Diving Fitness Examination

A diving fitness examination should be performed regularly by all divers, beginners and advanced alike. The Society for Diving and Hyperbaric Medicine (GTÜM) recommends an examination interval of three years for healthy individuals between the ages of 18 and 40. For all other persons and in the case of medical abnormalities (relative contraindications: e.g. otitis externa (inflammation of the ear canal), well-controlled bronchial asthma (with stable lung function), chronic atrial fibrillation (VHF) with good frequency control and normal exercise capacity without a limiting underlying disease), the interval is reduced to one year. Official certificates of fitness from the Society of Diving and Hyperbaric Medicine (GTÜM) may be issued by all physicians who adhere to the society’s current guidelines.

The procedure

The diving fitness examination includes:

  • Detailed medical history
    • Pre-existing conditions (including surgeries)
    • Physical fitness
    • Diving level of training
    • Psychological situation
    • Review of current findings

    Drug analysis

  • Physical examination (taking into account the examination forms of the professional societies: GTÜM; ÖGTH); examination or assessment:
    • Skin, eyes
    • Tympanic membrane by otoscopy (earoscopy; visual inspection/viewing of eardrum mobility).
    • Pressure equalization according to Valsalva (Valsalva trial)Execution: forceful expiration (exhalation) against closed mouth and nasal opening. At the same time, tense the respiratory muscles and abdominal muscles, which increases the air pressure in the airways. Via the Eustachi tube occurs during the Valsalva attempt to equalize the pressure between the nasopharynx and middle ear (= ventilation of the middle ear).Valsalva positive: If the eardrum is intact, this thereby bulges outward, which can be observed by means of an otoscope (otoscopy).
    • Auscultation (listening) of the heart and lungs.
    • Palpation (palpation) of the abdomen
    • Orienting examination of the musculoskeletal system
    • Orienting neurological examination
  • Resting ECG – study of the electrical activity of the heart during exercise and at rest.
  • Exercise ECG from the age of 40, in the case of a conspicuous anamnesis also in those under 40 years – examination of the electrical activity of the heart during exercise (cycle ergometry).
  • Spirometry (pulmonary function test: vital capacity (VC), one-second capacity (FEV1), forced vital capacity (FVC); FEV1/FVC)).
  • Urine examination by strip test (urine pH, proteins, glucose, nitrite content, bilirubin, ketones).
  • Blood tests (optional)
  • Sports medicine consultation

Absolute contraindications (contraindications) for fitness to dive (A claim to completeness does not exist! ):

  • Ear:
    • Clear swelling of the ear canal
    • Acute tubal dysfunction with non-functioning pressure equalization
    • Tympanic membrane perforations
    • Hearing loss (with vestibular symptoms; hearing loss or tinnitus (ringing in the ears) in the acute stage).
  • Lung:
    • Acute bronchitis
    • Uncontrolled bronchial asthma
    • Exercise and/or cold-induced asthma
    • Exacerbation (disease flare-up; acute worsening) of bronchial asthma
    • Chronic obstructive pulmonary disease (COPD) with pulmonary function limitations (stage 2 according to GOLD: FEV1 80-50% of target;FEV1/FVS <70%).
    • Acute exacerbation of COPD
    • Emphysema (irreversible hyperinflation of the smallest air-filled structures (alveoli, alveoli) of the lungs)
    • Lung cysts/bullae (larger bubbles), bronchiectasis (synonym: bronchiectasis; irreversible saccular or cylindrical expansion of the medium-sized airways (bronchi))
  • Heart:
    • Cardiac arrhythmias:
      • Tachycardia requiring treatment (> 100 heartbeats per minute)) with and without structural heart disease.
      • Supraventricular extrasystoles (cardiac extrasystole occurring above the ventricle (heart chamber)) with impaired consciousness
      • Complex arrhythmias
    • <1 year after acute coronary syndrome (ACS; stages of coronary artery disease (CAD) that are immediately life-threatening); also thereafter, if angina (chest tightness, heart pain), heart failure (cardiac insufficiency), reduced ventricular (heart chamber) function, or arrhythmias requiring treatment are present
    • Hemodynamically effective vitia (heart defects that effectively affect the flow mechanics of the blood (hemodynamics)): e.g., aortic and mitral stenosis (heart valve defects in which the opening of the aortic valve / mitral valve is narrowed) with valve opening areas of < 1.5 cm ²
    • Persistent foramen ovale (PFO; patent foramen ovale) – increased risk of embolism (occlusion of a vessel); clinically, the picture of a decompression illness (DCI) of unclear etiology (cause) arises

In pregnancy should not be dived with compressed gas equipment because of the risk of possible teratogenicity (damage to the fetus).The diving fitness expires:

  • In acute illness until complete recovery.
  • In ventilation disorders of any kind
  • After severe illnesses*
  • After surgical interventions*
  • After a diving accident*

* In these cases, a new diving medical examination is required! Note: In the group of recreational divers in the age group greater than 50 years, cardiovascular risks occurred particularly frequently. One in two was overweight, more than one in two was a former smoker, and one in three reported elevated cholesterol levels.Conclusion: as part of the diving fitness examination, BMI (body mass index) should be determined, smoking status asked about, history of cardiovascular risk factors such as hypertension (high blood pressure) collected, and cholesterol determined. This will help reduce the risk of fatal events during recreational diving.