Fitness to dive: what the medical bodies publish, and who decides.

Who decides

Nothing on this page, or anywhere on this site, can say whether a particular person is fit to dive. The two screening systems described on this site both hand that decision to a physician or a medical referee:

• The 2020 Recreational Diving Medical Screening System. As PADI describes the Diver Medical Participant Questionnaire (14 July 2020), a yes on the first page leads to a second page of more specific questions, and a yes there means the diver needs a physician's approval to dive. DAN describes the aim as letting everyone who can dive safely do so, while encouraging people with possible health risks to get a medical evaluation.
• The UKDMC self-declaration. In the UK club system used by BSAC, the Sub-Aqua Association and the Scottish Sub-Aqua Club, a yes answer for a new problem, or an assessment that has expired, means contacting a UKDMC Medical Referee. The UKDMC says a diver who develops a new health problem must contact a referee straight away rather than wait for the yearly renewal.

Both systems are explained in full on medical screening. Some courses also ask for a doctor's sign-off regardless of the answers: PADI's Divemaster requirements (16 April 2025) include a physician's evaluation and clearance from the past 12 months. Agencies also set fitness requirements of their own; SSI's Open Water Diver standard, for example, requires a Student Water Fitness Evaluation before open water training dives, and BSAC requires all diving members to meet its medical requirements before any training or diving.

Age and the heart in DAN's data

A DAN blog post of 10 July 2020 on health concerns for divers over 50 says DAN researchers found the risk of dying while diving rises with age, mainly because of heart problems. It puts heart-related death while diving at about ten times as likely in divers over 50 as in divers under 50. The post makes three further points:

• Strenuous effort, such as swimming against a current, rough seas or carrying too much weight, can trigger a cardiac event in a diver with coronary disease.
• Heart disease often progresses without symptoms.
• Risk factors include smoking, obesity, inactivity, high blood pressure, diabetes and high cholesterol.

DAN's page on cardiovascular fitness and diving, by LCDR James Caruso, MD (undated), states that cardiovascular events cause 20 to 30 percent of diving deaths and that sudden cardiac death can be the first sign that someone has coronary artery disease. It says older divers and divers with significant coronary risk factors should have regular medical evaluations with appropriate testing.

What the fatality studies found about age

The authors of the 2018 study recommended that divers keep physically fit and have regular medical check-ups, especially as they get older. The DAN Europe article's author adds a caution: it remains unresolved whether older divers have more accidents, or whether the diving population as a whole is simply ageing. The studies are compared in more detail on what the accident data shows.

How often DAN suggests a medical examination: two versions

DAN's own published schedules do not line up:

• DAN blog, 10 July 2020: divers over 45 should have a medical examination at least once a year, and people with a family history of heart disease or early death should start yearly examinations sooner.
• DAN's Guidelines for Lifelong Medical Fitness to Dive, 2020: DAN's announcement of the schedule (dated 15 July 2020 in its header and 15 June 2020 in its text) says it recommends a medical questionnaire every year for all divers, a fitness-to-dive evaluation every five years for divers over 45 or with multiple health risk factors, and a yearly evaluation for divers over 65 or with relevant chronic illnesses.

Which applies is a question for a doctor, not for this page.

Conditions with their own pages

Some conditions bear directly on fitness to dive and are described on other diving illnesses. DAN says a person who has had immersion pulmonary oedema is likely to have it again, and should have a detailed medical work-up and talk to a physician about continued diving. DDRC Healthcare says people who think they may have a patent foramen ovale should see a cardiologist with an interest in diving.

Age and insurance

Fitness also comes up outside training. DAN Europe states, on an undated insurance page, that applicants for its dive accident insurance aged 75 or over must provide a medical certificate covering fitness to dive, current health and medications. Insurance is described by category on dive insurance and chambers.