SCUBA, an acronym for self-contained underwater breathing apparatus, is a popular system for recreational diving practiced by hundreds of thousands of people all over the world. The history of diving with respiratory support can be traced back to the use of diving bells as described by Aristotle in the 4th century BC.1 Since then many important advances in diving technology and discoveries in underwater physiology have been made. Examples include the discovery of decompression sickness and bubble formation in the tissues of vipers in 1670 by Robert Boyle, the development of the open-circuit breathing system by French engineers in the 19th century, and the first reported case of human decompression sickness in French coal miners in 1841. The increasing amount of time spent by humans underwater has brought to the surface previously unknown and unanticipated risks associated with prolonged diving.
The latest statistic released by the Professional Association of Diving Instructors, one of the largest diving membership and training organizations, reports that they have issued over 23 million certifications since 1967 and have on average issued 900,000 certifications annually for the past 16 years.2 It was reported in 2012 that the incidence of SCUBA related injuries ranges from 7 to 35 per 10,000 divers and from 5 to 152 injuries per 100,000 dives. Factors found to have played a role in injury included insufficient training and preexisting medical conditions. Drowning was found to be the most common cause of death.3
There are many certifying organizations that exist to help educate and train those interested in diving so that they may do so safely. Examples include the National Association of Underwater Instructors (NAUI), the Professional Association of Diving Instructors (PADI), the British Sub Aqua Club (BSAC), and the Confédération Mondiale des Activités Subaquatiques (CMAS). Although each organization has their own training process for entry-level certification, there is no standardization among individual instructors. Unfortunately, there are also no barriers preventing people from buying equipment and diving without prior instruction. This has led to training regimens that range from a 2-day weekend course while aboard a cruise ship to a 6 week course at a university demonstrating varying amounts of supervised instructor-student time.
Because of these variables and how popular it has become, it is important for healthcare practitioners to understand and be ready to address the unique risks associated with SCUBA diving. It is an activity that is shared by both new and experienced divers, young and old, and in varying degrees of health, and the risks can be lethal to those who do not approach it with a sufficient level of understanding. Although there are shared risks between underwater diving and other activities like trauma, submersion injury, and hypothermia, those specific to pressure systems like barotrauma, narcosis, and decompression sickness will be discussed in another piece.
Buzzacott, Peter L. 'The Epidemiology Of Injury In Scuba Diving'. Medicine and Sport Science (2012): 57-79. Web. 15 Sept. 2015.
Bachrach, Arthur J. "History of the Diving Bell", Historical Diving Times, Iss. 21, 1998.
"Worldwide Corporate Statistics 2015, Data for 2009-2014." PADI Certification and Membership Statistics. PADI, 1 Feb. 2015. Web. 9 Sept. 2015.
Tintinalli, Judith E., and J. Stephan. Stapczynski. "Chapter 208 Dysbarism and Complications of Diving." Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York: McGraw-Hill, 2011. 1410-413. Print.