This person, _____________________, requires a medical examination to assess his/her fitness for certification as a Scientific Diver for the East Carolina University (ECU) Scientific Diving Program. His /her answers on the Diving Medical History Form (attached), may indicate potential health or safety risks as noted. Your evaluation is requested on the attached scuba Diving Fitness Medical Evaluation Report. If you have questions about diving medicine, you may wish to consult one of the references on the attached list or contact a physician with the Dives Alert Network (DAN) at (919)684-2948. Please contact the undersigned Diving Safety Officer if you have any questions or concerns about diving medicine or the ECU standards. Thank you for your assistance.

Steven H. Sellers
Director of Diving and Water Safety
East Carolina University
(252)328-4041

(Adapted from Davis 1986:47-50, bracketed numbers are pages in Davis)

1. Tympanic membrane perforation or aeration tube [7]
2. Inability to auto-inflate the middle ears [6,7,8]
3. External ear exostoses or osteomas adequate to prevent external ear canal pressure equilibration [4]
4. Meniere's Disease or other chronic vertiginous conditions, status post-surgery, such as subarachnoid endolymphatic shunt for Meniere's Disease [11]
5. Stapedectomy and middle ear prosthesis [9]
6. Chronic mastoiditis or mastoid fistula [5]
7. Any oral or maxillofacial deformity that interferes with the retention of the regulator mouthpiece [43]
8. Corrected near visual acuity not adequate to see tank pressure gauge, watch, decompression tables, and compass underwater. Uncorrected visual acuity not adequate to see the diving buddy or locate the boat in case corrective lenses are lost underwater [13]
9. Radial keratotomy or other recent ocular surgery [14]
10. Claustrophobia of a degree to predispose to panic [15,16]
11. Suicidal ideation [16]
12. Significant anxiety states [16]
13. Psychosis [18]
14. Severe depression [16]
15. Manic states [16]
16. Alcoholism [19,20]
17. Mood-altering drug use [19,20]
18. Improper motivation for diving [16,17,18]
19. Episodic loss of consciousness [1,22]
20. History of seizure. History of seizure in early childhood must be evaluated individually [21]
21. Migraine [20]
22. History of cerebrovascular accident or transient ischemic attack [23]
23. History of spinal cord trauma with neurologic deficit - whether fully recovered or not. [23]
24. Any degenerative or demyelinating CNS process [25]
25. Brain tumor with or without surgery [24]
26. Intracranial aneurysm or other vascular malformation [24]
27. History of neurological decompression sickness with residual deficit [23,24]
28. Head injury with sequelae [21]
29. History of intracranial surgery [24]
30. Sickle cell disease [34]
31. Polycythemia or leukemia [34]
32. Unexplained anemia [34]
33. History of myocardial infarction [28,29,20]
34. Angina or other evidence of coronary artery disease [29]
35. Unrepaired cardiac septal defects [32]
36. Aortic stenosis or mitral stenosis [32]
37. Complete heart block [31]
38. Fixed second-degree heart block [31]
39. Exercised-induced tachyarrhythmias [31,32]
40. Wolf-Parkinson-White (WPW) Syndrome with paroxysmal atrial tachycardia or syncope [31]
41. Fixed-rate pacemakers [33]
42. Any drugs which inhibit the normal cardiovascular response to exercise tolerance [31]
43. Peripheral vascular disease, arterial or venous, severe enough to limit exercise tolerance [33,41]
44. Hypertension with end-organ finding - retinal, cardiac, renal or vascular [30]
45. History of spontaneous pneumothorax [36]
46. Bronchial asthma.History of childhood asthma requires special studies [7,35]
47. Exercise or cold air-induced asthma [36,37]
48. X-ray evidence of pulmonary blebs, bullae, or cysts [36,37]
49. Chronic obstructive pulmonary disease [37]
50. Insulin-dependent diabetes mellitus. Diet or oral medication-controlled diabetes mellitus if there is a history of hypoglycemic episodes [38]
51. Any abdominal wall hernia with potential for gas-trapping until surgically corrected [41]
52. Paraesophageal or incarcerated sliding hiatal hernia [39]
53. Sliding hiatus hernia if symptomatic due to reflux esophagitis [39]
54. Pregnancy [1,45]
55. Osteonecrosis. A history consistent with a high risk of dysbaric osteonecrosis
56. Any condition requiring ingestion of the following medication: antihistamines, bronchodilators, steroids, barbiturates, phenytoin, mood-altering drugs, insulin

1. A	16. B	31. B	46. B	61. B
2. B	17 C	32. B	47. B	62. B
3. B	18. B	33. B	48. B	63. B
4. B	19. B	34. C	49. B	64. B
5. C	20. B	35. B	50. B	65. B
6. B	21. B	36. B	51. B	66. B
7. B	22. B	37. B	52. B	67. B
8. A	23. B	38. B	53. B	68. B
9. B	24. C	39. B	54. B	69. B
10. B	25. B	40. B	55. B	70. B
11. B	26. B	41. A	56. B	71. B
12. B	27. B	42. B	57. A	72. B
13. B	28. B	43. B	58. B	73. C
14. B	29. B	44. B	59. B	74. C
15. B	30. B	45. B	60. B	75. B

A = Absolute contraindication to diving;
B = Relative contraindication to diving, requires careful review by physician;
C = Of interest, not a contraindication.

DIVING MEDICINE, 1990. A. Bove and J. Davis. W.B. Saunders Company, Philadelphia

DIVING AND SUBAQUATIC MEDICINE, Third Edition, 1992. C. Edmonds, C. Lowery and J. Pennefather. Butterworth-Heinemann Ltd. Oxford. (Available from Best Publishing Company, P.O. Box 30100, Flagstaff, AZ 86003-0100)

MEDICAL EXAMINATION OF SPORT SCUBA DIVERS, Jefferson Davis, M.D. (ed.). Best Publishing Company, P.O. Box 30100, Flagstaff, AZ 86003-0100.

NOAA DIVING MANUAL, NOAA. Superintendent of Documents, U.S. Government Printing Office, Washington, D.C.

PHYSIOLOGY AND MEDICINE OF DIVING, Peter B. Bennett and David Elliot, Best Publishing, Carson, CA.

SCUBA DIVING IN SAFETY AND HEALTH, C.W. Deuker. Madison Publishing Associates, Diving Safety Digest, P.O. Box 2735, Menlo Park, CA 94026

THE PHYSICIAN'S GUIDE TO DIVING MEDICINE, C.W. Shilling, C.B. Carlston and R.A. Mathias. Plenum Press, New York, NY (Available through the Undersea and Hyperbaric Medical Association, Bethesda, MD)

U.S. NAVY DIVING MANUAL. Superintendent of Documents, U.S. Government Printing Office, Washington, D.C.

DSM96