Attention-Deficit/Hyperactivity Disorder and Diving
CREDITS: Text Jim Chimiak, M.D. | Photo: Stephen Frink
Attention-deficit/hyperactivity disorder (ADHD), formerly known as attention-deficit disorder (ADD), is a neuro-behavioral disorder that can involve difficulty paying attention, impulsiveness and restlessness. These symptoms may interfere with learning and daily functioning, and in divers and prospective divers they raise important questions about fitness to dive. The symptoms are related to an alteration in brain development starting in childhood, and the disorder may persist in adulthood.
The Centers for Disease Control and Prevention (CDC) reports that up to 11 percent of children have ADHD, while the National Institutes of Mental Health (NIMH) indicates that 4.1 percent of adults have it. It seems to occur more frequently in boys than girls. The symptoms are not the same in everybody, and in mild cases the individual may have problems only when engaging in certain tasks. For example, an adult may do very well throughout life until a new computer system with a very strict workflow is installed at his or her workplace. Alternatively, a child with ADHD who is placed in an academic setting without much structure might begin to have problems.
People with ADHD are at increased risk of being involved in motor vehicle accidents and sustaining injuries that lead to emergency room visits. Other conditions commonly associated with ADHD, particularly untreated ADHD, are depression, anxiety, cigarette smoking and substance abuse.
ADHD is treated with cognitive behavioural therapy and medications including stimulants and antidepressants. None of the medications used to treat ADHD have been tested for possible interactions with diving. To better understand how ADHD might affect safe diving, we ask the experts.
Attention-deficit/hyperactivity disorder (ADHD), formerly known as attention-deficit disorder (ADD), is a neuro-behavioral disorder that can involve difficulty paying attention, impulsiveness and restlessness. These symptoms may interfere with learning and daily functioning, and in divers and prospective divers they raise important questions about fitness to dive. The symptoms are related to an alteration in brain development starting in childhood, and the disorder may persist in adulthood.
The Centers for Disease Control and Prevention (CDC) reports that up to 11 percent of children have ADHD, while the National Institutes of Mental Health (NIMH) indicates that 4.1 percent of adults have it. It seems to occur more frequently in boys than girls. The symptoms are not the same in everybody, and in mild cases the individual may have problems only when engaging in certain tasks. For example, an adult may do very well throughout life until a new computer system with a very strict workflow is installed at his or her workplace. Alternatively, a child with ADHD who is placed in an academic setting without much structure might begin to have problems.
People with ADHD are at increased risk of being involved in motor vehicle accidents and sustaining injuries that lead to emergency room visits. Other conditions commonly associated with ADHD, particularly untreated ADHD, are depression, anxiety, cigarette smoking and substance abuse.
ADHD is treated with cognitive behavioural therapy and medications including stimulants and antidepressants. None of the medications used to treat ADHD have been tested for possible interactions with diving. To better understand how ADHD might affect safe diving, we ask the experts.
What are the classic symptoms of ADHD?
Steven Altchuler, M.D., Ph.D.: The symptoms vary; among the most common are inattention, hyperactivity and impulsivity. People with ADHD might make careless mistakes, not pay attention to details, not finish tasks, be forgetful or have difficulty managing tasks that must be done in a specific order. They might fidget, interrupt others or have difficulty waiting their turn.
The symptoms of ADHD change over time. As people grow up, symptoms may become less severe or even disappear. Someone who had ADHD as a child may do perfectly well as an adult.
How is ADHD diagnosed?
Timothy Wilens, M.D.: ADHD is a clinical diagnosis predicated upon careful review of the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), with the individual and, if the patient is a child, the family. While neuro-psychological testing may be helpful to examine co-occurring cognitive or psychiatric problems, it is not necessary to diagnose ADHD. The diagnosis requires that the individual have a sufficient number of symptoms from each symptom cluster listed in the DSM-5; this establishes context for the functional impairment and demonstrates that it is attributable to ADHD rather than another disorder.
How is ADHD treated?
Altchuler: The most common treatment is the use of stimulant medications such as methylphenidate (Ritalin). Students can benefit from measures to minimise distractability in the classroom and opportunities to move around. They may also do well with additional time to complete standardised tests such as college entrance exams. Other medications, including the antidepressant bupropion (Wellbutrin), are used to treat adults.
Wilens: In addition to prescribing medication, which is considered the first line of treatment, the doctor might also consider the individual’s academic or occupational setting and interpersonal or family issues. Appropriate accommodations in various settings (e.g., school, work) may be necessary. Psychotherapies directed at the person with ADHD and/or the family can be very useful for addressing core and associated symptoms.
What additional risks might a scuba diver with untreated ADHD be taking on?
Altchuler: Divers with ADHD might have difficulty concentrating or paying attention or might be easily distracted, particularly if they are multitasking. For example, observing a beautiful coral reef, maintaining buoyancy control, monitoring gas supply, fulfilling a decompression obligation, controlling depth or ascent rate and paying attention to a dive buddy’s location might prove overwhelming. Diving in an overhead environment where strict attention to detail is a life-or-death matter may be challenging.
Wilens: The many tasks involved in a successful diving venture may challenge individuals with ADHD, particularly if they are untreated. Difficulties with associated neuro-cognitive functions such as working memory (remembering and managing short-term issues) and executive functioning (e.g., organisation) may also adversely affect diving.
What are the risks for divers with ADHD who are successfully treated with medication?
Altchuler: Little is known about the effects of stimulant medications such as methylphenidate at depth. Theoretically, stimulants and bupropion might increase the risk of oxygen toxicity. Practical concerns may exist if somebody who is taking methylphenidate or another medicine for ADHD surfaces and is acting unusual. This might prompt the question of whether the changes are related to the medicine or are indications of decompression illness.
Wilens: There are numerous studies and reviews of studies of the use of ADHD medications by people of various ages. Surprisingly few of these studies consider this use in athletic contexts, and none to my knowledge focused on diving. Our laboratory at Massachusetts General Hospital has completed studies of high-dose amphetamine administration in adults with ADHD who were comprehensively tested at baseline and again six months later using multi-modal cardiovascular imaging and graded-exercise testing. We failed to find concerning adverse cardiovascular outcomes but did note non-clinically significant slower heart-rate recovery after exercise, which means longer recovery times following peak exercise performance. In standard atmospheric testing we did not find varying rates of oxygenation or cardiac output or any evidence of arhythmias. Of interest, after thorough diagnostics many professional athletes are treated for ADHD and demonstrate improved overall outcomes and excellent toleration of the medications.
Can people with ADHD dive if they stop taking their medication?
Altchuler: Certainly, if a diver no longer requires medication, then he or she should stop taking it. We are concerned about whether the diver can pay adequate attention to detail and the dive plan to be able to dive safely. Frequently, school-age children and teenagers are given “vacations” from their ADHD medications during the summer. When people need medication to function well in school, where paying attention to detail can affect their grades, we are even more concerned about them paying attention while scuba diving, where attention to detail can become a life-or-death matter.
So whether someone with ADHD can scuba dive really depends on whether the person in fact has ADHD and what treatment is needed. If the person needs stimulant medication to function normally, we have concerns about how the medicine would affect him or her when scuba diving. The U.S. Navy medically disqualifies from diving a person with active ADHD, but “a history of ADHD greater than 1 year prior to military service is not disqualifying.” Use of the medicines that treat ADHD is similarly disqualifying.
Wilens: While we do not have adequate data on the effects of stimulants or non-stimulants in diving conditions, we are accumulating data on the positive effects of treatment on other complex activities such as driving. These data show improvements in all aspects of driving behaviour in simulators. There are also large epidemiological studies that demonstrate a lower overall risk for motor vehicle accidents with treatment. If we were to extrapolate from other complex behaviours that are aberrant in ADHD, I would recommend treatment over no treatment.
What should be done when a prospective diver reports a history of ADHD?
Altchuler: The first thing to do is find out if the person is taking medicine or undergoing some other treatment for ADHD. If the prospective diver is a teenager, do not ask the parents, ask the youth directly. In too many cases teenagers start taking a medication, take it for several months, notice no difference and stop taking it.
People not undergoing treatment need an operational diving examination. We do one for all divers who are new to us. We observe their functioning starting in easy diving environments and progress to more challenging environments to determine if they can dive successfully. It’s critical to observe divers as they progress to more challenging environments. As the number and complexity of tasks divers must do increases, so does the likelihood that ADHD will cause problems. Things an experienced diver might find routine can be overwhelming to a new diver, particularly one with ADHD. Even dives in calm conditions involve management of many tasks, and additional challenges such as choppy seas, low visibility and cold water might make the situation overwhelming.
A challenge diving physicians face is that many recreational diver health forms ask only, “Are you currently taking prescription medications?” A teenager or young adult learning to dive during the summer and taking a “medication vacation” can truthfully answer “no.” Health forms typically do not ask specifically about ADHD but rather list “behavioural health, mental or psychological problems.” While we in the medical field may consider ADHD to fall in this category, the diver or the diver’s parent may think of ADHD as only a school problem and again truthfully answer “no.”
The next challenge is that the diver’s primary physician who completes the form may lack knowledge about dive medicine and the potential for enhanced side effects in high-partial-pressure oxygen environments. The primary doctor may also lack knowledge about the multiple tasks a scuba diver must perform to be able to dive safely.
Divemasters and instructors cannot be expected to be medical experts. They should, however, be observant. Simple questions such as, “Did you take any prescription medicines in the past year, and did your doctor know about them when he completed this form?” may provide useful information.
Wilens: To Dr. Altchuler’s comprehensive response I would add only the recommendation to determine if the individual has been swimming, freediving or scuba diving in the past, whether the person took medications while doing so and how his or her experience was with or without them, noting in particular any adverse effects. These data may help guide the conversation.
Any further comments?
Altchuler: If a person comes to us and says he has ADHD, we should ask if he needs treatment for it in any part of his life to be able to function well. If he needs medications, it is probably best that he not scuba dive. On the other hand, if he functions very well without medications, he is at higher risk for having difficulty while diving but may well be able to do so. Some divers with ADHD might benefit from limiting themselves to clear, calm, warm water and not going beyond 60 feet.
Wilens: ADHD itself should not automatically exclude anyone from diving. Untreated or under-treated ADHD is what places an individual at the greatest risk of difficulties while executing complex actions. The available medications seem to be effective and well tolerated in athletes, and the limited data pertaining to the use of stimulants by adults undergoing multi-modal cardiovascular assessments do not indicate difficulties during peak performance. I recommend that divers with ADHD get treatment, that individuals who are medicated for ADHD dive carefully and that doctors of divers with ADHD monitor the effects of the divers’ medications on their overall performance.
Steven Altchuler, M.D., Ph.D.: The symptoms vary; among the most common are inattention, hyperactivity and impulsivity. People with ADHD might make careless mistakes, not pay attention to details, not finish tasks, be forgetful or have difficulty managing tasks that must be done in a specific order. They might fidget, interrupt others or have difficulty waiting their turn.
The symptoms of ADHD change over time. As people grow up, symptoms may become less severe or even disappear. Someone who had ADHD as a child may do perfectly well as an adult.
How is ADHD diagnosed?
Timothy Wilens, M.D.: ADHD is a clinical diagnosis predicated upon careful review of the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), with the individual and, if the patient is a child, the family. While neuro-psychological testing may be helpful to examine co-occurring cognitive or psychiatric problems, it is not necessary to diagnose ADHD. The diagnosis requires that the individual have a sufficient number of symptoms from each symptom cluster listed in the DSM-5; this establishes context for the functional impairment and demonstrates that it is attributable to ADHD rather than another disorder.
How is ADHD treated?
Altchuler: The most common treatment is the use of stimulant medications such as methylphenidate (Ritalin). Students can benefit from measures to minimise distractability in the classroom and opportunities to move around. They may also do well with additional time to complete standardised tests such as college entrance exams. Other medications, including the antidepressant bupropion (Wellbutrin), are used to treat adults.
Wilens: In addition to prescribing medication, which is considered the first line of treatment, the doctor might also consider the individual’s academic or occupational setting and interpersonal or family issues. Appropriate accommodations in various settings (e.g., school, work) may be necessary. Psychotherapies directed at the person with ADHD and/or the family can be very useful for addressing core and associated symptoms.
What additional risks might a scuba diver with untreated ADHD be taking on?
Altchuler: Divers with ADHD might have difficulty concentrating or paying attention or might be easily distracted, particularly if they are multitasking. For example, observing a beautiful coral reef, maintaining buoyancy control, monitoring gas supply, fulfilling a decompression obligation, controlling depth or ascent rate and paying attention to a dive buddy’s location might prove overwhelming. Diving in an overhead environment where strict attention to detail is a life-or-death matter may be challenging.
Wilens: The many tasks involved in a successful diving venture may challenge individuals with ADHD, particularly if they are untreated. Difficulties with associated neuro-cognitive functions such as working memory (remembering and managing short-term issues) and executive functioning (e.g., organisation) may also adversely affect diving.
What are the risks for divers with ADHD who are successfully treated with medication?
Altchuler: Little is known about the effects of stimulant medications such as methylphenidate at depth. Theoretically, stimulants and bupropion might increase the risk of oxygen toxicity. Practical concerns may exist if somebody who is taking methylphenidate or another medicine for ADHD surfaces and is acting unusual. This might prompt the question of whether the changes are related to the medicine or are indications of decompression illness.
Wilens: There are numerous studies and reviews of studies of the use of ADHD medications by people of various ages. Surprisingly few of these studies consider this use in athletic contexts, and none to my knowledge focused on diving. Our laboratory at Massachusetts General Hospital has completed studies of high-dose amphetamine administration in adults with ADHD who were comprehensively tested at baseline and again six months later using multi-modal cardiovascular imaging and graded-exercise testing. We failed to find concerning adverse cardiovascular outcomes but did note non-clinically significant slower heart-rate recovery after exercise, which means longer recovery times following peak exercise performance. In standard atmospheric testing we did not find varying rates of oxygenation or cardiac output or any evidence of arhythmias. Of interest, after thorough diagnostics many professional athletes are treated for ADHD and demonstrate improved overall outcomes and excellent toleration of the medications.
Can people with ADHD dive if they stop taking their medication?
Altchuler: Certainly, if a diver no longer requires medication, then he or she should stop taking it. We are concerned about whether the diver can pay adequate attention to detail and the dive plan to be able to dive safely. Frequently, school-age children and teenagers are given “vacations” from their ADHD medications during the summer. When people need medication to function well in school, where paying attention to detail can affect their grades, we are even more concerned about them paying attention while scuba diving, where attention to detail can become a life-or-death matter.
So whether someone with ADHD can scuba dive really depends on whether the person in fact has ADHD and what treatment is needed. If the person needs stimulant medication to function normally, we have concerns about how the medicine would affect him or her when scuba diving. The U.S. Navy medically disqualifies from diving a person with active ADHD, but “a history of ADHD greater than 1 year prior to military service is not disqualifying.” Use of the medicines that treat ADHD is similarly disqualifying.
Wilens: While we do not have adequate data on the effects of stimulants or non-stimulants in diving conditions, we are accumulating data on the positive effects of treatment on other complex activities such as driving. These data show improvements in all aspects of driving behaviour in simulators. There are also large epidemiological studies that demonstrate a lower overall risk for motor vehicle accidents with treatment. If we were to extrapolate from other complex behaviours that are aberrant in ADHD, I would recommend treatment over no treatment.
What should be done when a prospective diver reports a history of ADHD?
Altchuler: The first thing to do is find out if the person is taking medicine or undergoing some other treatment for ADHD. If the prospective diver is a teenager, do not ask the parents, ask the youth directly. In too many cases teenagers start taking a medication, take it for several months, notice no difference and stop taking it.
People not undergoing treatment need an operational diving examination. We do one for all divers who are new to us. We observe their functioning starting in easy diving environments and progress to more challenging environments to determine if they can dive successfully. It’s critical to observe divers as they progress to more challenging environments. As the number and complexity of tasks divers must do increases, so does the likelihood that ADHD will cause problems. Things an experienced diver might find routine can be overwhelming to a new diver, particularly one with ADHD. Even dives in calm conditions involve management of many tasks, and additional challenges such as choppy seas, low visibility and cold water might make the situation overwhelming.
A challenge diving physicians face is that many recreational diver health forms ask only, “Are you currently taking prescription medications?” A teenager or young adult learning to dive during the summer and taking a “medication vacation” can truthfully answer “no.” Health forms typically do not ask specifically about ADHD but rather list “behavioural health, mental or psychological problems.” While we in the medical field may consider ADHD to fall in this category, the diver or the diver’s parent may think of ADHD as only a school problem and again truthfully answer “no.”
The next challenge is that the diver’s primary physician who completes the form may lack knowledge about dive medicine and the potential for enhanced side effects in high-partial-pressure oxygen environments. The primary doctor may also lack knowledge about the multiple tasks a scuba diver must perform to be able to dive safely.
Divemasters and instructors cannot be expected to be medical experts. They should, however, be observant. Simple questions such as, “Did you take any prescription medicines in the past year, and did your doctor know about them when he completed this form?” may provide useful information.
Wilens: To Dr. Altchuler’s comprehensive response I would add only the recommendation to determine if the individual has been swimming, freediving or scuba diving in the past, whether the person took medications while doing so and how his or her experience was with or without them, noting in particular any adverse effects. These data may help guide the conversation.
Any further comments?
Altchuler: If a person comes to us and says he has ADHD, we should ask if he needs treatment for it in any part of his life to be able to function well. If he needs medications, it is probably best that he not scuba dive. On the other hand, if he functions very well without medications, he is at higher risk for having difficulty while diving but may well be able to do so. Some divers with ADHD might benefit from limiting themselves to clear, calm, warm water and not going beyond 60 feet.
Wilens: ADHD itself should not automatically exclude anyone from diving. Untreated or under-treated ADHD is what places an individual at the greatest risk of difficulties while executing complex actions. The available medications seem to be effective and well tolerated in athletes, and the limited data pertaining to the use of stimulants by adults undergoing multi-modal cardiovascular assessments do not indicate difficulties during peak performance. I recommend that divers with ADHD get treatment, that individuals who are medicated for ADHD dive carefully and that doctors of divers with ADHD monitor the effects of the divers’ medications on their overall performance.
Categories
2021
2020
January
February
Group Fitness at the PoolHow to Rescue a Distressed diver at the SurfaceHow to manage Near-DrowningNo Sit-ups no problem How to manage MalariaHow to manage Oxygen Deficiency (Hypoxia)What to do when confronted by a sharkHow to manage Scombroid PoisoningHow to perform a Deep Diver RescueHow to perform One-rescuer CPRHow to perform a Neurological Assessment
March
DAN’s Quick Guide to Properly Disinfecting Dive GearCOVID-19 : Prevention Recommendations for our Diving CommunityGermophobia? - Just give it a reasonable thoughtScuba Equipment care – Rinsing and cleaning diving equipmentCOVID-19 and DAN MembershipFurther limitations imposed on travels and considerations on diving activitiesDAN Membership COVID-19 FAQsLancet COVID-19 South African Testing SitesCOVID-19 No Panic Help GuideGetting Decompression Sickness while FreedivingDown in the DumpsCardiovascular Disease and DivingDelayed Off-GassingDiving after Dental surgeryDiving with Multiple MedicationsPygmy Seahorses: Life AquaticAfrica DustCOVID-19 Myth BustersScuba Units Are Not Suitable Substitutes for VentilatorsDisinfection of Scuba Equipment and COVID-19Physioball Stability Exercises
April
COVID-19 AdvisoryScuba Equipment Care - Drying & Storing Your GearTransporting Diving Lights & BatteriesHow to Pivot Your Message During a CrisisTourism Relief FundCOVID-19 Business Support ReviewDiving After COVID-19: What We Know TodayEUBS-ECHM Position Statement on Diving ActivitiesPart 2: COVID-19 Business Support ReviewPress Release
May
Diving in the Era of COVID-19Dive Operations and COVID-19: Prepping for ReturnCOVID-19 & Diving Activities: 10 Safety RecommendationsCOVID-19: Surface Survival TimesThe Philippines at its FinestThe Logistics of ExplorationThe Art of the Underwater SelfieShooter: Douglas SeifertFAQs Answered: Disinfecting Scuba EquipmentStock your First-Aid KitResearch and OutreachCovid-19 ResearchOut of the BlueEffects of Aspirin on DivingThe New Pointy end of DivingDiving and Hepatitis CCaissons, Compressed-Air work and Deep TunnellingPreparing to Dive in the New NormalNew Health Declaration Form Sample Addressing C-19 IssuesDiving After COVID 19: What Divers Need to Know
June
Travel Smarter: PRE-TRIP VACCINATIONSAttention-Deficit/Hyperactivity Disorder and DivingCOVID-19: Updated First Aid Training Recommendations From DANDiving with a Purpose in National Marine SanctuariesStay Positive Through the PandemicFor the Dive Operator: How to Protect Your Staff & ClientsStudying Deep reefs and Deep diversAsking the Right QuestionsLung squeeze under cold diving conditions
July
Dive DeprivationVolunteer Fish Surveys: Engage DiversDAN Member Profile: Mehgan Heaney-GrierTravel Smarter: Don’t Cancel, Reschedule InsteadDive Boat Fire SafetyRay of HopePartner ExercisesDiving at AltitudeAluminium ExposureHip FracturesAcoustic NeuromaGuidelines for Lifelong Medical Fitness to DiveNew Dive Medical Forms
August
Women in Diving: Lauren Arthur, Conservationist & Natural History Story TellerWomen in Diving: Dr Sara Andreotti White Shark ResearcherTiming ExerciseWomen in Diving: The Salty Wanderer, Charlie WarlandWomen in Diving: Beth Neale, Aqua soul of freedivingWomen in Diving: Diving and spearfishing Diva, Jean HattinghWomen in Diving: Zandile Ndhlovu, The Black Mermaid
September
October
Freediving For ScienceStep Exercises with CardioFluorescence Imaging help Identify Coral BleachingChildren and DivingThe Watchman device and divingScuba Diving and Factor V Leiden gene mutationNitrogen Narcosis at shallow depthsOil and Particulates: Safe levels in Breathing Air at depthDive Principles for Coping with COVID-19The Importance of a Predive Safety CheckTalya Davidoff: the 'Plattelandse Meisie' Freediver
2019
February
April
May
DAN Press ReleaseYour Dive Computer: Tips and tricks - PART 1Your Dive Computer: Tips and tricks - PART 2Aural HygieneDCS AheadHow Divers Can Help with coral conservationRed Tide and shellfish poisoningDiving after Kidney DonationDiving with hypertrophic cardiomyopathyEmergency Underwater Oxygen Recompression
June
July
September
October
November
Exercise drills with DowelsHeart-rate TrainingCultivating ConservationTRavel Smarter : Evaluating an unfamiliar Dive operatorChallenging the Frontiers of Decompression ResearchTravel Smarter: Plan for Medical EmergenciesWhen should I call my Doctor?DAN Student Medical Expense CoverageAdvice, Support and a LifelineWetsuits and heat stressDiving after Chiropractic adjustments
2018
April
Flying after pool diving FAQLung squeeze while freediving FAQDiving after Bariatric surgery FAQMarine injuries FAQVasovagal Syncope unpredictable FAQIncident report procedure FAQDiving after knee surgery FAQDiving when in RemissionDive with orbital Implant FAQInert gas washout FAQOxygen ears FAQPost Decompression sicknessChildren and diving. The real concerns.Diving after SurgeryPhysiology of Decompresssion sickness FAQDiving and regular exerciseGordon Hiles - I am an Underwater Cameraman and Film MakerScuba Air QualityBreath-hold diving. Part 3: The Science Bit!Compensation Legislation and the Recreational DiverCape Town DivingFive pro tips for capturing better images in cold waterThe Boat Left Without You: Now What?
May
When things go wrongEmergency Planning: Why Do We Need It?Breath-hold diving: Running on reserve -Part 5 Learning to RebreatheSweet Dreams: When Can I Resume Diving Post Anaesthesia?Investing in the future of reefsTo lie or not to lie?THE STORY OF A RASH AFTER A DIVEFirst Aid KitsTaravana: Fact or Falacy?
June
Oxygen Unit MaintenanceKnow Your Oxygen-Delivery Masks 1Know Your Oxygen-Delivery Masks 2Emergency Oxygen unitsInjuries due to exposure - HypothermiaInjuries due to exposure - Altitude sicknessInjuries due to Exposure - Dehydration and other concernsHow to plan for your dive tripThe Future of Dive MedicinePlastic is Killing our ocean
September
Return to DivingDiagnoses: Pulmonary blebSide effects of Rectogesic ointmentDiving with ChemotherapyReplacing dive computers and BCDsCustomize Your First-Aid KitPlan for medical emergenciesHow the dive Reflex protects the brain and heartDry suits and skin BendsAltitude sickness and DCSScuba Diving and Life Expectancy
2017
March
April
Incident Insight: TriageA Field Guide to Minor MishapsSnorkels: Pros & ConsTime & RecoveryMedication & Drug UseDiving with CancerNitrox FAQCOPD FAQHyperbaric Chamber FAQJet Lag FAQHydration FAQAnticoagulant Medication FAQFluid in the Ear FAQEye Surgery FAQElderly Divers FAQNitrogen FAQHealth Concerns FAQMotion Sickness FAQMicronuclei FAQ
June
August
2016
February
March
Breath-Hold Diving & ScubaReturn to Diving After DCITiming Exercise & DivingHot Tubs After DivingSubcutaneous EmphysemaIn-Water RecompressionDiving at AltitudeFlying After DivingDiving After FlyingThe Risks of Diabetes & DivingFlu-like Symptoms Following a DiveHand & Foot EdemaFrontal HeadachesBladder DiscomfortLatex AllergiesRemember to BreatheProper Position for Emergency CareAches & PainsCell Phones While DrivingSurfers Ear Ear Ventilation TubesDealing with Ear ProblemsDiving with Existing Ear InjuriesPerforated Ear DrumENT SurgeryUnpluggedCochlear ImplantsPortuguese Man-of-WarJellyfish StingsLionfish, Scorpionfish & Stonefish EnvenomationsStingray Envenomation Coral Cuts, Scrapes and RashesSpeeding & Driving Behaviour
June
Newsflash! Low Pressure Hose DeteriorationItching & rash go away & come back!7 Things we did not know about the oceanMigraine HeadacheAttention Deficit Disorder Cerebral Vascular AccidentEpilepsyCerebral PalsyHistory of SeizuresMultiple Sclerosis Head TraumaBreast Cancer & Fitness to Dive IssuesLocal Allergic ReactionsSea LiceHow ocean pollution affects humans Dive Fatality & Lobster Mini-Season StatisticsPregnancy & DivingReturn to Diving After Giving BirthBreast Implants & DivingMenstruation During Diving ActivitiesOral Birth ControlBreast FeedingPremenstrual SyndromeOsteoporosisThe Aftermath of Diving IncidentsCompensation Legislation & the Recreational DiverNoise-Induced Hearing LossLegal MattersThe Nature of Liability & DivingDAN Legal NetworkWaivers, Children & Solo DivingHealthy, but overweight!Taking Medication while Scuba DivingGetting Fit for the Dive SeasonBone Considerations in Young DiversAsthma and Scuba DivingHepatitisDiving with HyperglycemiaShoulder PainDiving After Spinal Back Surgery
August
Hazard Identification & Risk AssessmentCaring For Your People Caring For Your FacilitiesCaring For Your BusinessScuba Air Quality Part 1Scuba Air Quality Part 2Chamber Maintenance Part 1Chamber Maintenance Part 2The Aging Diver Propeller SafetyRelease The PressureDon't Get LostMore Water, Less Bubbles13 Ways to Run Out of Air & How Not To7 Mistakes Divers Make & How To Avoid ThemSafety Is In The AirHow Good Is Your Emergency Plan
2015
January
March