Pressure Points: The Diver's Guide to Staying Afloat in Diving Medicine

Welcome to our guide on safe diving in Scotland! Whether you're a seasoned professional or an enthusiastic beginner, this blog aims to be your go-to resource for diving safely in Scottish waters. We'll provide valuable information for both the general public and health professionals on where to find the most up-to-date guidelines, training resources, and local expertise to ensure a safe and enjoyable diving experience in Scotland's beautiful marine environments.

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How Healthy do you need to be to SCUBA dive?

SCUBA diving is an exhilarating sport, but it does come with certain health requirements. While you don't need to be an Olympic athlete, a good level of overall health and fitness is essential.

Key Health Considerations:

1. Cardiovascular Health: Your heart and lungs need to be in good condition to handle the physical exertion and pressure changes. Poorly controlled hypertension (high blood pressure) can lead to Immersion Pulmonary Oedema, which is one of the most common diving illnesses and has caused fatalities.

2. Respiratory Function: Clear airways and healthy lungs are crucial for managing breathing underwater. Scarred lungs for any reason, can cause the pressure to increase within lung cavities on ascent, and with no-where else to go, this air can cause a pneumothorax (popped lung).

3. Ear and Sinus Health: These areas must equalize pressure easily to prevent discomfort or injury, such as a perforated ear drum.

4. Physical Fitness: While not overly strenuous, diving requires some strength and endurance. Scottish diving is often more demanding, due to currents and tides, or swimming fast to keep up with that playful seal. You should be fit and able to help rescue another diver in an emergency, and consider whether there are any conditions that may hinder your own rescue, such as obesity. If so, altering your diving habits is advised to keep everyone safe.

5. Mental Health: You should be able to stay calm under pressure and follow safety protocols.

Medical Conditions to Consider:

Some conditions may prevent you from diving or require medical clearance, including:

- Heart disease or poorly controlled hypertension

- Lung conditions like asthma

- Recent surgeries

- Pregnancy

- Certain medications that make you drowsy, make you more likely to bleed, make you more likely to have a fit whilst under pressure, or increase the risk of diving problems such as narcosis and decompression illness.

The Bottom Line:

Before diving, you'll need to complete a medical questionnaire. If any issues arise, a doctor's approval may be necessary. Remember, being honest about your health is crucial for your safety.

While you don't need to be a fitness guru, maintaining good overall health and addressing any medical concerns is key to enjoying safe and enjoyable SCUBA adventures.

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Diving Health Information: Where to Look

When it comes to diving health, it's crucial to consult experts who understand the unique challenges of underwater environments. Here are some key points to consider:

1. Seek specialized knowledge: Not all doctors are familiar with diving medicine. While your regular GP or consultant may give well-intentioned advice, they may not fully understand the hyperbaric effects on your body and medications.

2. Be cautious of general medical opinions: Many divers have reported receiving a casual "OK to dive" from their doctors. However, without specific knowledge of diving physiology, this advice could be incomplete or potentially risky.

3. Find a diving medicine specialist: For the safest approach to your health, seek out a doctor with additional training in hyperbaric and diving medicine. These specialists can provide more accurate assessments of your fitness to dive and offer tailored advice.

4. Reliable resources:

• NHS Scotland Scottish Diving Medicine website has a concise website with further information on diving illnesses and useful links for support.

• Water Safety Scotland is a voluntary association of organisations all working towards safer use of Scotlands waterways.

• Local diving clubs: Often have links to diving doctors in your area. You can find your local diving club via the Scottish Sub Aqua Club (ScotSac), British Sub Aqua Club (BSAC) or Professional Association of Diving Instructors (PADI) websites.

• The UK Diving Medical Committee (UKDMC) has the list of approved UK doctors who are registered to provide advice for recreational divers in the UK.

• Internationally, the Divers Alert Network (DAN): Offers extensive information and can connect you with diving medical professionals.

• Working divers in the UK are regulated by the Health & Safety Executive (HSE), and divers need an annual medical with a HSE Approved Medical Examiner of Divers.

Remember, your health and safety underwater depend on accurate, specialized medical advice. Don't hesitate to seek out experts in diving medicine for the most reliable information.

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How to Get Fit for Scuba Diving

Scuba diving is an exhilarating sport, but it also demands a good level of fitness. Here are some key ways to prepare your body for diving adventures:

1. Boost cardiovascular fitness

• Regular jogging, swimming, or cycling

• Improves stamina for longer dives

• Helps you handle emergencies better

2. Maintain a healthy weight

• Easier to move in water

• Reduces strain on your body

• Makes rescue situations more manageable

3. Quit smoking and vaping

• Improves lung capacity and overall respiratory health

• Enhances oxygen efficiency underwater

4. Strengthen core and leg muscles

• Aids in finning technique

• Improves overall stability in water

5. Practice flexibility exercises

• Helps with donning gear comfortably

• Reduces risk of muscle cramps

6. Stay hydrated

• Crucial for preventing decompression sickness

• Improves overall diving performance

7. Prepare your mental health

• see our 3 part blog with tips from a diving psychologist.

Remember, a fit diver is a safer diver. Start your fitness journey well before your diving trip for the best results.

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What if I have a health concern I would like to discuss?

If you have health concerns related to diving, you can book an appointment with Dr. Zacheshigriva. She is trained in diving medicine, serves as a medical referee for the UKDMC, and is a HSE Approved Medical Examiner of Divers. To ensure a thorough assessment, bring a copy of your health summary from your GP and any relevant hospital letters to your appointment.

Importance of Medical Assessments for Divers:

1. Safety: Medical assessments help identify conditions that could increase the risk of diving-related injuries or emergencies.

2. Early detection: Some medical conditions may be exacerbated by diving. Regular check-ups can catch these early.

3. Customized advice: A diving medicine specialist can provide tailored recommendations based on your health status.

4. Legal compliance: Many diving organizations require medical clearance before allowing individuals to participate in diving activities.

5. Insurance considerations: Some dive insurance policies require regular medical assessments.

Remember, diving medicine is complex, and individual health situations can vary greatly. That's why it's crucial to consult with a specialist like Dr. Zacheshigriva for personalized advice and assessment.

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Where can health professionals get more information on diving health?

Here's a summary of professional diving advice sources. These can provide valuable information on diving safety, medical fitness and industry standards:

• The UK Diving Medical Committee (UKDMC) has the list of approved UK doctors who are registered to provide advice for recreational divers in the UK. There is guidance on their website for professionals.

• The Undersea & Hyperbaric Medical Society has developed a brief guidance document for clinicians around the common diving related illnesses.

• The Diving Diseases Research Centre (DDRC) is based in Plymouth and has support for divers and educational courses and resources for clinicians.

• Hyperbaric medical centers, such as the Hyperbaric Medical Unit in Aberdeen Royal Infirmary, are usually staffed with physicians knowledgeable about diving-related health issues.

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How do I get help in a diving medical emergency in Scotland?

This is important safety information for divers. Here's a concise summary of the key points:

1. In a diving emergency:

- Work with your dive buddy to safely surface

- Coordinate with your diving group and skipper on shore

- Use a radio to contact the coastguard

2. Preparation is crucial:

- Train for emergency situations

- Always carry a radio

3. Key contacts:

- Coastguard (see this how-to guide from the RNLI)

- Oncall Hyperbaric Consultant in Aberdeen: 0345 408 6008

4. For international diving:

- Research local emergency services before diving

This information emphasizes the importance of proper training, equipment, and knowledge of emergency procedures for safe diving. Before you return to diving after an injury or illness, seek the advice of a diving doctor.

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Demystifying OEUK medicals: Answering your Top 5 Burning Questions! #oilandgas #safetyfirst #healthmatters

In the dynamic world of the offshore industry, the health and well-being of employees is paramount. With demanding conditions and the potential for unique health risks, understanding the intricacies of OEUK medicals is essential for every worker. Whether you're a seasoned professional or just starting your journey, having clarity about the medical requirements can ensure you're always primed for success.

In this blog, we dive into the top five questions that employees commonly have regarding their medical assessments in the oil and gas sector. Here, you will find not just answers, but also valuable insights and practical tips to help dymistify and prepare you for your next OEUK offshore medical.

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1. What do they test for in an offshore medical?

When preparing for work in the offshore environment, a comprehensive medical examination is crucial for your health and safety, adhering to the OEUK standards. So, what exactly can you expect during an offshore medical evalutation?

The process begins with a thorough medical history, where you'll fill out a detailed questionnaire. This document captures essential insights about your past and current health conditions, ensuring that any pre-existing issues are flagged before working in what can be a demanding environment.

Next, your occupatioanl history comes into play. This assessment evaluates your previous work exposures, capturing any relevant details that might impact your health on-site. Understanding your background helps healthcare professionals determine the readiness for the responsibilities ahead and the best support available for your health whilst at work.

Once this initial paperwork is completed, you'll undergo a physical examination. A thorough assessment generally includes standard tests such as blood pressure measurements, Body Mass Index (BMI), hearing tests, and vision checks. An examination of your chest, abdomen and for any hernia is also checked.

Depending on your particular responsibilities and health background, there are additional tests that could be performed. For instance, those whose roles involve catering for others will specifically be asked to provide a stool (poo) sample examination to check for organisms that may pose health risks to colleagues.

In other situations, workers may be subject to a range of respiratory tests, such as spirometry, to measure lung function. This can be crcial for individuals with a history of breathing issues, those who smoke or vape, or those who may use breathing apparatus in their role. An ECG may also be carried out to monitor heart rhythm if there is a history of cardiac disease.

Furthermore, for some roles that require high levels of fitness and endurance, an exercise test may be necessary as well. This ensures participants can meet the physical demands of their positions, especially considering the often rugged and challenging offshore conditions.

While drug and alcohol screenings might be essential in many industries, they are generally not included as standard procedures within the basic OEUK medicals, unless specified by specific roles/employers. The ultimate goal of these assessments is to maintain a safe and healthy work environment for all offshore personnel.

In conculsion, an offshore medical is a detailed examination tailored to provide insight into your fitness for work, with specific tests adapted to your role and medical history, safeguaring not just you, but your colleagues, amid the vast and variable surroundings of offshore operations.

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2. How long does an offshore medical take?

Generally, you can expect the basic OEUK examination to last between 30 minutes to 1 hour. This initial evaluation includes a thorough assessment of your medical history, and a general physical examination. However, if your role requires specialised tests such as an ECG or other diagnostic procedures, this will extend the duration of your medical assessment. These additional tests ensure that every aspect of your health is reviewed, potentially adding extra time - so it's wise to budget a bit more time than just the basic examination duration.

In summary, while the core examination could take about an hour, it's essential to consider your unique medical needs and the specific career requirements that may necessitate further testing, which could elongate the process. Being prepared and informed can help you navigate this essential step and if you have any questions, it is advised to email info@scottishmedicals.co.uk ahead of booking your appointment.

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3. Where to get an offshore medical?

If you’re seeking an offshore medical assessment, it’s essential to understand the requirements set forth by the offshore energy industry. The OEUK (Offshore Energies UK) is the principal representative body, ensuring offshore workers are fit to live and work offshore. As per industry policies, offshore workers are required to undergo regular medical examinations conducted by a doctor registered with the OEUK. This is crucial for ensuring that all personnel are physically fit for their demanding working environments. A reputable option for obtaining your offshore medical is through Dr. Sarah Zacheshigriva, an OEUK registered practitioner who has the necessary credentials to carry out these assessments. To schedule an appointment and facilitate your medical examination, you can visit the website www.scottishmedicals.co.uk, where you’ll find all the relevant information to help you comply with the offshore medical requirements efficiently. Prioritising your health and safety is vital, and having the right medical assessment is a key step in your offshore career.

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4. Can you go offshore with medication or a medical problem?

When considering whether you can work offshore with a medical problem, it's crucial to assess the nature of your condition and the specific requirements of your role. Most minor medical issues, such as chronic allergies or mild respiratory conditions, typically do not hinder your ability to work offshore, as they pose minimal risk to both yourself and your colleagues. However, more serious health concerns require deeper scrutiny. It's essential to consult with the OEUK doctor to evaluate your condition and determine what resources are necessary to support your health while you work.

Facilities on offshore installations can vary greatly, with some equipped to handle special medical needs, such as refrigeration for medication or avoiding scenarios that exacerbate your health condition. Discussions between the OEUK doctor and the installation medical advisor can clarify what accommodations may be possible, ensuring that you can perform your duties safely. Ultimately, the decision hinges on your ability to execute your job responsibilities without jeopardizing your safety or that of other personnel, as well as the medical infrastructure available at your prospective offshore location. By openly addressing your health concerns and understanding the capabilities of the installation, you can make an informed decision about your ability to work offshore.

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5. How to pass the offshore medical?

Passing the offshore medical examination, specifically the OEUK medical, is a crucial step for anyone looking to work in offshore operations. This assessment is designed to evaluate your overall fitness for the role and ensure safety for both yourself and your colleagues. Here are some essential tips to help you prepare effectively and increase your chances of passing the offshore medical:

1. Understand the Health Requirements. Familiarize yourself with the specific medical standards required for offshore work. These can include vision and hearing tests, cardiovascular assessments, and checks for respiratory conditions. Knowing what to expect can help you prepare.

2. Consult Your GP. If you have any existing health conditions, particularly if they aren’t well controlled, it’s beneficial to consult with your GP. Discuss any concerns and seek guidance on managing these conditions prior to your medical examination. They can provide tailored advice and possibly adjust your treatment plan. Consult your dentist for any dental concerns.

3. Maintain a Healthy Lifestyle: Leading up to the medical, prioritize healthy habits. Regular exercise, a balanced diet, and sufficient hydration can improve your overall fitness. Being in good shape can positively influence the results of your medical evaluation.

4. Get Adequate Sleep: Ensure you have good sleep hygiene in the days before your appointment. Rest helps your body perform at its best and reduces anxiety, both of which are vital for a successful medical.

5. Be Honest in Assessments: During the medical examination, be honest about your health history and any conditions you may have. Providing accurate information helps medical practitioners make informed decisions regarding your fitness for offshore work.

6. Prepare for Specific Tests: If you want to glide through fitness routines, ensure to prepare accordingly. Try practicing any fitness tests you might anticipate. Regular aerobic exercises can improve your stamina and ensuring your ability to pass any evaluations involving physical exertion.

7. Follow Guidelines on Medication: If you are taking any medication, particularly any that may affect your fitness for duty, discuss these with your GP. They can advise on the potential implications of your medication during the assessment.

8. Stay Calm and Collected: Anxiety can affect your physical performance during tests; practice relaxation techniques such as deep breathing or visualization ahead of your medical to counter stress.

9. Documentation Preparedness: Bring any necessary documentation, such as a list of medications, previous medical reports, and any notes from your GP. Ensuring that you have everything organized can streamline the examination process.

Following these steps not only aids you in preparing for your offshore medical but reinforces your commitment to safety and wellness, both personally and in the context of working offshore.

Good luck!

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Book your offshore medical with Scottish Medicals here:

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Keeping Mentally Fit to Dive - Psychology as you progress through your diving career.

Insight on Diving Psychology and Mental Health: Q&A with a Clinical Psychologist.

Dr Laura Walton is a PADI Master Instructor and experienced Clinical Psychologist who specialises in working with divers. We caught up with Dr Walton to ask her some frequent questions and to gain her insights into diving psychology.

This blog is the final installment in a three-part series covering:

1.       Keeping calm underwater

2.       Psychology research of divers

3.       Psychology as you progress through your diving career.

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You have been diving recreationally and now thinking of doing saturation diving. What psychological challenges to commercial diver’s face?

Commercial diving is a demanding profession that poses several mental challenges. The first is the issue of isolation. Divers often work in remote locations, away from their families and friends for extended periods of time. This isolation can lead to feelings of loneliness and depression.

Commercial divers face elevated levels of stress due to the high-risk nature of their work. They must be ready to deal with the threat of equipment failure, decompression sickness, and other underwater hazards. This chronic stress can lead to anxiety disorders and other mental health issues.

The physical demands of diving can also have mental health implications. Long hours, strenuous work, and exposure to cold temperatures can lead to fatigue, which can affect a diver's cognitive function and mental resilience. There is also the challenge of maintaining focus and concentration. Divers must remain alert to their surroundings and any changes in their physical condition. This constant need for vigilance can be mentally exhausting. 

It is often noted that after a shift, there can be a lot of stored tension. This can arise from events that occurred during dives as well as the pressures of the working environment. Saturation divers are living and working in teams for extended periods. Their actions are continuously monitored and directed from the surface, under the authority of the dive supervisor. The proximity, depersonalisation, lack of privacy, and power dynamics can all have an impact.

There is a lot that can be done, at a systemic level, to increase the physical and psychological safety of diving teams. I would strongly recommend looking up the Human Diver, which addresses human factors in diving.

When faced with the impact of stress after work, many divers are understandably reluctant to take these issues home. Fears about gaining jobs and professional reputation also tend to drive people to "bottle-up" reactions, use harmful coping strategies, and avoid talking. However, there does seem to be an increasing recognition of the need to support the mental health of commercial divers to address burnout and trauma.

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How do you know if you will be able to keep mentally fit in this environment?

To determine your psychological readiness for such an environment, consider the following 5 factors:

1.       Firstly, assess your comfort level with isolation and confinement. Saturation divers live in small, closed spaces for weeks at a time, often with limited contact with the outside world. While also living in close proximity to colleagues and without the option to leave! Oddly, this requires the ability to be isolated and, in some way, requires comfort with solitude, at the same time as the ability to tolerate and have a good relationship with other people. Also, if you are prone to feelings of claustrophobia or have difficulty being away from loved ones for extended periods, this could pose a significant challenge. The nature of the work means it is not likely to be possible to try out these living conditions in advance of training. Instead, reflect on the most similar experiences that you have. How do you usually react to small, confined spaces, extended periods with small groups, and sitting alone?

2.       Secondly, evaluate your stress management skills. The nature of saturation diving means that you will be exposed to high-pressure situations, both literally and figuratively. Being able to stay calm under pressure, make quick decisions, and manage stress effectively are crucial skills for saturation divers. Think about other times in your life that you have been in stressful situations. What did you learn about yourself? The commercial diving schools do offer "aptitude days." While a single day cannot replicate the extended living conditions, it can offer a taste of the sort of tasks involved and conversations with working divers to reflect on whether the career is really for you.

3.       Consider reading and watching documentaries. Check out the quotes from divers in this study describing the challenges, and this subjective evaluation of commercial diver experience.

4.       Consider your physical health. While this is not related to your psychological readiness, your physical health can significantly impact your mental well-being. Ensure you are in good health and have the physical stamina to withstand the demands of saturation diving. Although this is of course a pre-requisite and can feel obligatory and a bit of a stress, engaging in physical activities and exercise is also a potential way to take action and build a sense of being in control of physical and mental health.

5.       It may be beneficial to consider how you may want to address any current mental health concerns. In talking to saturation divers, I have arrived at an educated opinion that the two key issues that lead to mental health concerns in divers are rooted in self-worth and trauma. Trauma in diving, I have already described; what I did not yet mention is that trauma sticks to earlier experiences of unprocessed trauma. For example, in scuba diving training, I regularly see students who have trouble with mask skills realise that they had a drowning experience in childhood that was never addressed. That can be treated before the person goes on to have additional trauma underwater! With self-worth, there is a particular pressure in saturation diving because, while the diver's skills and ability to do the job are of high monetary value, they may perceive that, as an individual person, they do not matter. Prior self-worth issues can also be put under pressure by the shift pattern and extended periods away from friends and family. Being aware of these potential issues and ways to address them can help. I'd recommend looking up "Combat Journal".  This was developed by a saturation diver as a way to process experience by writing about it. This is a portable and relatively discreet strategy that can be used while on shift. 

Many divers find their work rewarding and appreciate the unique experiences that the work offers. It is possible to develop coping mechanisms to deal with the mental demands of the job while maintaining a strong support network. 

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Where can I go for more information or support? 

For scuba divers who have been affected by adverse events in diving, I have developed a self-help resource, which is available on FitToDive.org.  You can also check out the blog, free e-guides, and the courses I create on topics such as panic and trauma. The Divers Alert Network and DAN Europe also have information about mental and psychological health in recreational diving. If you are looking for support after a diving-related trauma or want to address anxiety or phobias that affect your diving, then I offer a private psychology service that specialises in supporting divers. 

If you are experiencing wider issues with mental health, then, in the UK, it would be advised to consult your doctor, who can assess and refer. In a mental health emergency, contact your GP or (in life-threatening situations) emergency services at 999. If you need to talk anonymously, contact the Samaritans or Breathing Space (Scotland). 

If you are a working diver, then occupational health is an option. I know that the Health and Safety Executive in the UK is encouraging employers to take mental health and work-related stress seriously. However, I also understand the concerns I hear from divers and their reluctance to talk to employers. Some people may prefer private therapy, and it is useful to note that this is an option. Consider raising discussions about stress at work and support for psychological resilience as a general matter and connect with people in the industry who care about divers' mental health.

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You can learn more about Dr Walton and her work here: https://blog.padi.com/diving-careers-interview-padi-staff-instructor-clinical-psychologist-laura-walton/

If you would like to hear more from Dr Walton, her clinical psychology services, or courses, please visit www.fittodive.org

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We hope you have enjoyed these insights over the last few weeks. If you’d like to be involved in future blogs, please contact info@scottishmedicals.co.uk and we’d love to hear your thoughts.