings should be fully investigated.
(b) Any abdominal herniation may be a cause for rejection until satisfactory treatment has taken place.
Candidates should be free of significant acute or chronic gastro-intestinal problems that may cause an acute
crisis, or which might cause incapacity in a remote situation (e.g. peptic ulceration). Specialist opinion should
be sought if required.
A4.12 Musculo-skeletal
Any impairment of musculo-skeletal function should be carefully assessed against the potential
requirements of emergency situations which might occur in the water. The mass of diving equipment out of the
water can represent a significant hazard to those with pre-existing back or other joint injury or disease.
6 The SPUMS Diving Medical
A4.13 Female
The safety of diving while pregnant has not been established. Risks of diving to the foetus are under
investigation, but pregnancy shall be considered a contraindication to diving.
A4.14 General
(a) Dip-stick test of urine shall be performed and urine tested for albumin and sugar. Glycosuria calls for
investigation before acceptance. Albuminuria may be innocent, but acceptance should be considered after 24
hour protein excretion studies. Any abnormal findings should be fully investigated.. Diabetes requiring
medication with insulin is a contraindication to diving. Any haematological abnormality should be fully
assessed.
(b) Candidates taking medication of any type, including non-prescription drugs, require individual
consideration. Many medications have altered effects or risks underwater, or may increase decompression
sickness risk, or the effects of nitrogen narcosis. Drugs that affect the cardiovascular, respiratory or
neurological system, may be contraindicated. In particular, cardiac or central nervous system drugs require
careful assessment.
(c) Cigarette smoking has deleterious effects on cardiac, pulmonary and upper respiratory systems and
should be strongly discouraged in divers.
(d) The effects of alcohol can be detrimental to divers, increasing the tendency to vomiting, narcosis,
dehydration and decompression illness. Dehydration following alcohol intake is a risk factor for
decompression illness.
NOTE: Medical practitioners without training in diving medicine should not perform diving
medicals. If for some reason the medical has to be done by someone untrained in this field, then any
abnormalities detected, on either history or examination, should result in the candidate being made
unfit to dive, until specialist medical advice, or an examination by a medical practitioner with training in
diving medicine, has been obtained.
A 5 QUALIFICATIONS REQUIRED FOR MEDICAL PRACTITIONERS PERFORMING PRE-DIVING
MEDICALS ON ENTRY-LEVEL SCUBA DIVERS
Registered medical practitioners shall undergo accredited formal training and have verified capability of
performing diving medical examinations before carrying out pre-diving medicals in accordance with this
Standard (AS 4005.1).
The Censors of South Pacific Underwater Medicine Society Incorporated (SPUMS) approve
specific courses in the teaching of this skill. In May 1999 the Censors had approved the following courses:
Christchurch Hospital Basic Course
Diving Medical Centre Medical Examiner Course
Freemantle Hospital Medical Assessment of Divers Course
Institute of Naval Medicine (U.K.) Medical Examiner course
Royal Adelaide Hospital Basic Course
Royal Adelaide Hospital Advanced Course (preceded by the basic)*
Royal Australian Navy Diving Medical Course*
Royal New Zealand Navy Basic Course
School of Public Health and Tropical Medicine, James Cook University, Course in Diving Medicine
Townsville General Hospital Diving Medical Course
United States Navy Diving Medical Officer Course*
*denotes a course of at least 10 working days. It is a recommendation by SPUMS that only doctors who
have satisfactorily completed one of the courses marked by an asterisk perform occupational diving medicals,
AS 2299.
Note. The Diving Medical Centre Medical Examiner Course is designed for the examination of recreational
divers.
The SPUMS Diving Medical 7
It is likely that other courses of equal standing will be approved in the future. As a general rule for
approval, at least 12 hours of any diving medicine course to be approved, should be spent specifically on the
requirements of the diving medical examination. This 12 hours does not include a description of diving
medicine, diving physics, etc. Any such course should also be under the control and instruction of specialist
diving physicians.
Courses in introductory diving medicine, such as the Resort Medical Diving Courses and many of the
others throughout the world, would not be accepted, on the basis that these are not specifically designed to
teach doctors the techniques and complexities of diving medical examinations. Many of these courses bear no
relationship to the Australian Standards required.
Special application can be made to SPUMS for recognition of training in underwater medicine.
The address of Board of Censors of SPUMS is
C/o Australian and New Zealand College of Anaesthetists,
630 St Kilda Road,
Melbourne, Victoria 3004, Australia.
8 The SPUMS Diving Medical

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APPENDIX B
PRE-DIVE MEDICAL FORM FOR PROSPECTIVE ENTRY-LEVEL SCUBA DIVERS
The first two pages to be completed by candidate.
1 Surname Other Names 2 Date of Birth
4 Sex: Male Female
3 Address
5 Telephone (Home)
6 Principal Occupation 7 Telephone (Work)
8 Intended Dive School
9 Do you participate in any regular physical activity? Yes No
10 Description of activity
11 Do you smoke? If so how many a day. Yes No
12 Do you drink alcohol? Yes No
13 How many drinks a week?
14 Are you taking any tablets, medicines or drugs? Yes No
List:
15 Do you have any allergies? Yes No
Details:
16 Have you had any reactions to drugs or medicines or foods? Yes No
Details:
Have you ever had or do you now have any of the following? Tick Yes or No.
Yes No Notes on History
17 Previous diving medical
18 Prescription glasses
19 Contact lenses
20 Eye or visual problems
21 Hay Fever
22 Sinusitis
23 Other nose or throat problem
24 Dentures/Plates, etc.
25 Recent dental procedures
26 Deafness or ringing noises in ear(s)
27 Discharging ears or other infections
28 Operation on ears
29 Giddiness or loss of balance
30 Severe motion sickness
31 Seasickness medication
32 Problems when flying in aircraft
33 Severe or frequent headaches
34 Migraine
35 Fainting or blackouts
36 Convulsions, fits or epilepsy
37 Unconsciousness
38 Concussion or head injury
39 Sleep-walking
40 Severe depression
41 Claustrophobia
42 Mental illness
43 Heart disease
44 Abnormal blood test
45 ECG (Heart tracing)
46 Awareness of your heart beat
47 High blood pressure
48 Rheumatic fever
49 Discomfort in your chest with exertion
50 Short of breath on exertion
51 Bronchitis or pneumonia
52 Pleurisy or severe chest pain
53 Coughing up phlegm or blood
The SPUMS Diving Medical 9
Yes No
54 Chronic or persistent cough
55 TB
56 Pneumothorax (“collapsed lung”)
57 Frequent chest colds
58 Asthma or wheezing
59 Use a puffer
60 Other chest complaint
61 Operation on chest, lungs, or heart
62 Indigestion, peptic ulcer or acid reflux
63 Vomiting blood or passing red or black motions
64 Recurrent vomiting or diarrhoea
65 Jaundice, hepatitis or liver disease
66 Malaria or other tropical disease
67 Severe loss of weight
68 Hernia or rupture
69 Major joint or back injury
70 Limitation of movement
71 Fractures (broken bones)
72 Paralysis, muscle weakness or numbness
73 Kidney or bladder disease (cystitis)
74 Any chronic disease (see note below)
75 Any sexually transmitted disease
76 Diabetes
77 Blood disease or bleeding problem
78 Skin disease
79 Contagious disease
80 Operations
81 In hospital for any reason
82 Life insurance rejected
83 A job or licence refused on medical grounds
84 Unable to work for medical reasons
85 An invalid pension
86 Other illness or injury or any other
medical conditions
Have any blood relations had
87 Heart disease
88 Asthma or chest disease
89 TB
Females Only
90 Are you now pregnant or planning to be?
91 Do you have any incapacity during periods?
92 Date of most recent chest x-ray
Previous Diving Experience Yes No
93 Can you swim?
94 Have you ever had any problem 99 Year trained
during or after swimming or diving? 100 Approximate number of dives
95 Have you ever had to be rescued? 101 Maximum depth of any dive
96 Do you snorkel dive regularly? 102 Longest duration of any dive
97 Have you tried scuba diving before?
98 Have you had previous formal scuba training?
I certify that the above information is true and complete to the best of my knowledge and I hereby authorise
Dr ......................................... to give medical opinion as to my fitness, or temporary or permanent unfitness to dive to my
diving instructor. I also authorise him or her to obtain or supply medical information regarding me to other doctors as
may be necessary for medical purposes in my personal interest.
Signed: Date:
Note
Any chronic disease, such as hepatitis A, B, C, AIDS or tuberculosis, may increase your risks from diving. If you
have a chronic disease please discuss it with the doctor who will then be able to advise you whether you will be at
increased risk.
10 The SPUMS Diving Medical
MEDICAL EXAMINATION: To Be Completed By An Approved Medical Practitioner.
1 Height 2 Weight 3 Visual Acuity 4 Blood Pressure 5 Pulse
R6/ Corrected 6/
cm kg L6/ Corrected 6/
6 Urinalysis 7 Respiratory function test (Measured by 8 Chest x-ray (if indicated)
equipment capable of reading to 7 litres) Date
Albumen Vital capacity Place
Glucose FEV1
Percentage Result
9 Audiometry (air conduction)
Frequency, Hz 500 1,000 2.000 4,000 6,000 8,000
Loss in DB(R)
Loss in DB(L)
If abnormal enter in diver’s log book and on certificate
Clinical Examination/Assessment
Normal Abnormal Notes on Abnormalities
10 Nose, septum, airway
11 Mouth, throat, teeth, bite
12 External auditory canal
13 Tympanic membrane
14 Middle ear auto-inflation
15 Neurological
Eye movements
Pupillary reflexes
Limb reflexes
Finger-nose
Sharpened Romberg
16 Abdomen
17 Chest auscultation
18 Cardiac auscultation
19 Other abnormalities
20 ECG if indicated
MEDICAL FITNESS TO DIVE
No contraindications Advice put on certificate
Temporary contraindications (detail)
Permanent contraindications (detail)
Printed Name
Signed Date
The SPUMS Diving Medical 11
STATEMENT OF HEALTH FOR RECREATIONAL DIVING
This Section to be completed by a Medical Practitioner with appropriate training diving medicine.
This is to certify that I have today interviewed and examined:
Name........................
Address.....................
................................
Date of birth................../................./................
Initial the statements that apply:
........... I have assessed the candidate in accordance with AS 4005.1.
........... I can find no conditions which are incompatible with compressed gas, scuba and surface supplied breathing
apparatus (SSBA) and or breath-hold diving.
............ I have explained the health risks of diving disclosed by this examination to the candidate and we have discussed
how these risks may be reduced. The candidate appears to have a good understanding of these risks.
........... Based upon my assessment, the candidate should not dive with compressed gases (Scuba and SSBA).
........... Based upon my assessment, the candidate should not breath-hold dive.
Advice:
.......................................................... .........../.........../...........
(Signature of Medical Practitioner) (Date)
(Name, address and telephone number of the Medical Practitiioner)
This Section to be completed by the Candidate.
Initial the statements that apply:
........... I understand the health risks that I may encounter in diving and how these risks may be reduced.
........... I also understand that the Medical Practitioner’s recommendation herewith is based, in part, upon the disclosure
of my medical history.
........... I agree to accept any responsibility and liability for health risks associated with my participation in underwater
diving, including those that are due to or are influenced by a change in my health and or my failure to disclose
any existing or past health condition to the Medical Practitioner.
........... I hereby authorise the medical practitioner to supply information with regard to my medical fitness to dive to
the diving instructor.
.......................................................... ..................................................... ........../............/...........
(Signature of Candidate) (Name of Candidate) (Date)

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