Scuba Diving Medicals in Australia: What Conditions Will Disqualify You?

# Scuba Diving Medicals in Australia: What Conditions Will Disqualify You?

> The medical questionnaire is the part of getting certified that quietly worries the most people. Here's what actually disqualifies you in Australia, what doesn't, and what happens if you tick "yes" to a question.

## Why a medical even exists

Scuba diving puts your body through pressure changes that almost nothing else in everyday life does. At 10 metres you are breathing air at twice atmospheric pressure. At 30 metres, four times. Gas dissolves into your tissues on the way down, and has to come out in a controlled way on the way up. A condition that is mildly inconvenient on land, a head cold, a heart that skips, a lung scarred by an old infection, can become serious underwater.

The medical screen is not there to gatekeep. It is there to find the small number of conditions that genuinely make diving dangerous, and the larger number that need a specialist's clearance to dive safely. Most people who fill out the form pass without further checks. A meaningful minority need a quick visit to a dive doctor. A very small number are advised against diving.

> **The honest framing:** Most things people privately worry about, asthma, mild anxiety, being over 60, contact lenses, glasses, tattoos, mild hearing loss, do not stop you from diving. The conditions that genuinely disqualify are uncommon and usually known to the person well before they walk into a dive shop.

## Contents

1. [The two-form system used in Australia](#two-forms) 2. [Absolute disqualifications, the short list](#absolute) 3. [Conditional disqualifications, where most people land](#conditional) 4. [Asthma and diving, the most common worry](#asthma) 5. [Heart and circulation conditions](#cardiac) 6. [Ear, nose and throat issues](#ent) 7. [Diabetes](#diabetes) 8. [Pregnancy](#pregnancy) 9. [Mental health and medications](#mental-health) 10. [Recent surgery, injuries and infections](#recent) 11. [What happens if you tick "yes"](#tick-yes) 12. [Finding a dive doctor in Australia](#dive-doctor) 13. [Cost, validity and the Queensland question](#cost-validity) 14. [What to do before your appointment](#prep)

## The two-form system used in Australia {#two-forms}

Australian dive shops use a layered system. You meet the first form. Most people never see the second.

**Form 1: The RSTC / agency medical questionnaire**

This is the standard one-page form handed to every student before an Open Water course. PADI, SSI, NAUI and most other agencies use a version of the same Recreational Scuba Training Council (RSTC) questionnaire. It asks roughly 25 yes/no questions covering heart, lung, ear, neurological, gastrointestinal and metabolic history.

- **All "no" answers:** You sign the form and proceed. No doctor required. - **Any "yes" answer:** You must obtain medical clearance before diving. This is not the dive shop being officious, it is the agency standard worldwide.

**Form 2: AS 4005.1 dive medical assessment**

If you tick "yes" to anything, or your dive shop is conservative, or you choose to do this proactively, you book a dive medical. Australia and New Zealand have a national standard, **AS/NZS 4005.1**, that defines what a recreational diver medical assessment must include. It involves:

- A detailed medical history covering the conditions on the questionnaire and more. - A physical examination including ears, lungs, blood pressure, neurological signs. - A spirometry (lung-function) test for anyone with respiratory history. - An ECG if there are cardiac risk factors or you are over a certain age (typically 45). - A signed certificate of fitness, valid 12 months for recreational divers.

The doctor is not just ticking boxes, they are looking specifically at how a condition behaves at depth. A SPUMS-registered diving medicine physician (more on that below) is trained to evaluate exactly this.

## Absolute disqualifications, the short list {#absolute}

Very few conditions are absolute lifelong contraindications to recreational scuba diving. The widely accepted ones in Australian dive medicine are:

- **History of spontaneous pneumothorax (collapsed lung).** A lung that has spontaneously collapsed once is significantly more likely to do so again, and a pneumothorax at depth or on ascent can be fatal. Some specialists may clear divers after pleurodesis or other surgical fixes, but this is rare and case-by-case. A pneumothorax caused by an external injury (a car accident, a stab wound) is a different evaluation. - **Severe chronic obstructive pulmonary disease (COPD), emphysema, cystic fibrosis or pulmonary fibrosis.** Any condition that traps air in the lungs or impairs gas exchange is incompatible with breathing compressed gas at depth. - **Untreated or uncontrolled epilepsy.** A seizure underwater means losing your regulator. Most dive medicine specialists require a minimum five-year seizure-free period without medication before considering clearance. Childhood febrile seizures alone are usually not a disqualifier. - **Severe, structurally significant heart disease.** Active ischaemic disease, recent myocardial infarction, severe valvular disease, severe congestive heart failure, complex congenital defects. - **Some inner ear conditions,** particularly Meniere's disease and any history of inner ear barotrauma, perilymph fistula, or surgical procedures on the inner ear. - **Pregnancy.** Considered an absolute contraindication for the duration of the pregnancy. Resumes after birth.

If none of those apply to you, you almost certainly are not facing an absolute disqualification.

## Conditional disqualifications, where most people land {#conditional}

These are the ones that get a "yes" tick on the form and then need a dive doctor's evaluation. Most are clearable.

- **Asthma** (see the dedicated section below). - **Hypertension (high blood pressure).** If well controlled with medication and no end-organ damage, almost always cleared. - **Mild to moderate sleep apnoea.** Treated with CPAP and well managed, usually cleared. Untreated, generally not. - **History of decompression illness.** Case-by-case. A clean, recovered hit usually clears for further diving with conservative profiles. - **Migraines.** Cleared unless they include neurological symptoms (visual disturbance, weakness) that overlap with DCI presentations. - **Diabetes** (see dedicated section). - **Anxiety, depression, panic disorder.** Cleared if stable, especially on SSRIs (see mental health section). - **Recent ear surgery, including grommets.** Wait until cleared by an ENT, typically 6-12 weeks for grommets. - **Hearing loss.** Permanent stable hearing loss is not itself a disqualifier. Active middle-ear disease is. - **Reflux disease (GORD).** Mild and treated, fine. Severe with regurgitation risk, evaluated. - **Hernias.** Inguinal, fine after repair. Diaphragmatic or hiatus hernia, evaluated more carefully because of air-trapping concerns. - **Past back, neck or joint surgery.** Almost always fine once healed. - **Vision issues, contact lenses, prescription glasses.** Not a medical issue at all. Soft contacts are fine underwater. Prescription masks are widely available.

## Asthma and diving, the most common worry {#asthma}

Asthma is the single most common condition that makes new divers anxious about the medical, partly because the rules used to be much stricter. They have changed significantly in the last 20 years.

**Old rule (pre-2000s):** Any asthma, ever, lifetime ban.

**Current Australian dive medicine consensus:** Asthma can be compatible with recreational diving if:

- It is well controlled on a stable medication regime. - You have not had an asthma attack requiring a reliever in the last 48 hours before a dive. - It is not exercise-induced, cold-induced, or emotion-induced (these are the dangerous triggers underwater). - A spirometry test, performed by a dive doctor, shows normal lung function with no significant response to a bronchodilator challenge.

Well-controlled adult asthma, especially when it has not been symptomatic for years, frequently clears. Childhood asthma that has not recurred since adolescence is rarely a problem. The asthma that does not clear is the brittle, exercise-triggered, frequently-symptomatic type, exactly the asthma most people would not be confident managing at depth themselves.

> **Practical:** If you have asthma, do not panic about the form. Book the dive medical, take your inhaler and any specialist letters with you, and let the dive doctor make a proper evaluation rather than guessing from the questionnaire.

## Heart and circulation conditions {#cardiac}

The heart questions on the medical form are extensive because cardiac events at depth account for a significant share of recreational diving fatalities, particularly in divers over 50.

**Generally clear with documentation:**

- Well-controlled hypertension on standard medications (ACE inhibitors, beta-blockers, calcium channel blockers, ARBs). - Stable, treated arrhythmias such as atrial fibrillation if rate-controlled and anticoagulated appropriately. - Past cardiac surgery (bypass, valve repair) once recovered and exercise-tolerance is established. - Patent foramen ovale (PFO) discovered incidentally without prior unexplained DCI. PFO is common (about 25% of the population) and most carriers dive safely. Closure is sometimes recommended if you have had unexplained DCI.

**Generally do not clear:**

- Active angina or recent myocardial infarction (waiting periods of 6-12 months minimum, then evaluation). - Uncontrolled hypertension (over 160/100 on treatment, or untreated). - Severe valvular disease, severe heart failure, dilated cardiomyopathy. - Implanted cardiac devices (pacemakers, ICDs) that are not rated for dive depths. Most modern pacemakers are pressure-rated and clearable, but it must be checked.

**Age and the cardiac question:** Most Australian dive doctors will request an exercise ECG for new divers over 45-50, even with a clean medical history. This is a precaution against silent coronary disease, not a disqualification.

## Ear, nose and throat issues {#ent}

The ears and sinuses are where most divers experience their first real difficulty. The medical screens for things that turn ordinary equalisation into serious barotrauma.

**Common, almost always clear:**

- A history of childhood ear infections. - A deviated septum that does not affect sinus drainage. - Mild seasonal allergies. - Stable, healed ruptured eardrum. (An active perforation does not clear until it heals.) - Surgical grommets that have been removed and the eardrum has fully healed.

**Conditional:**

- Chronic sinusitis, evaluated for whether sinuses can equalise on descent. - Recurrent middle-ear infections in adulthood. - Eustachian tube dysfunction. Treatable, but persistent dysfunction is a barrier.

**Generally do not clear:**

- Meniere's disease. - History of inner-ear barotrauma or perilymph fistula. - Active middle-ear infection or eardrum perforation (until healed). - Stapedectomy and certain other inner-ear surgeries.

If you cannot equalise reliably on land (yawning, swallowing, gentle Valsalva should all work for most people), get an ENT review before a dive medical, the ENT report often shortcuts the process.

## Diabetes {#diabetes}

Diabetes used to be an absolute disqualification. It is no longer.

**Type 1 diabetes** is now considered compatible with recreational diving under specific protocols, originally pioneered by the Diabetes UK guidelines and adopted in modified form in Australia. Typical clearance criteria include:

- Stable on insulin for at least 12 months. - HbA1c within a target range, typically below about 9%. - No history of severe hypoglycaemic events requiring assistance in the last year. - Demonstrated self-management skills, including regular blood glucose checks. - Pre-dive blood glucose check (typically aiming for 8-15 mmol/L before descent). - Conservative dive profiles, no decompression diving, no extreme depths.

**Type 2 diabetes** is generally easier to clear, especially if managed with diet and oral medications rather than insulin.

The SPUMS website maintains current Australian guidance, and any reasonable dive doctor will work through the criteria with you. It is no longer a closed door.

## Pregnancy {#pregnancy}

Pregnancy is an absolute contraindication to recreational scuba diving for the duration of the pregnancy. The reasoning is precautionary rather than well-evidenced. Decompression effects on a developing foetus have not been studied directly (for obvious ethical reasons), but the bubble physiology that affects an adult diver could theoretically affect a foetus much more severely. The blanket recommendation is consistent across all major training agencies and dive medicine bodies.

There is no waiting period after birth, you can dive again as soon as you feel physically recovered. If you are breastfeeding there are no restrictions related to diving itself.

If you are trying to conceive, current medical opinion is that diving up until conception is fine. Some divers choose to stop earlier as a personal precaution.

## Mental health and medications {#mental-health}

The mental health questions catch a lot of new divers off guard. They are not a screen for whether you have ever felt anxious or sad, they are looking for two specific things:

1. **Conditions that could cause loss of consciousness or impaired judgement underwater.** Active psychotic episodes, uncontrolled bipolar disorder, severe untreated panic disorder. 2. **Medications that could change risk underwater.** A small number of psychiatric medications, principally older antipsychotics and certain mood stabilisers, lower the seizure threshold. That is the concern, not the diagnosis itself.

**Almost always clear:**

- Stable depression or anxiety on SSRIs (sertraline, escitalopram, fluoxetine, etc.). The agency-level position is that SSRIs alone do not exclude diving in stable patients. - ADHD, including treated with stimulant medication, in stable adults. - Past episodes of anxiety or depression that have fully resolved.

**Evaluated more carefully:**

- Bipolar disorder (clearance often depends on stability and medication choice). - PTSD (clearance possible but case-by-case, especially regarding panic triggers underwater). - Recent or active eating disorders.

**Generally do not clear:**

- Active psychosis. - Recent serious suicide attempt. - Medications that significantly impair consciousness or lower seizure threshold.

Be honest on the form. Dive doctors are not there to judge, they are there to evaluate fitness, and an undisclosed condition that becomes relevant underwater is a much bigger problem than a disclosed one that gets cleared.

## Recent surgery, injuries and infections {#recent}

These are the temporary contraindications, the ones that simply require waiting.

**Typical waiting periods (always confirm with the surgeon and a dive doctor):**

- **Eye surgery (LASIK, PRK):** 4-12 weeks depending on procedure. Cataract surgery, similar. - **Ear surgery:** 6-12 weeks for simple grommets, longer for tympanoplasty or stapedectomy. - **Abdominal surgery:** 8-12 weeks, longer for major procedures. - **Chest surgery:** Significantly longer, and a respiratory clearance is required. - **Dental work involving sinuses or extractions:** 1-2 weeks. - **Fractures:** Once cast off and full mobility restored. - **Common cold, flu, sinus infection, ear infection:** Until fully resolved. Diving with congestion is the most common cause of avoidable barotrauma in new divers, do not push through. - **Gastroenteritis:** Until 24-48 hours symptom-free and rehydrated. - **Head injury / concussion:** Cleared by a neurologist before resuming diving.

## What happens if you tick "yes" {#tick-yes}

Flowchart of the typical Australian process:

1. You complete the agency medical questionnaire, ticking "yes" to one or more questions. 2. The dive shop hands you back the form and asks you to obtain medical clearance before starting the course. 3. You book an appointment with a doctor experienced in dive medicine, ideally one on the SPUMS register (see below). 4. The doctor reviews the form, takes a history, performs the physical examination called for under AS 4005.1, and either: - Issues a fitness-to-dive certificate (12 months validity), or - Asks for additional investigation (specialist referral, spirometry, ECG, hearing test, ENT review), or - Declines to clear and explains why. 5. You return the certificate to the dive shop and proceed with the course.

Most "yes" answers result in a clean clearance after one appointment. Specialist referrals are the exception, not the rule.

## Finding a dive doctor in Australia {#dive-doctor}

Not every GP can or will sign a dive medical. The condition-specific knowledge needed (effects of pressure on lung physiology, gas absorption, ear barotrauma, decompression risk) is specialist territory. You want one of the following:

- **A SPUMS-registered diving medicine physician.** SPUMS (the South Pacific Underwater Medicine Society) maintains a register of doctors trained specifically in dive medicine. Most are GPs or occupational physicians who have completed extra training. Their list is at spums.org.au. - **A doctor working at a dedicated dive medicine clinic.** These exist in most major cities, often attached to a hyperbaric facility (Royal Hobart, Royal Adelaide, Prince of Wales Sydney, The Alfred Melbourne). - **A travel-medicine GP** with explicit dive-medical training. Some travel clinics provide AS 4005.1 medicals.

A standard GP without dive medicine training can sometimes sign the simpler RSTC form questions, but for anything beyond a basic clearance, go to a specialist. They are quicker, cheaper in the long run, and they understand exactly what the dive shop needs to see.

## Cost, validity and the Queensland question {#cost-validity}

**Cost:** A recreational AS 4005.1 dive medical in Australia typically runs $80-$200, depending on the city, whether spirometry and ECG are included, and whether the doctor bulk-bills (most do not for dive medicals, since they are not Medicare-rebatable for recreational diving).

**Validity:** 12 months for recreational divers. After that you do not need a full repeat unless something has changed, but you re-attest fitness on each course re-engagement.

**The Queensland question:** Until 2014, Queensland's Workplace Health and Safety regulations required every Open Water student to undergo a full AS 4005.1 medical, regardless of questionnaire answers. This is no longer the case, Queensland now follows the same questionnaire-first approach as the rest of Australia. However, some Cairns and Whitsundays liveaboard operators still strongly encourage or require a dive medical for multi-day, multi-dive trips, partly out of conservatism and partly because being remote from medical help on a four-day liveaboard raises the bar. Check with your operator before booking.

## What to do before your appointment {#prep}

- **Bring your medical history.** Specialist letters, recent test results, medication lists. The dive doctor cannot make a fair evaluation from memory. - **List your current medications,** including dose and how long you have been on each. SSRIs, blood pressure medications, asthma inhalers, the lot. - **Be ready for spirometry.** Easier if you have not smoked, used your reliever, or done heavy exercise within an hour of the test. - **Plan around it.** Most clinics need 30-60 minutes for a full medical. Block out the afternoon. - **Be honest.** A dive doctor's job is to evaluate risk, not to gatekeep. Underplaying a condition is the worst possible strategy because the form becomes useless and so does the clearance.

## A final word on risk and honesty

The medical screen is the only formal check you will get before strapping on a tank, and it relies entirely on the truthfulness of the form. Dive instructors do not have the training to evaluate cardiac history. Dive shops do not run blood tests. The system works because most people answer honestly and the small fraction who need a closer look get one.

The single biggest risk to a diver is not the condition they declared, it is the one they hid. If you are unsure whether something matters, tick "yes" and let the dive doctor decide. Worst case, you spend an hour with a specialist and get cleared. Best case, you find out about something that mattered before it became a problem at 18 metres.

## Next steps

- If you have not yet decided whether scuba is for you, read [Is Scuba Diving Right for Me?](/blog/is-scuba-diving-right-for-me) for the broader fit question. - Once cleared, see [What to Expect in the Theory Module](/blog/what-to-expect-in-your-theory-module-knowledge-development) for the academic component, [What to Expect in Your Pool Sessions](/blog/what-to-expect-in-your-pool-sessions-confined-water-training) for the confined-water training, and [What to Expect in Your Open Water Training Dives](/blog/what-to-expect-in-your-open-water-training-dives) for the four certification dives. - Choosing a school? Read [PADI vs SSI vs NAUI](/blog/padi-vs-ssi-vs-naui-which-scuba-certification-agency-is-right-for-you) on agency differences.

> **Disclaimer:** This article is general information about how the recreational dive medical process works in Australia. It is not medical advice. Diagnoses, clearances and any decisions about whether you can safely dive are the role of a qualified diving medicine physician, not a website.