HAR DU DYKKERCERTIFIKAT, SÅ LÆS HER

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1 Dykkerinfo for Sharm el Sheikh og Dahab For at sikre at du får det bedste ud af din dykkerrejse har vi samlet en række praktiske råd og nyttige informationer. Læs dem før du rejser! Har du husket certifikat og logbog? Husk at medbringe både dit dykkercertifikat og din logbog uden dem ingen dykning! Husk også dit nitroxcertifikat, hvis du ønsker at dykke med nitrox. Er helbredet i orden? Før du kan få lov at dykke, skal du bl.a. underskrive en helbredserklæring. Vi har vedlagt en pdf af helbredserklæringen, så du kan læse den på forhånd. Bemærk, at kun side 1 skal udfyldes, hvis du allerede har certifikat, mens også side 2 skal udfyldes, hvis du skal tage certifikat. Svarer du ja til et af spørgsmålene, bør du opsøge din læge for at få skriftligt bekræftet, at du er i stand til at dykke. Har du tegnet forsikring? En tur i trykkammer koster ca kr., et hospitalsophold endnu mere og en redningshelikopter et astronomisk beløb. Mere end 20% af al bagage på verdensplan kommer med et andet fly, end det den skulle. Bemærk at flyselskabet ikke dækker for dykkerudstyr, der bliver skadet under transporten, med mindre du har pakket dykkerudstyret separat og betalt kr. for det som specialbagage. Rejseforsikringer kan købes gennem Atlantis Rejser. Tilladelse til specialbagage hos Jet Time købes på deres hjemmeside og hos SAS ved check-in i lufthavnen. Hvad må jeg have med på flyet? Der må på både SAS og Jet Time højst medbringes 25 kg bagage inkl. 5 kg håndbagage. Medbringer du egen dykkerflaske, skal bagagen checkes in som specialbagage, hvilket koster kr. ekstra, som du selv skal betale hhv. på Jet Time s hjemmeside eller direkte til SAS ved check-in. Medbringer du dykkerlygte, skal lygte og batterier være adskilt under flyvningen af sikkerhedsgrunde. Dykkerflasker skal være tomme. Bagagehåndteringen kan være voldsom, så anbring kamera, regulatorsæt og andet kostbart udstyr i håndbagagen. Hvad med udstyr? Al dykning inkluderer fyldt 12 ltr. tank og bly. Der dykkes oftest med aluminiumsflasker. Alt andet udstyr er ikke inkluderet i prisen men kan evt. lejes gennem dykkercentret. Vedhæftet finder du en liste med aktuelle priser på leje af udstyr. Eneste undtagelser er Scuba Review og PADI Open Water Diver og Advanced-kurser, hvor fuldt udstyr er inkluderet i prisen under kurset. Du er selv ansvarlig for sikker opbevaring og for forsikring af dit eget udstyr. Og du hæfter selv for lejet udstyr. Vælger du at holde en dags pause i dykningen, skal udlejningsudstyr afleveres i de dage, du ikke dykker. HAR DU DYKKERCERTIFIKAT, SÅ LÆS HER Skal jeg have et check dive? Er det mellem 6 og 12 måneder siden, du har dykket sidst, kan dykkercentret kræve, at du tager et Check Dive, inden du kan begynde almindelig dykning. Under Check Dive tjekker en instruktør dine grundlæggende dykkerfærdigheder, og det foregår normalt på båden den første dykkerdag. Se vedlagte prisliste for henholdsvis Sharm el Sheikh og Dahab. Skal jeg have et Scuba Review? Er det mere end 12 måneder siden, du sidst har dykket, skal du tage et Scuba Review, før du får lov at dykke i Sharm el Sheikh. Scuba Review er et genopfriskningskursus, der varer en hel dag. Det består af teori og øvelser i åbent vand. Scuba Review skal forudbestilles hjemmefra af hensyn til reservation af instruktøren. Du kan kombinere en dags Scuba Review med fire dages dykning. Hvad er ikke inkluderet i dykning? Udstyr ud over tank og bly er ikke inkluderet i prisen. Hertil kommer obligatorisk trykkammerafgift på 1 pr. dykkerdag (NB! Dette er ikke forsikring) samt evt. entré til Ras Mohamed National Park på 5. Disse udgifter betales lokalt. Check Dive og Scuba Review købt lokalt koster ekstra og afregnes direkte til dykkercentret. Se prislisten. Frokost (25 LE, frivillig) og drikkevarer (20 LE, obligatorisk) på båden ved dagsdyk er ikke inkluderet men købes direkte hos bådens besætning. Vi tager forbehold for prisændringer. Hvad er det for et dykkercenter, jeg skal dykke med? I Sharm el Sheikh samarbejder Atlantis Rejser med Dive Center Werner Lau ved dykkerkurser og dagsdykning, og Sinai Divers, King Snefro samt Colona Dive Center ved liveaboards. Hvilket center, du skal dykke med, får du oplyst ved ankomst. I Dahab bruger vi Sinai Divers. Alle centre er udenlandsk ejede PADI-centre. Hvornår starter min dykning? Som udgangspunkt starter al dagsdykning dagen efter ankomsten. Ønsker du at starte din dykning på et senere tidspunkt, skal dette på forhånd aftales med Atlantis Rejser. Har du købt én uge med 5 dages dykning, kan starttidspunktet dog ikke ændres, da der ikke bør dykkes senere end 24 timer før en flyrejse. Vi beder dig informere os om din dykkerstatus (certifikattype, antal loggede dyk og dato for sidst registrerede dyk), så din dykning kan blive planlagt bedst muligt. Hvordan finder jeg dykkercenteret? Dykkercenteret finder dig. Ved ankomsten i Sharm el Sheikh får du et brev med afhentningstider fra dit hotel, mødested m.m. Er du i tvivl om noget, når du ankommer, så ring og spørg vores rejseledere vores servicetelefonnummer i Sharm el Sheikh er Ved henvendelse skal du have dit rejsebevisnummer klar, så de evt. kan slå din booking op i vores bookingsystem. Hvad inkluderer et dagsdyk i Sharm el Sheikh? Alle dagsdyk inkluderer to dyk fra båd på de lokale rev ved Sharm el Sheikh. Ønsker du at dykke i Ras Mohamed eller i Tiranstrædet koster det 5 ekstra; du kan kun deltage, hvis kvalifikationerne er tilfredsstillende, og du har dykket lokalt først. Et evt. tredje dyk på dagsturen bestilles og betales lokalt. Hvilke dyk er indeholdt i 5 dages dykkerpakken? Første dag starter med et Check Dive på et af de lokale rev, hvor dykkercentret vurderer dine dykkerfærdigheder. Bemærk at de kan vurdere, at du har behov for et Scuba Review, før du får lov til at deltage i den videre dykning. De fire øvrige dage dykkes der dels lokalt samt i Ras Mohamed og i Tiranstrædet, såfremt kvalifikationerne er tilfredsstillende. Kan jeg bestille mere dykning i Sharm el Sheikh? I prislisten finder du priser på ekstra dykning, vragdyk, kurser m.m. samt information om de ekstra udgifter, der ikke er inkluderet i rejsens pris. Alle ekstraydelser betales kontant i Sharm el Sheikh. Ekstra dykning kan med fordel bestilles og betales hos Atlantis Rejsers rejseledere, der har daglige træffetider på hotellerne. Bestillingen kan kun ske ved personlig henvendelse. Træffetiderne finder du på vores opslagstavle og i infomappen på dit hotel. Dykning, der købes direkte hos dykkercentrene, er til dykkercenterets almindelige listepriser, der er op til 30% dyrere, end hvis du køber gennem Atlantis Rejser.

2 Kan jeg holde pause mellem mine dykkerdage? Så længe du overholder reglen om ikke at dykke 24 timer før flyafgang, kan du holde pauser fra dykningen og fordele dykkedagene, som du vil. Du skal aftale pausen med dykkercentret eller dykkerguiden senest kl.12 dagen før. Husk også at aftale, hvornår du ønsker at starte igen, senest dagen før kl.12. Er Thistlegorm og Dunraven inkluderet i dagsdyk? Nej. Men hvis din dykkerstatus er til det, kan du enten tilkøbe disse vragdyk eller bytte en af dine dykkerdage ud med et af vragene mod tillæg. Dette bestilles og betales direkte hos dykkercentret. Se prislisten. Hvad skal jeg have med på en liveaboard? Medbring evt. udstyr, håndklæde, solcreme, shorts, T-shirts, badetøj samt i vinterhalvåret varmt tøj. Vi anbefaler på det kraftigste, at du selv medbringer en dykkercomputer. Du har selv ansvaret for dine bundtider og dybder, og dykkercentret har kun få dykkercomputere til udlejning. Vi anbefaler ligeledes, at du selv medbringer dykkerlygte og deko-bøje (SMB), da disse er forholdsvis dyre at leje. Du bliver normalt kørt fra lufthavnen til dykkercentret og efter indskrivning og evt. leje af udstyr videre til liveaboard-båden. Der er ikke mulighed for at købe ind undervejs, så medbring alt hvad du har brug for af reservedele, film, solbriller m.m. hjemmefra. Du kan veksle til egyptiske pund i lufthavnen i Sharm el Sheikh, men ud over drikkepenge til besætningen er der ikke meget at bruge kontanter til ombord. Hvad inkluderer en liveaboard? En liveaboard inkluderer dykning på lokale rev ved Sharm el Sheikh, i Ras Mohamed og Tiranstrædet samt vragdykning typisk på Thistlegorm og evt. et eller to andre vrag. 3-4 dyk pr. dag. Ruten, dykkerseværdighederne og dykningen er helt afhængig af vind, vejr, strømforhold, guidens valg og dykkergruppens erfaring. Efter liveaboard-turen bliver du kørt fra dykkercentret og afhængig af program til dit hotel eller til lufthavnen. Er du på 7 nætters liveaboard er det ikke ualmindeligt, at der undervejs lægges til i Sharm el Sheikh for at sætte gæster på 3 nætters-turen af samt for at proviantere. Er du på 3 nætters liveaboard inkluderer det efter selve liveaboard-turen 2 dages båddykning med 2 dyk pr. dag. Liveaboard inkluderer også helpension og vand ad libitum, mens sodavand og øl m.m. kan købes ombord. Ekstraydelser som udstyr, nitrox, kurser, trykkammerafgift, nationalparkafgift, øl, sodavand og vin afregnes direkte med båden eller dykkercentret efter endt liveaboard. Skal du til Dahab eller dykke Best of Sinai? Efter at have mødt vores rejseledere i lufthavnen køres du igennem ørkenen langs Sinais østkyst til Dahab. Turen tager ca. 1-1,5 time. Atlantis Rejser har ingen repræsentant i Dahab, så her er dykkercentret din faste kontakt mht. dykning og overnatninger samt information om din hjemrejse/videre rejse mm. Opholdet inkluderer for 1 uges rejse 5 dages dykning og for 2 ugers rejse 10 dages dykning. 2 dyk pr. dag. Husk at for at dykke Best af Sinai skal du have Advancedcertifikat el. tilsv. og minimum 25 loggede dyk. Du skal påregne 4-5 dages undervisning og øvelser fra ca. kl. 9 om morgenen til sidst på eftermiddagen. Og der skal laves lektier til næste dag. FOR ALLE Hvad er det, der står med småt? Forudbestilte dyk kan ikke aflyses og refunderes ikke pga. sygdom, med mindre din rejseforsikring dækker dette. De kan heller ikke overdrages til andre, og du kan ikke bytte forudbestilte dyk til at betale f.eks. Check Dive eller Scuba Review, leje af udstyr eller lignende. Må ikke-dykkere komme med på båden? Rejser du med en, der ikke dykker, men som gerne vil med på en dagstur, kan det som regel lade sig gøre. Der skal blot bestilles plads som snorkler på dykkerbåden, og det betales direkte til dykkercentret. Hvordan afregner jeg med dykkercentret? Dykkercentret tager ved dykningens start en kopi af dit kreditkort. Inden du rejser hjem, skal du udskrives fra dykkercentret og betale evt. ekstraregninger. Hos alle dykkercentrene kan du betale med fx Visakort eller kontant fx eller US$. Dykkercentret opbevarer dit dykkercertifikat i hele den periode, du dykker med dem; husk at få det med hjem igen. Hvilke regler er der for miljøet ved Rødehavet? Undervandsmiljøet i Rødehavet er meget skrøbeligt, så derfor Take nothing and leave only bubbles. Du risikerer en stor bødestraf, hvis du forsøger at udføre koraller, skaller eller effekter lavet af truede dyrearter som f.eks. havskildpadde. Hvad hvis jeg er utilfreds med noget? Påpeg fejl eller mangler direkte på stedet til dykkercentret eller vores danske rejseledere. Hvis du venter, til du kommer hjem, er det jo for sent for os at gøre noget for at afhjælpe problemet. VIGTIGE TELEFONNUMRE Alle dykkercentre har åbent fra 8-18 hele ugen igennem. Hvis du ringer fra en dansk mobiltelefon, skal du sætte 0020 foran nummeret (og fjerne nullet i parentesen). Werner Lau: (0) Sinai Divers i Sharm: (0) Sinai Divers i Dahab: (0) King Snefro: (0) Colona i Sharm: (0) Atlantis Rejsers servicetelefon i Sharm el Sheikh (0) Venlig hilsen SKAL DU TAGE BEGYNDERKURSUS, SÅ LÆS HER Hvad inkluderer et PADI Open Water Diver-kursus? Et begynderkursus inkluderer komplet udstyr: Tank, bly, våddragt, BCD, regulator, konsol, maske, snorkel og finner. Gebyr for udstedelse af certifikat er ikke inkluderet i prisen men koster ca. 35, der betales til dykkercentret. Kursusmaterialerne fra PADI er heller ikke inkluderet men er obligatoriske for at deltage i kurset. Materialer på dansk kan købes hjemmefra hos Atlantis Rejser for 435 kr. + evt. porto. Som udgangspunkt foregår undervisning på engelsk, men Werner Lau har også danske instruktører, og vi gør alt, hvad vi kan for, at du får en dansk instruktør. Før kursets start skal du bestå en svømmeprøve og underskrive en helbredserklæring uden dette intet dykkerkursus.

3 Please read carefully before signing. This is a statement in which you are informed of some potential risks involved in scuba diving and of the conduct required of you during the scuba training program. Your signature on this statement is required for you to participate in the scuba training program offered by and Instructor located in the Facility city of, state/province of. Read this statement prior to signing it. You must complete this Medical Statement, which includes the medical questionnaire section, to enroll in the scuba training program. If you are a minor, you must have this Statement signed by a parent or guardian. Diving is an exciting and demanding activity. When performed correctly, applying correct techniques, it is relatively safe. When Divers Medical Questionnaire To the Participant: The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in dive activities. Could you be pregnant, or are you attempting to become pregnant? Are you presently taking prescription medications? (with the exception of birth control or anti-malarial) Are you over 45 years of age and can answer YES to 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 high blood pressure diabetes mellitus, even if controlled by diet alone Have you ever had or do you currently have Asthma, or wheezing with breathing, or wheezing with exercise? Frequent or severe attacks of hayfever or allergy? Frequent colds, sinusitis or bronchitis? Any form of lung disease? Pneumothorax (collapsed lung)? Other chest disease or chest surgery? Behavioral health, mental or psychological problems (Panic attack, fear of closed or open spaces)? Epilepsy, seizures, convulsions or take medications to prevent them? Recurring complicated migraine headaches or take medications to prevent them? Blackouts or fainting (full/partial loss of consciousness)? Frequent or severe suffering from motion sickness (seasick, carsick, etc.)? MEDICAL STATEMENT Participant Record (Confidential Information) established safety procedures are not followed, however, there are increased risks. To scuba dive safely, you should not be extremely overweight or out of condition. Diving can be strenuous under certain conditions. Your respiratory and circulatory systems must be in good health. All body air spaces must be normal and healthy. A person with coronary disease, a current cold or congestion, epilepsy, a severe medical problem or who is under the influence of alcohol or drugs should not dive. If you have asthma, heart disease, other chronic medical conditions or you are taking medications on a regular basis, you should consult your doctor and the instructor before participating in this program, and on a regular basis thereafter upon completion. You will also learn from the instructor the important safety rules regarding breathing and equalization while scuba diving. Improper use of scuba equipment can result in serious injury. You must be thoroughly instructed in its use under direct supervision of a qualified instructor to use it safely. If you have any additional questions regarding this Medical Statement or the Medical Questionnaire section, review them with your instructor before signing. Please answer the following questions on your past or present medical history with a YES or NO. If you are not sure, answer YES. If any of these items apply to you, we must request that you consult with a physician prior to participating in scuba diving. Your instructor will supply you with an RSTC Medical Statement and Guidelines for Recreational Scuba Diver s Physical Examination to take to your physician. Dysentery or dehydration requiring medical intervention? Any dive accidents or decompression sickness? Inability to perform moderate exercise (example: walk 1.6 km/one mile within 12 mins.)? Head injury with loss of consciousness in the past five years? Recurrent back problems? Back or spinal surgery? Diabetes? Back, arm or leg problems following surgery, injury or fracture? High blood pressure or take medicine to control blood pressure? Heart disease? Heart attack? Angina, heart surgery or blood vessel surgery? Sinus surgery? Ear disease or surgery, hearing loss or problems with balance? Recurrent ear problems? Bleeding or other blood disorders? Hernia? Ulcers or ulcer surgery? A colostomy or ileostomy? Recreational drug use or treatment for, or alcoholism in the past five years? The information I have provided about my medical history is accurate to the best of my knowledge. I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition. Signature Date Signature of Parent or Guardian Date PRODUCT NO (Rev. 9/01) Ver. 2.0 International PADI, Inc. 1989, 1990, 1998, 2001 Page 1 of 6 Recreational Scuba Training Council, Inc. 1989, 1990, 1998, 2001

4 STUDENT Please print legibly. Name Birth Date _ Age First Initial Last Day/Month/Year Mailing Address _ City State/Province/Region Country Zip/Postal Code Home Phone ( ) Business Phone ( ) FAX Name and address of your family physician Physician Clinic/Hospital _ Address Date of last physical examination _ Name of examiner Clinic/Hospital Address Phone ( ) Were you ever required to have a physical for diving? Yes No If so, when? PHYSICIAN This person applying for training or is presently certified to engage in scuba (self-contained underwater breathing apparatus) diving. Your opinion of the applicant s medical fitness for scuba diving is requested. There are guidelines attached for your information and reference. Physician s Impression I find no medical conditions that I consider incompatible with diving. I am unable to recommend this individual for diving. Remarks Date Physician s Signature or Legal Representative of Medical Practitioner Day/Month/Year Physician Clinic/Hospital_ Address Phone ( ) Page 2 of 6

5 Guidelines for Recreational Scuba Diver s Physical Examination Instructions to the Physician: Recreational SCUBA (Self-Contained Underwater Breathing Apparatus) can provide recreational divers with an enjoyable sport safer than many other activities. The risk of diving is increased by certain physical conditions, which the relationship to diving may not be readily obvious. Thus, it is important to screen divers for such conditions. The RECREATIONAL SCUBA DIVER S PHYSICAL EXAMINA- TION focuses on conditions that may put a diver at increased risk for decompression sickness, pulmonary overinflation syndrome with subsequent arterial gas embolization and other conditions such as loss of consciousness, which could lead to drowning. Additionally, the diver must be able to withstand some degree of cold stress, the physiological effects of immersion and the optical effects of water and have sufficient physical and mental reserves to deal with possible emergencies. The history, review of systems and physical examination should include as a minimum the points listed below. The list of conditions that might adversely affect the diver is not all-inclusive, but contains the most commonly encountered medical problems. The brief introductions should serve as an alert to the nature of the risk posed by each medical problem. The potential diver and his or her physician must weigh the pleasures to be had by diving against an increased risk of death or injury due to the individual s medical condition. As with any recreational activity, there are no data for diving enabling the calculation of an accurate mathematical probability of injury. Experience and physiological principles only permit a qualitative assessment of relative risk. For the purposes of this document, Severe Risk implies that an individual is believed to be at substantially elevated risk of decompression sickness, pulmonary or otic barotrauma or altered consciousness with subsequent drowning, compared with the general population. The consultants involved in drafting this document would generally discourage a student with such medical problems from diving. Relative Risk refers to a moderate increase in risk, which in some instances may be acceptable. To make a decision as to whether diving is contraindicated for this category of medical problems, physicians must base their judgement on an assessment of the individual patient. Some medical problems which may preclude diving are temporary in nature or responsive to treatment, allowing the student to dive safely after they have resolved. Diagnostic studies and specialty consultations should be obtained as indicated to determine the diver s status. A list of references is included to aid in clarifying issues that arise. Physicians and other medical professionals of the Divers Alert Network (DAN) associated with Duke University Health System are available for consultation by phone during normal business hours. For emergency calls, 24 hours 7 days a week, call or DAN (collect). Related organizations exist in other parts of the world DAN Europe in Italy , DAN S.E.A.P. in Australia and Divers Emergency Service (DES) in Australia , DAN Japan and DAN Southern Africa There are also a number of informative websites offering similar advice. NEUROLOGICAL Neurological abnormalities affecting a diver s ability to perform exercise should be assessed according to the degree of compromise. Some diving physicians feel that conditions in which there can be a waxing and waning of neurological symptoms and signs, such as migraine or demyelinating disease, contraindicate diving because an exacerbation or attack of the preexisting disease (e.g.: a migraine with aura) may be difficult to distinguish Page 3 of 6 from neurological decompression sickness. A history of head injury resulting in unconsciousness should be evaluated for risk of seizure. Complicated Migraine Headaches whose symptoms or severity impair motor or cognitive function, neurologic manifestations History of Head Injury with sequelae other than seizure Herniated Nucleus Pulposus Intracranial Tumor or Aneurysm Peripheral Neuropathy Multiple Sclerosis Trigeminal Neuralgia History of spinal cord or brain injury Temporary Risk Condition History of cerebral gas embolism without residual where pulmonary air trapping has been excluded and for which there is a satisfactory explanation and some reason to believe that the probability of recurrence is low. Any abnormalities where there is a significant probability of unconsciousness, hence putting the diver at increased risk of drowning. Divers with spinal cord or brain abnormalities where perfusion is impaired may be at increased risk of decompression sickness. Some conditions are as follows: History of seizures other than childhood febrile seizures History of Transient Ischemic Attack (TIA) or Cerebrovascular Accident (CVA) History of Serious (Central Nervous System, Cerebral or Inner Ear) Decompression Sickness with residual deficits CARDIOVASCULAR SYSTEMS The diagnoses listed below potentially render the diver unable to meet the exertional performance requirements likely to be encountered in recreational diving. These conditions may lead the diver to experience cardiac ischemia and its consequences. Formalized stress testing is encouraged if there is any doubt regarding physical performance capability. The suggested minimum criteria for stress testing in such cases is at least 13 METS.* Failure to meet the exercise criteria would be of significant concern. Conditioning and retesting may make later qualification possible. Immersion in water causes a redistribution of blood from the periphery into the central compartment, an effect that is greatest in cold water. The marked increase in cardiac preload during immersion can precipitate pulmonary edema in patients with impaired left ventricular function or significant valvular disease. The effects of immersion can mostly be gauged by an assessment of the diver s performance while swimming on the surface. A large proportion of scuba diving deaths in North America are due to coronary artery disease. Before being approved to scuba dive, individuals older than 40 years are recommended to undergo risk assessment for coronary artery disease. Formal exercise testing may be needed to assess the risk. * METS is a term used to describe the metabolic cost. The MET at rest is one, two METS is two times the resting level, three METS is three times the resting level, and so on. The resting energy cost (net oxygen requirement) is thus standardized. (Exercise Physiology; Clark, Prentice Hall, 1975.)

6 History of Coronary Artery Bypass Grafting (CABG) Percutaneous Balloon Angioplasty (PCTA) or Coronary Artery Disease (CAD) History of Myocardial Infarction Congestive Heart Failure Hypertension History of dysrythmias requiring medication for suppression Valvular Regurgitation Pacemakers The pathologic process that necessitated should be addressed regarding the diver s fitness to dive. In those instances where the problem necessitating pacing does not preclude diving, will the diver be able to meet the performance criteria? * NOTE: Pacemakers must be certified by the manufacturer as able to withstand the pressure changes involved in recreational diving. Severe Risks Venous emboli, commonly produced during decompression, may cross major intracardiac right-to-left shunts and enter the cerebral or spinal cord circulations causing neurological decompression illness. Hypertrophic cardiomyopathy and valvular stenosis may lead to the sudden onset of unconsciousness during exercise. PULMONARY Any process or lesion that impedes airflow from the lungs places the diver at risk for pulmonary overinflation with alveolar rupture and the possibility of cerebral air embolization. Many interstitial diseases predispose to spontaneous pneumothorax: Asthma (reactive airway disease), Chronic Obstructive Pulmonary Disease (COPD), cystic or cavitating lung diseases may all cause air trapping. The 1996 Undersea and Hyperbaric Medical Society (UHMS) consensus on diving and asthma indicates that for the risk of pulmonary barotrauma and decompression illness to be acceptably low, the asthmatic diver should be asymptomatic and have normal spirometry before and after an exercise test. Inhalation challenge tests (e.g.: using histamine, hypertonic saline or methacholine) are not sufficiently standardized to be interpreted in the context of scuba diving. A pneumothorax that occurs or reoccurs while diving may be catastrophic. As the diver ascends, air trapped in the cavity expands and could produce a tension pneumothorax. In addition to the risk of pulmonary barotrauma, respiratory disease due to either structural disorders of the lung or chest wall or neuromuscular disease may impair exercise performance. Structural disorders of the chest or abdominal wall (e.g.: prune belly), or neuromuscular disorders, may impair cough, which could be life threatening if water is aspirated. Respiratory limitation due to disease is compounded by the combined effects of immersion (causing a restrictive deficit) and the increase in gas density, which increases in proportion to the ambient pressure (causing increased airway resistance). Formal exercise testing may be helpful. History of Asthma or Reactive Airway Disease (RAD)* History of Exercise Induced Bronchospasm (EIB)* History of solid, cystic or cavitating lesion* Pneumothorax secondary to: -Thoracic Surgery -Trauma or Pleural Penetration* -Previous Overinflation Injury* Obesity History of Immersion Pulmonary Edema Restrictive Disease* Interstitial lung disease: May increase the risk of pneumothorax * Spirometry should be normal before and after exercise Active Reactive Airway Disease, Active Asthma, Exercise Induced Bronchospasm, Chronic Obstructive Pulmonary Disease or history of same with abnormal PFTs or a positive exercise challenge are concerns for diving. History of spontaneous pneumothorax. Individuals who have experienced spontaneous pneumothorax should avoid diving, even after a surgical procedure designed to prevent recurrence (such as pleurodesis). Surgical procedures either do not correct the underlying lung abnormality (e.g.: pleurodesis, apical pleurectomy) or may not totally correct it (e.g.: resection of blebs or bullae). Impaired exercise performance due to respiratory disease. GASTROINTESTINAL Temporary Risks As with other organ systems and disease states, a process which chronically debilitates the diver may impair exercise performance. Additionally, dive activities may take place in areas remote from medical care. The possibility of acute recurrences of disability or lethal symptoms must be considered. Temporary Risk Conditions Peptic Ulcer Disease associated with pyloric obstruction or severe reflux Unrepaired hernias of the abdominal wall large enough to contain bowel within the hernia sac could incarcerate. Inflammatory Bowel Disease Functional Bowel Disorders Severe Risks Altered anatomical relationships secondary to surgery or malformations that lead to gas trapping may cause serious problems. Gas trapped in a hollow viscous expands as the divers surfaces and can lead to rupture or, in the case of the upper GI tract, emesis. Emesis underwater may lead to drowning. Gastric outlet obstruction of a degree sufficient to produce recurrent vomiting Chronic or recurrent small bowel obstruction Severe gastroesophageal reflux Achalasia Paraesophageal Hernia ORTHOPAEDIC Relative impairment of mobility, particularly in a boat or ashore with equipment weighing up to 18 kgs/40 pounds must be assessed. Orthopaedic conditions of a degree sufficient to impair exercise performance may increase the risk. Amputation Scoliosis must also assess impact on respiratory function and exercise performance. Aseptic Necrosis possible risk of progression due to effects of decompression (evaluate the underlying medical Page 4 of 6

7 cause of decompression may accelerate/escalate the progression). Temporary Risk Conditions Back pain HEMATOLOGICAL Abnormalities resulting in altered rheological properties may theoretically increase the risk of decompression sickness. Bleeding disorders could worsen the effects of otic or sinus barotrauma, and exacerbate the injury associated with inner ear or spinal cord decompression sickness. Spontaneous bleeding into the joints (e.g.: in hemophilia) may be difficult to distinguish from decompression illness. Sickle Cell Disease Polycythemia Vera Leukemia Hemophilia/Impaired Coagulation METABOLIC AND ENDOCRINOLOGICAL With the exception of diabetes mellitus, states of altered hormonal or metabolic function should be assessed according to their impact on the individual s ability to tolerate the moderate exercise requirement and environmental stress of sport diving. Obesity may predispose the individual to decompression sickness, can impair exercise tolerance and is a risk factor for coronary artery disease. Hormonal Excess or Deficiency Obesity Renal Insufficiency The potentially rapid change in level of consciousness associated with hypoglycemia in diabetics on insulin therapy or certain oral hypoglycemic medications can result in drowning. Diving is therefore generally contraindicated, unless associated with a specialized program that addresses these issues. Pregnancy: The effect of venous emboli formed during decompression on the fetus has not been thoroughly investigated. Diving is therefore not recommended during any stage of pregnancy or for women actively seeking to become pregnant. BEHAVIORAL HEALTH Behavioral: The diver s mental capacity and emotional make-up are important to safe diving. The student diver must have sufficient learning abilities to grasp information presented to him by his instructors, be able to safely plan and execute his own dives and react to changes around him in the underwater environment. The student s motivation to learn and his ability to deal with potentially dangerous situations are also crucial to safe scuba diving. Developmental delay History of drug or alcohol abuse History of previous psychotic episodes Use of psychotropic medications Inappropriate motivation to dive solely to please spouse, partner or family member, to prove oneself in the face of personal fears Claustrophobia and agoraphobia Active psychosis History of untreated panic disorder Drug or alcohol abuse OTOLARYNGOLOGICAL Equalisation of pressure must take place during ascent and descent between ambient water pressure and the external auditory canal, middle ear and paranasal sinuses. Failure of this to occur results at least in pain and in the worst case rupture of the occluded space with disabling and possible lethal consequences. The inner ear is fluid filled and therefore noncompressible. The flexible interfaces between the middle and inner ear, the round and oval windows are, however, subject to pressure changes. Previously ruptured but healed round or oval window membranes are at increased risk of rupture due to failure to equalise pressure or due to marked overpressurisation during vigorous or explosive Valsalva manoeuvres. The larynx and pharynx must be free of an obstruction to airflow. The laryngeal and epiglotic structure must function normally to prevent aspiration. Mandibular and maxillary function must be capable of allowing the patient to hold a scuba mouthpiece. Individuals who have had mid-face fractures may be prone to barotrauma and rupture of the air filled cavities involved. Recurrent otitis externa Significant obstruction of external auditory canal History of significant cold injury to pinna Eustachian tube dysfunction Recurrent otitis media or sinusitis History of TM perforation History of tympanoplasty History of mastoidectomy Significant conductive or sensorineural hearing impairment Facial nerve paralysis not associated with barotrauma Full prosthedontic devices History of mid-face fracture Unhealed oral surgery sites History of head and/or neck therapeutic radiation History of temperomandibular joint dysfunction History of round window rupture ى ىل ىز م م مس Monomeric TM Open TM perforation Tube myringotomy History of stapedectomy History of ossicular chain surgery History of inner ear surgery Facial nerve paralysis secondary to barotrauma Inner ear disease other than presbycusis Uncorrected upper airway obstruction Laryngectomy or status post partial laryngectomy Tracheostomy Uncorrected laryngocele History of vestibular decompression sickness Page 5 of 6

8 BIBLIOGRAPHY/REFERENCE 1. Bennett, P. & Elliott, D (eds.)(1993). The Physiology and Medicine of Diving. 4th Ed., W.B. Saunders Company Ltd., London, England. 2. Bove, A., & Davis, J. (1990). Diving Medicine. 2nd Edition, W.B. Saunders Company, Philadelphia, PA. 3. Davis, J., & Bove, A. (1986). Medical Examination of Sport Scuba Divers, Medical Seminars, Inc., San Antonio, TX 4. Dembert, M. & Keith, J. (1986). Evaluating the Potential Pediatric Scuba Diver. AJDC, Vol. 140, November. 5. Edmonds, C., Lowry, C., & Pennefether, J. (1992).3rd ed., Diving and Subaquatic Medicine. Butterworth & Heineman Ltd., Oxford, England. 6. Elliott, D. (Ed) (1994). Medical Assessment of Fitness to Dive. Proceedings of an International Conference at the Edinburgh Conference Centre, Biomedical Seminars, Surry, England. 7. Fitness to Dive, Proceedings of the 34th Underwater & Hyperbaric Medical Society Workshop (1987) UHMS Publication Number 70(WS-FD) Bethesda, MD. 8. Neuman, T. & Bove, A. (1994). Asthma and Diving. Ann. Allergy, Vol. 73, October, O Conner & Kelsen. 9. Shilling, C. & Carlston, D. & Mathias, R. (eds) (1984). The Physician s Guide to Diving Medicine. Plennum Press, New York, NY. 10. Undersea and Hyperbaric Medical Society (UHMS) 11. Divers Alert Network (DAN) United States, 6 West Colony Place, Durham, NC 12. Divers Alert Network Europe, P.O. Box Roseto, Italy, telephone non-emergency line: weekdays office hours , emergency line 24 hours: Divers Alert Network S.E.A.P., P. O. Box 384, Ashburton, Australia, telephone Divers Emergency Service, Australia, telephone South Pacific Underwater Medicine Society (SPUMS), P.O. Box 190, Red Hill South, Victoria, Australia, 16. European Underwater and Baromedical Society, ENDORSERS Paul A. Thombs, M.D., Medical Director Hyperbaric Medical Center St. Luke s Hospital, Denver, CO, USA Peter Bennett, Ph.D., D.Sc. Professor, Anesthesiology Duke University Medical Center Durham, NC, USA Richard E. Moon, M.D., F.A.C.P., F.C.C.P. Departments of Anesthesiology and Pulmonary Medicine Duke University Medical Center Durham, NC, USA Roy A. Myers, M.D. MIEMS Baltimore, MD, USA William Clem, M.D., Hyperbaric Consultant Division Presbyterian/St. Luke s Medical Center Denver, CO, USA John M. Alexander, M.D. Northridge Hospital Los Angeles, CA, USA Des Gorman, B.Sc., M.B.Ch.B., F.A.C.O.M., F.A.F.O.M., Ph.D. Professor of Medicine University of Auckland, Auckland, NZ Alf O. Brubakk, M.D., Ph.D. Norwegian University of Science and Technology Trondheim, Norway Alessandro Marroni, M.D. Director, DAN Europe Roseto, Italy Hugh Greer, M.D. Santa Barbara, CA, USA Christopher J. Acott, M.B.B.S., Dip. D.H.M., F.A.N.Z.C.A. Physician in Charge, Diving Medicine Royal Adelaide Hospital Adelaide, SA 5000, Australia Chris Edge, M.A., Ph.D., M.B.B.S., A.F.O.M. Nuffield Department of Anaesthetics Radcliffe Infirmary Oxford, United Kingdom Richard Vann, Ph.D. Duke University Medical Center Durham, NC, USA Keith Van Meter, M.D., F.A.C.E.P. Assistant Clinical Professor of Surgery Tulane University School of Medicine New Orleans, LA, USA Robert W. Goldmann, M.D. St. Luke s Hospital Milwaukee, WI, USA Paul G. Linaweaver, M.D., F.A.C.P. Santa Barbara Medical Clinic Undersea Medical Specialist Santa Barbara, CA, USA James Vorosmarti, M.D. 6 Orchard Way South Rockville, MD, USA Tom S. Neuman, M.D., F.A.C.P., F.A.C.P.M. Associate Director, Emergency Medical Services Professor of Medicine and Surgery University of California at San Diego San Diego, CA, USA Yoshihiro Mano, M.D. Professor Tokyo Medical and Dental University Tokyo, Japan Simon Mitchell, MB.ChB., DipDHM, Ph.D. Wesley Centre for Hyperbaric Medicine Medical Director Sandford Jackson Bldg., 30 Chasely Street Auchenflower, QLD 4066 Australia Jan Risberg, M.D., Ph.D. NUI, Norway Karen B.Van Hoesen, M.D. Associate Clinical Professor UCSD Diving Medicine Center University of California at San Diego San Diego, CA, USA Edmond Kay, M.D., F.A.A.F.P. Dive Physician & Asst. Clinical Prof. of Family Medicine University of Washington Seattle, WA, USA Christopher W. Dueker, TWS, M.D. Atherton, CA, USA Charles E. Lehner, Ph.D. Department of Surgical Sciences University of Wisconsin Madison, WI, USA Undersea & Hyperbaric Medical Society Metropolitan Avenue Kensington, MD 20895, USA Diver s Alert Network (DAN) 6 West Colony Place Durham, NC Page 6 of 6

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