Dive medical gets tougher for scuba instructors

Posted on October 20th 2015

Diving instructors working in the United Kingdom now have to prove higher levels of fitness after safety regulators introduced more stringent medical checks.

Any diver working in a professional capacity to deliver training courses is required, under the Diving at Work Regulations 1997, to have an Health & Safety Executive (HSE) fitness to dive medical issued by an approved examiner.

Earlier this month (October), the HSE introduced tougher guidelines relating to the medical standards, in both weight and fitness levels, for of those working in the recreational training and commercial diving industries.

The revised Medical Examination and Assessment of Commercial Divers (MA1) document caught out a number of instructors who were shocked to find they no longer met the required medical standards to continue working.

The new MA1 now gives clear guidelines on Body Mass Index (BMI) measurements, an area that is thought will lead to more medical failures and diving restrictions on applicants. In short, those with a BMI greater than 35 will be declared 'unfit to dive'; those with a BMI less than 30 will be declared fit.

For those in the middle range, a measurement of waist circumference will be used as the deciding factor because it is considered a "better predictor of body fat." Men with a waistline greater than 102cm and women greater than 88cm will be declared unfit to dive. The document includes a flow chart (Fig1) to help divers understand the process.

All divers will be required to complete a fitness examination, known as the Chester Step Test, to measure of aerobic capacity and cardiorespiratory fitness and estimate the maximal oxygen uptake (VO2 max).

Under the guidelines, working divers should be able to achieve a minimum VO2 max of 45 ml/kg/min. By comparison, the recommended aerobic capacity standard for UK firefighters, is 42 ml/kg/min.

Those with a VO2 max of 40 ml/kg/min will fail the test, those with levels in between 40 and 45 may be declared fit to dive with certain restrictions specifying the diving activity. (See Fig 2).

"In undertaking the review, HSE collaborated with the UK Sports Diving Medical Committee, received contributions from invited experts and consulted stakeholders. Contributions from experts covered sections on obesity, mental health, respiratory fitness, cardiovascular fitness, neurological fitness, ENT, diabetes and exercise testing," the HSE said on its website.

"Applying the standards and guidelines set out in the document will help promote a consistent approach to fitness assessments. They are based on scientific evidence and expert opinion and will be subject to periodic review."

Update, December 23: PADI have issued guidance to its professional members. "PADI is in active consultation with the HSE about these changes and are monitoring the situation to see if the new guidance show signs of being to be overly restrictive. Following our discussions, the HSE have send a message to all AMEDs (Approved Diving Doctors) on 1 December 2015 which clarified what leeway AMEDs have when interpreting the fitness (VO2) results.

"PADI is continuing to represent you in discussions with the HSE and similar bodies and will advise you if there is any more progress."


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