The following informations of scuba diving restrictions will be helpful for official examiner of divers and divers worldwide to assess ability and nonability of scuba diving sports.

Collected and compiled by Licenced Examiner of Divers Dr. Gregor Dietze, Ueberlingen am Bodensee, Germany this basic medical assessment is for your safety. Please be strict in your scuba diving choices and diving partners.

However these collected informations will be not complete and is no manual or instruction. Feel free to get some medical guidance an let me know if you have some other/another experiences.

Pulmonary System

Absolute restrictions:

• acute lung diseases generally
• acute pulmonary infections, obstructive changes of airways
• all lung diseases with relevant respiratory insufficiency
• spontane pneumothorax in history, pneumothorax with known cause 3 months
• known caverns, emphysema, lung vesicles, cysts, bronchiectasia and other morphologic changes with danger of blow outs and bursts
• severe asthma bronchiale with continuous medication of corticoids or bronchodilatators
• Diseases of lungs and pleura with severe restrictional changes (fibrosis, pneumokoniosis)
• directly after surgical intervention of the lungs

Relative restrictions:

• Chronically obstructive lung illnesses (COPD, COB) with moderate restriction of lung function
• completely recovered sarcoidosis ( X-ray ) and normal lung function
• accidental pneumothorax / barotrauma thereafter 3 months
• supplied lung injuries or lung operations, at the earliest 3 months post office-surgically
• Asthma bronchiale with normal lung function, or in symptomless interval, or just moderate activity
• very strong nicotine consumption with suspicion on morphologic changes

Cardiovascular System

Absolute restrictions:

• Coronary Heart Disease with stable or unstable angina pectoris
• remaining coronary heart symptoms after dilatation,or bypass operation, or remarkable ECG
• After large cardiac infarct, remaining cardiacsymptoms, or increased cardiovascular risks
• Heart insufficiency or clearly limited ventricle function in the heart echo
• Heartbeat disturbances: Sick sinus syndrome, complex ventricular disturbances, supraventricular disturbances with consciousness loss, transition disturbances with temporary tachycardia, block screens starting from degrees of II, link thigh block screens with morphologic basic illness
• all flap illnesses with haemodynamic relevance
• after heart flap replacement, reduced efficiency, relevant heartbeat disturbances or reduced dynamic flow
• known aneurysmatic changes of aorta
• Atrial or ventricular septum defects with haemodynamic relevance
• Cardiac pacemaker with reduced efficiency and according to type of cardiac pacemaker
• Myocarditis = heart muscle inflammation thereafter 6 months
• Pulmonary embolism thereafter 3 months
• hypertonia of lung, cor pulmonale
• increased blood pressure over > 160/100 mmHg
• Symptomatic peripheral blood circulation disturbances
• Deep thrombosis of venes, until the full mobilisation
• open skin lessions according to vascular system

Relative restrictions:

• Cardiac infarct or heart surgery starting from 12 months, stable ECG and good efficiency and ventricle function
• Flap illnesses degrees of I or starting from 12 months after flap replacement with proper blood flow dynamics and flap function (echo + long-term electrocardiogram)
• Atrial or ventricular septum defects without haewmodynamic relevant shunt
• Functionally open Foramen ovale with diving limitations restrictions and recommendations
• according to total estimate heartbeat disturbances such as AV block IIB , extrasystoles, ventricular arrhythmia, link thigh block, normofrequent atrium flares
• Cardiac pacemaker dependent on type and basic illness
• Heart muscle inflammation after 6 months when good healing completely
• Pulmonary embolism after 3 months with good lung function
• deep thrombosis of venes, completely recovering up to 6 months
• An anti-coagulation/a blood dilution does not represent a contraindication for dipping.
•  

ENT ears - noses - throat / head

Absolute restrictions:

• missing or severe reduced pressure balance
• Eardrum perforation or lying drum tube, atelectasis of ear
• acute and chronic inflammation of the outer ear, tympanic cavity, interior ear or tube
• atresia or impossible clinical assessment of the eardrum by closed outer ear
• persisting dysfunction of eartube after successful operation of the eardrum
• extensive radical operations tympanic cavity and mastoid bone
• acute and chronic vertigo or dysfunction of body balance in rest or moderate physical performance
• Nasal septum changes with disturbed tube function
• Inability in holding and work with all scuba diving "mouthpieces" (e.g. after stroke or accident of jaws)
• Functionally restrictive and relevant laryngeal illnesses
• acute tooth illnesses

Relative restrictions:

• moderate irritation of outer ear or changes after ENT operations
• good tube function after successful treatment of pressure balance disturbances, complete recovered eardrum afeter perforation, relevant scars, atrophic changes, katarrh of eartube, after tympanic cavity inflammation, operation etc..
• after operations of the nose, larynx or eardrum with good overall function starting from 3 months
• hearing-improving operations individually
• chronic vertigo or dysfunction of body balance under heavy physical performance, normal provocation test or without persisting symptoms
• Deafness, high-grade hearing dysfunctions, acute Tinnitus or after hearing fall
• Laryngeal illnesses without dysfunction or without complaints
• chronic tooth illnesses, insufficient fillings and prostheses

Psyche - personality - mentality

Absolute restrictions:

• repeated hyperventilation syndrome with suspected repetition
• Panic attacks and fears, unstable psychological situation, acute mental problems
• acute psychotic syndroms (Schizophrenia, manic - depressive situations) of psychological or organic origin, suizids
• danger of aggressive behavior
• acute depression or new medication of antidepressives
• anorexia nervosa and bulaemia
• physical or psychological dependence (drugs, medicines, alcohol etc)
• restricted personal mental faculty for diving risks

Relative restrictions:

• single hyperventilation syndrome with known origin
• after psychotic episodes of each kind with stable conditions and no necessity for medication
• after depression without medication or danger of suizid
• after anorexia nervosa / bulaemia with normal eating behavior and social reintegration
• after dependence starting from 12 months, depending upon remaining organic or psychological damage

Internal Medicine

Absolute restrictions:

• decompensation or unstable metabolic diseases (e.g. phaeochromozytoma generally)
• all relevant inflammatory illnesses
• all acute illnesses with danger of metabolic or cardiac collapse
• acute diarrhoea or symptomatic colitis
• known gatrointestinal ulcers or after repeated gastrointestinal bleedings
• acute anemia of unclear genesis, (Thallasaemia major generally)
• Diabetes 1 and 2 with reduced individual compliance, hypoglycaemia in the last 2 years because of poor self-management
• known intestine bottle-neck or ileus, big intestinal operations
• heavy flatulence or other bowl gases
• Hernia inguinalis, not reponable or painfully
• acute symptomatical gallstones, ureter stones generally
• diseases of prostata with relevant urine retention
• severe kidney insufficiency, hemodialysis
• Operations without sufficient recovery of wounds
• insufficiently treated changes of intensified blood coagulation, kryoglobulinaemia generally

Relative restrictions:

• stable moderate metabolic diseases without hazard potential
• all stable chronic illnesses with good metabolic efficiency
• Overweight and Adiposits because high fat mass has increased inert gas enrichment! - depends also on physical fitness and diving behavior
• moderate dysfunction of urination of each kind
• known morphologic changes and deformations of urigenital system, good function, symptom-free kidney stones, after kidney transplantation in good matter
• Kidney insufficiency (Clearance > 20) and good efficiency of urination
• not-symptomatic inguinal hernia, or after operation
• Intestine bottle-neck with adhaesiolysis and without functional problems
• moderate flatulence and other bowl gases
• recovered from gastrointestinal ulcers without complaints
• known diabetes in experienced and disciplined scuba divers, reliable behavior, well-known signals of hypoglycaemia and what to do
• Operations with sufficient recovery good morphologic efficiency
• admitted acute anemia with adaequate physical performance
• unstable anti-coagulation, also sufficiently treated thrombophilia

• Degenerative, inflammatory or posttraumatic dysfunctions without sufficient self-control, physical efficiency or co-ordination
• not sufficient ability of swimming or breathing
• Rehablitation phase after operations, fresh repositions or orthetic helps
• Thorax deformations with reduced lung function (< 70%)
• acute bone necroses of each kind

• secured self-responsebility in physical activity and experienced and assistancable company, altogether (with aids) sufficient efficiency !
• repeated or single luxation of joints with persisting instability
• successful rehablitation after trauma or big operations
• Thorax deformations without lung function restriction
• Bone necroses subacutely - and without symptoms

• glaucoma after operations, after acute attack
• intraocular operations (e.g. Qatar act) 1 month
• Cornea/callosity operations 3-12 months according to operationstype
• severe eye vessel diseases or after acute eye bleedings
• relevant visual field restrictions of any type, after eye loss 4 months because of missing stereopsis adaptions
• not balanced or corrected hyperopia > 4 diopters

• after eye inflammations
• primary glaucomaalso with restricted function
• known more closely however symptom-free chamber angle
• intraocular operations (e.g. Qatar act) 3 months
• Visual field restrictions > 80% horizontal and > 50% vertically depends on basic diseases, diving beginners starts with handicapped status
• eye loss 4-12 months because of pseudostereopsis, experienced diving partner recommended
• reduced visual ability Visus < 0.5
• contact lenses, soft ones recommended because of better adhesion

• consciousness-changing medication such as antidepressives, cytostatic drugs or other like Lariam with vertigo or other systemic symptoms
• Pregnancy (recommended nevertheless missing danger approvement)

• Skin diseases e.g. ekzema or urticaria with infection risks
• after pregnancy 4-6 weeks, 6-10 weeks after sectio
• any external exits of intestine with sufficient care of stoma - especially self-interest in case of flatulance - in fact no restriction
• any medication with restriction of physical and mental performance
• Anti-coagulation or bleeding risks
• inadaequat "fearlessness" based of dominant personal presentation without experiences - male dominating behavior of "big boss"
• real fears and coping pleasures by peer pressure - female dominating marriaged-divers

• insufficient mental faculty and ripe, no perception of dangers and personal failures, normally children < 5 years
• Handicaps mentally or physically with danger of injuries
• juvenile diabetes
• acute or chronic diseases with impairment in pressure balance, breathing flow and lung restriction
• gastrointestinal diseases illnesses with diarroea / severe flatulence or other resriction of faeces course function also being missing, strong blowing etc

• Children about 8-14 years depending on physical performance, mental faculty, undercooling risks, recommondations of good swimming, start with snorkeling training, check of parents motivation of diving, special diving programs of kids
• according to examiners assessment usually no limitations starting from 16 if presence of sufficient physical and psychological ripe
• food changes of vacation with reduced general condition
• moderate mental or physical handicaps without relevant risks