Scuba

01 Overview

Scuba diving, a water-based activity that involves the use of a self-contained underwater breathing apparatus (scuba), may be done recreationally or professionally. It is a fun, adventurous activity for exploring underwater places but requires proper training and certification. Due to the inhospitable environment of swimming underwater at depth, the injuries reported from scuba diving are typically due to changes in pressure during ascent from deeper water.

(see Section 04 - Prevention)
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Decompression sickness is the most common diving-related injury. It occurs when dissolved gases, mainly nitrogen, become gas bubbles within the body due to quick changes in pressure. This can happen when resurfacing too quickly from a deep dive. Decompression sickness can affect many areas of the body, including the lungs, brain, heart, joints, and skin. It can be fatal if not treated.

Although not common, heart conditions/heart attack and drowning are the leading cause of death in scuba diving.

Injury to the mouth or face is common in scuba diving, including jaw pain during a dive.

Lower back pain is common among scuba divers, due in part to heavy equipment on land and swimming technique in water.

02 Injury Statistics

Injuries that occur while scuba diving are typically due to changes in pressure during ascent from deeper water. These injuries vary from minor to fatal. The Divers Alert Network (DAN) reported the most common injuries in 2015 included barotrauma such as injury to the ear and sinus due to pressure exerted by the water, decompression sickness, and lung issues. Decompression sickness results from bubbles forming in tissue and causing local damage, or arterial gas embolisms where bubbles form in the circulatory system, travel through the arteries, and cause tissue damage by blocking blood flow at the small vessel level. For every 100,000 dives, 155 divers will report some decompression sickness symptoms and 6 divers will be treated.

DAN identified 127 diving fatalities worldwide in 2015; with fewer than five deaths occurring in Canada. The scuba deaths among U.S. and Canadian citizens were predominantly among males, and among ages 50 to 69 years. The leading cause of death was heart conditions/heart attack, followed by drowning, and arterial gas embolism. Contributing factors included underlying health conditions, lack of air, and panic.

Mouth and facial discomfort are commonly reported among scuba divers. During a dive, 33% of divers report clenching and 20% report jaw pain. Additionally, 41% of divers experience dental symptoms during a dive. Some lower back pain is also reported in scuba diving.

Curious about the research on injuries?

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03 Risk Factors

Risk factors for scuba diving injury include personal factors such as age, sex, pre-existing conditions, and body mass index. Additional factors can include experience, exercise after diving, flying after diving, and equipment-related factors.

  • Age

    There is a higher risk for decompression illness and diving-related fatality among older divers. The risk of arterial gas embolism, asphyxia, or disabling cardiac injury during a dive is greater for those older than 49-years-old as compared to younger divers.

  • Health Conditions

    The presence of underlying health conditions can place scuba divers at increased risk for injury. Divers with asthma, diabetes mellitus, right-to-left shunt (a cardiac abnormality) and spinal stenosis (narrowing of the spinal canal) are at increased risk of injury.

  • Experience

    Divers in their first year of certification, particularly divers on their first dive, are at increased risk of injury.

  • Flying After Diving

    Flying too soon after a dive can increase the risk of decompression sickness due to additional changes in pressure. For a single no-decompression dive, divers should wait at least 12 hours before flying; for multiple dives per day or multiple days of diving, 18 hours is suggested, and for any decompression dives, substantially longer than 18 hours is suggested to reduce the risk of decompression sickness.

  • Sex

    When comparing male and female divers 25 years of age, males were found to be at 6 times higher risk of suffering a diving-related fatality as compared to females. This difference in risk lessens with increased age, with similar fatality rates among males and females at 65 years of age.

  • Body Mass Index (BMI)

    BMI is a measure of body composition based on your weight and height. The odds of surviving an arterial gas embolism are greater for divers with a normal BMI as compared to those with higher BMIs.

  • Exercise After Diving

    Exercise following a dive increases the risk of decompression sickness by increasing arterialization from 13% (at rest) to 52%. Arterialization is the conversion of venous blood (oxygen-deprived blood) into arterial blood (oxygen-rich blood) by the absorption of oxygen in the lungs.

  • Equipment

    Arterial gas embolism and asphyxia are associated with issues with buoyancy, equipment, air supply, and ascent time. Using more weights on weight belts during indoor training and during outdoor dives may be a risk factor for lower back pain. Biting on the mouthpiece, clenching, and quality of the mouthpiece are risk factors for jaw pain.

04 How can I prevent injury?

  • Participant & Parent

    Talk to your coach or organization, if applicable, about the prevention strategies below and how they might be incorporated into training and policies.

    Consecutive Daily Dives

    The completion of identical daily dives can reduce the odds of having decompression sickness on consecutive days. This suggests that protective adaptations take place after a diver completes more dives.

    Other Considerations (about this section)

    Diving Resources
    The Divers Alert Network (DAN) is the world’s largest association of recreational scuba divers. Being affiliated with this network gives you access to resources for provision of emergency assistance, medical information resources, educational opportunities, and more. Members help to build a better picture of scuba-related injuries by reporting incidents and injuries.

    AdventureSmart is a national program providing information to keep you safe while participating in outdoor recreational activities. Learn more about scuba safety.

    Education
    Ascent training can reduce the risk of decompression sickness. This was specifically studied among Vietnamese fisherman divers, where they were educated on in-water recompression techniques. It is also suggested that using a pre-dive checklist can decrease the incidence of major mishaps by 36%.

    Sport-related Physicals
    Scuba diving is a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce the risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.

    Learn more about Kids Health Sports Physicals.

  • Coach & Teacher

    Talk to your organization or school about the prevention strategies below and how they might be incorporated into training and policies.

    Consecutive Daily Dives

    The completion of identical daily dives can reduce the odds of having decompression sickness on consecutive days. This suggests that protective adaptations take place after a diver completes more dives.

    Other Considerations (about this section)

    Diving Resources
    The Divers Alert Network (DAN) is the world’s largest association of recreational scuba divers. Being affiliated with this network gives you access to resources for provision of emergency assistance, medical information resources, educational opportunities, and more. Members help to build a better picture of scuba-related injuries by reporting incidents and injuries.

    AdventureSmart is a national program providing information to keep you safe while participating in outdoor recreational activities. Learn more about scuba safety.

    Education
    Ascent training can reduce the risk of decompression sickness. This was specifically studied among Vietnamese fisherman divers, where they were educated on in-water recompression techniques. It is also suggested that using a pre-dive checklist can decrease the incidence of major mishaps by 36%.

    Facilities
    The Ontario Physical Education Association (OPHEA) provides recommendations for safely implementing scuba in secondary schools.

    Learn more about implementing scuba in secondary schools.

    Sport-related Physicals
    Scuba diving is a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical ensuring fitness to participate can help to reduce the risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.

    Learn more about Kids Health Sports Physicals.

  • Official & Administrator

    Talk to your coaches, teachers, organization, or school about the prevention strategies below and how they might be incorporated into training and policies.

    Consecutive Daily Dives

    The completion of identical daily dives can reduce the odds of having decompression sickness on consecutive days. This suggests that protective adaptations take place after a diver completes more dives.

    Other Considerations (about this section)

    Diving Resources
    The Divers Alert Network (DAN) is the world’s largest association of recreational scuba divers. Being affiliated with this network gives you access to resources for provision of emergency assistance, medical information resources, educational opportunities, and more. Members help to build a better picture of scuba-related injuries by reporting incidents and injuries.

    AdventureSmart is a national program providing information to keep you safe while participating in outdoor recreational activities. Learn more about scuba safety.

    Facilities
    The Ontario Physical Education Association (OPHEA) provides recommendations for safely implementing scuba in secondary schools.

    Learn more about implementing scuba in secondary schools.

    Education
    Ascent training can reduce the risk of decompression sickness. This was specifically studied among Vietnamese fisherman divers, where they were educated on in-water recompression techniques. It is also suggested that using a pre-dive checklist can decrease the incidence of major mishaps by 36%.

    Sport-related Physicals
    Scuba diving is a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to participate can help to reduce the risk of injury. KidsHealth provides information about what sports physicals are, why they may be appropriate and where you may go to get them.

    Learn more about Kids Health Sports Physicals.

  • Health Professional

    The role of health professionals in preventing scuba injuries has two main components:

    1. Providing ongoing education to participants, parents, and coaches on effective injury prevention programs such as balance and resistance training; and
    1. Ensuring that injured scuba divers are completely healed and fit-to-perform before returning to activity to prevent re-injury or chronic injury.

    Health professionals working with scuba divers should be aware of the factors that may increase the risk of decompression sickness in individuals, including pre-existing medical conditions. Know how to detect symptoms of decompression sickness and appropriate treatment and rehabilitation strategies (e.g. hyperbaric oxygen therapy).

    Consecutive Daily Dives

    The completion of identical daily dives can reduce the odds of having decompression sickness on consecutive days. This suggests that protective adaptations take place after a diver completes more dives.

    Other Considerations (about this section)

    Sport-related Physicals
    Scuba diving is a physically demanding sport and some pre-existing conditions may increase the risk of injury. An annual sport-related physical evaluation ensuring fitness to play can help to reduce the risk of injury. The American Academy of Pediatrics provides information about preparticipation physical evaluation.

    Learn more about Preparticipation Physical Evaluation.

    Education
    Ascent training can reduce the risk of decompression sickness. This was specifically studied among Vietnamese fisherman divers, where they were educated on in-water recompression techniques. It is also suggested that using a pre-dive checklist can decrease the incidence of major mishaps by 36%.

    Diving Resources
    The Divers Alert Network (DAN) is the world’s largest association of recreational scuba divers. DAN has information on scuba diving safety and resources for provision of emergency assistance, medical information resources, educational opportunities, and more.

    AdventureSmart is a national program providing information to keep you safe while participating in outdoor recreational activities. Learn more about scuba safety.