THE EUROPEAN DIVING TECHNOLOGY COMMITTEE

Goal-setting Principles for Harmonised Diving Standards in Europe

Aimed primarily at offshore (oil and gas-related) and inland/inshore (civil engineering and in docks and harbours) commercial diving. November

PURPOSE OF THIS DOCUMENT

The purpose of this document is to provide a common basis for the development of European standards for safe diving, and the development of national diving regulations in Europe. It is hoped that European countries will make use of this document as described above.

The effect of using this document actively would be harmonised standards and regulations for offshore and inland/inshore diving, as well as harmonisation between the European countries. This will ease the free flow of: (i) labour and capital items such as diving vessels, diving equipment, and (ii) diving services and diving personnel.

This document is not mandatory or binding and is published for general information and guidance. Not all subjects are covered, other "Principles" may be added at future revisions of the document.

INTRODUCTION

Commercial diving is carried out in all European countries but the nature and extent varies considerably, dependent in part on whether the country has a marine border or is landlocked. About 50% of European countries have regulations which set health and safety standards for commercial divers. However, the scope and detail of these regulations varies considerably.

The European Diving Technology Committee (EDTC) was set up in 1973 and has as a main objective harmonisation so that common standards may be achieved.

Made up as it is of government, industry, trade union and medical representatives from European states, it was appropriate for the Committee to take steps to try and harmonise diving standards in Europe and a Workshop was held with that objective on 13, 14 and 15 April 1994 in Luxembourg with support from the Directorate General, Employment, Industrial Relations and Social Affairs of the Commission of the European Communities. A report was prepared as a result of the valuable discussions which took place at that Workshop, and a copy was sent to the European Commission. However, the report only reflected the concensus views expressed at the Workshop on the topics which were discussed at it, and was therefore simply a report of what happened at it. It went no further than that.

This document takes the work further by making specific recommendations relating to safe standards which should be used. It is aimed primarily at offshore and inshore/inland commercial diving operations. It does not apply to diving operations related to police work, rescue operations, science/archaeology, tunnelling/compressed air work, instruction of amateur/sports divers etc. However, the principles which it contains may also be useful for those types of diving operations.

MEDICAL EXAMINATIONS TO DETERMINE FITNESS TO DIVE

Medical examinations should be carried out in accordance with the principles set out in this section.

The name, full address, telephone number and signature of the doctor who examined the diver and evaluated his medical history should be written in the diver's personal logbook.

The purpose of the medical examinations should be to:

- determine fitness to dive (safety at work),

- satisfy occupational health requirements,

- give information about potential long-term health effects of diving, and

- allow screening and surveillance.

Initial Medical Examination

All potential commercial divers should undergo a thorough initial medical examination in order to determine their fitness to work as a diver and to provide baseline data for subsequent medical examinations.

The initial medical examination and evaluation should be performed by a diving medicine physician.

The initial medical examination must be thorough and in great detail, and should take into account all aspects of the individual's physical and mental health; including careful evaluation of his medical history.

Periodic Evaluations/Examinations

Following the initial medical examination, all divers should be periodically examined in order to ensure their continuing fitness to dive. Such periodic examinations should include a careful evaluation of the diver's diving and medical history since the previous medical examination.

Periodic examinations should be performed by a Diving Medicine Physician or by a Medical Examiner of Divers.

Detailed Diving Medical Examinations at five-year Intervals

At intervals not exceeding five years, all commercial divers should undergo a complete diving medical examination. Such examinations should be similar in scope to the initial examination but should also contain examinations and tests with respect to occupational health requirements and special tests and examinations to detect potential long-term health effects.

This medical examination should be carried out by a Diving Medicine Physician who has been approved to carry out this type of medical examination.

The purpose of the detailed medical examination is to determine continuing fitness to dive and therefore safety at work, satisfy occupational health aspects, and obtain necessary information about long-term health effects of diving.

QUALIFICATIONS, EDUCATION AND TRAINING OF MEDICAL DOCTORS

Medical Examiner of Divers

A Medical Examiner of Divers is a medical doctor who has attended and successfully completed a basic course in diving medicine and who can undertake both the continued surveillance of a diver's health and perform a qualitative evaluation of a diver's continuing fitness to dive. Such doctors will normally be family doctors or general practitioners who have been specifically approved by relevant national authorities to make periodic examinations, limited in scope, but on a fairly frequent basis.

The basic course for Medical Examiner of Divers should have a duration of approx. 25 - 30 hours. In addition there is a need for such doctors to attend and satisfactorily complete refresher courses at regular intervals.

Diving Medicine Physician

A Physician specialing in diving medicine will normally be a medical doctor with knowledge in relevant aspects of occupational health, who has received special training in and has extensive experience in diving medicine. They should be approved by relevant national authorities to undertake the special initial and subsequent periodic examinations of commercial divers. However, they will also be competent to manage diving accidents and advise diving contractors on medical matters relating to diving. A Diving Medicine Physician would normally work full-time or for much of his time in this field.

Expert or Consultant in diving medicine

An Expert or Consultant in diving medicine is a medical specialist in a relevant clinical subject, who has undertaken some training and has some experience in diving medicine. He/she can assess a diver's fitness to dive in relation to a particular medical problem falling within their speciality, after referral to them by either a Medical Examiner of Divers or a Diving Medicine Physician.

Approval of Diving Medical Doctors

Approval of Medical Examiner of Divers and Diving Medicine Physicians (as defined above) should be given by a relevant national authority. The authority should keep records of these doctors and update them annually. Mutual recognition of such doctors between European countries should be an important objective.

Quality Control

All medical doctors, in the context of these standards, should be subject to quality control by relevant national authorities in order to ensure their continued competence. This should take into account the number of examinations, which they undertake each year, as well as the quality of those examinations.

PROTOCOLS FOR DETAILED INITIAL AND PERIODIC MEDICAL EXAMINATIONS

Protocols still need to be developed for the initial, periodic and 5 yearly medical examinations. The purpose of the Protocols (and standard examination forms which would be used for them) would be to ensure the uniformity of data in national registries and to assist in the mutual acceptance internationally of diving health certificates.

The initial thorough examination should be identical for all divers, regardless of the type of diving which they propose to undertake. The protocols for the periodic and 5 yearly examinations should contain guidance on the scope of examinations and tests which should be carried out, dependent upon the type of diving activity.

TRAINING, CERTIFICATION AND COMPETENCE OF THE DIVING TEAM

GENERAL

Training or Competence Standards for diving personnel should be based on the type of equipment to be used. The following categories of personnel are considered
- Surface oriented divers (SCUBA or surface supplied diving)
- Mixed gas divers
- Life support technicians
- Life support supervisors
- Inland/inshore diving supervisors
- Offshore diving supervisors

RECOGNITION OF COMPETENCE

Certificates issued on the basis of training in accordance with the EDTC Training Standard (1988) and these goal setting principles should be recognised by European countries, provided that the quality of the training has been validated by a national governmental body or an accredited body which is accredited by a National Accreditation Board.

DIVER TRAINING

Basic diver training should be based towards safety including teamwork, rather than vocational aspects. The safety aspects of a range of typical tools and equipment should however be addressed. Commercial divers carry out a wide variety of tasks and it would therefore not be practical to train them properly in all potential skills. The word 'training' means 'the use of' both normal as well as emergency procedures.

There are a wide variety of types of diving equipment, the characteristics of which may be different. For example there are different types of suits, masks, helmets, life jackets, and reserve systems. It is not reasonable to require trainee divers to be competent to use all types of equipment but it is necessary to them to be trained to use a fair and representative sample.

METHODS OF ASSESSMENT

There should be a strict selection procedure for all trainee commercial divers, which should include: medical, physical, educational aspects, and their attitude.

Practical training should be objectively assessed against stated criteria.

Theoretical training should be assessed by means of a written (which might be multiple choice) examination.

If a trainee has been accepted to attend a diver training course and at some point, during the conduct of the course, is judged to be a danger to himself or others, then he should be failed.

TRAINING SCHOOL

Diver training schools should possess or have ready access to their own infrastructure and equipment so that the quality of training remains constant.

The majority of subjects taught to trainee divers, especially practical diving subjects, should be taught by instructors having an appropriate level of practical diving experience to at least the category which they are teaching. Theoretical subjects may be taught by instructors having no practical diving experience, however they must have an appreciation of diving relevant to their subject. For both practical and theoretical subjects, tutorial skills or a proven instructional capability is essential.

All commercial diver training schools should be monitored by an independent body, preferably, the relevant national government department having experience and capabilities to do such work. Such monitoring should involve periodic audits of each school and spot checks.

SURFACE ORIENTED DIVERS

This covers surface supplied and SCUBA diving, the training for which may be as part of a single course or separate courses.

SCUBA diving is not considered appropriate for offshore use, and in some European countries it is not considered appropriate for inland/inshore diving.

The two techniques should be considered as complementary to each other and not as alternatives.

Divers should be trained and regularly exercised throughout their training in the use of emergency procedures.

MIXED GAS/BELL DIVER

Divers should only be trained to use diving bells once they have been certified as competent to work as a surface supplied diver and have achieved a certain amount of work experience with that type of diving equipment.

As the trainee bell diver must be an experienced surface supplied diver, he will not need special tools or tasks training. However, training dives from a diving bell should include work with commonly-used tools on typical tasks, in order to demonstrate their safe use under working conditions. Divers should also be trained, and regularly exercised throughout their training, in the use of emergency procedures.

LIFE SUPPORT TECHNICIAN

The life support technician should undergo theoretical training according to recognised industry standards and have practical experience of the operation of life support systems used to support bell diving operations.

LIFE SUPPORT SUPERVISOR

To become a life support supervisor, a person must be able to document at least 200 days work as a life support technician and have a minimum of four years experience in the diving industry. A life support supervisor should be appointed in writing by his company on the basis of their experience, character and ability to accept responsibility.

OFFSHORE DIVING SUPERVISOR

An offshore diving supervisor must be a qualified surface oriented or mixed gas/bell diver who has completed formal theoretical training according to a recognised industry standard and who has appropriate experience as a trainee offshore diving supervisor. A diving supervisor should be appointed in writing by his company on the basis of their experience, character and ability to accept responsibility.

INLAND/INSHORE DIVING SUPERVISOR

An inland/inshore diving supervisor should be a qualified surface supplied or SCUBA diver and have at least two years experience as a trainee inland/inshore/offshore diving supervisor. A diving supervisor should be appointed in writing by his company on the basis of their experience, character and ability to accept responsibility.

FIRST AID

All divers should be competent to carry out basic first aid and 100% oxygen treatment, appropriate for commercial diving. The initial first aid training should be completed at the same time as, or included in the basic diver training. Thereafter divers should satisfactorily complete refresher training at appropriate intervals.

The frequency and scope of refresher training should be in accordance with the guidelines of the European Resuscitation Council, which recommends a three-year period.

More advanced first aid training (sometimes referred to as training to a 'diver medic' standard) is not necessary for all commercial divers but an appropriate number should be qualified to this higher standard in diving teams, where there may be a high level diving risk or where a diving team may be operating remotely from other medical or first aid support. It may be appropriate for non-diving personnel to be qualified to this higher standard so long as they have been certified fit to go under pressure (to treat an ill or injured diver) in a surface compression chamber.

DIVING OPERATIONS

SAFETY MANAGEMENT

Safety should be understood in the broadest sense and should also cover health and the working environment. Safety principles should be applied to all forms of diving operations.

The principles of risk analysis (which should include hazard identification and risk assessment) should be used where appropriate as the basis for planning, assessing and carrying out diving operations.

The risk analysis may be 'quantitative' or 'qualitative' in form, or a combination of both.

Wherever reasonably practicable (taking into account economic implications), no single operational failure should entail health hazards or life-threatening situations for the diver and other persons involved. This principle should apply to human errors as well as to equipment failure.

For all diving operations there should be systems for recording incidents and accidents. Records should be maintained for subsequent analysis and review of the safety performances of the diving operations so that safety can be improved.

ORGANISATION, DUTIES AND RESPONSIBILITIES

There should be documented responsibilities and clearly defined lines of reporting for all personnel engaged in commercial diving operations.

For all diving operations there should be a designated Diving Medicine Physician who can be consulted and who can provide assistance in the event of a diving medical emergency.

The employer (diving contractor) should take all reasonable steps to ensure the health and safety of all members of the diving team. The employer must ensure that the diving operations comply with specific national regulations and that they are carried out in accordance with good industry practice.

Supervisors (whether diving, life support or others) should ensure that all operations carried out under their control are in accordance with prearranged procedures, and that personnel are competent to undertake safely all work required of them.

All commercial divers should be medically fit to dive, and be competent to carry out work of the type and at the depth required. They should carry out the tasks in accordance with the diving contractor's prescribed procedures, recognising that any action which they might take may have a bearing not only on their own safety but on that of their colleagues.

Where there is a client he should satisfy himself that the diving contractor will carry out the diving operation in accordance with relevant national regulations and good industry practice.

PLANNING

The risks involved in diving operations should be carefully considered and the safety of all diving operations should be planned. Plans for the safe and efficient conduct of the operations should be documented.

Diving personnel should be actively involved in decision making in matters relating to safety. Appropriate safety delegate systems in conformance with national regulations should be adhered to.

Team briefing and familiarisation with work procedures and safety arrangements should be carried out prior to the start of diving operations. This should be done in order to inform all personnel about the work to be carried out, the procedures to be used, the potential risks relating to it, the emergency and contingency procedures and other matters of relevance to the safety of the work.

Prior to the operation, verification should be conducted by means of appropriate checklists in order to ensure that the environment, personnel, equipment and procedures comply with the specified safety requirements.

DECOMPRESSION

All decompression procedures should be validated according to recognised principles.

Divers should report any symptoms of decompression illness (DCI) to their diving supervisor. All diving personnel should be trained to recognise the signs and symptoms of DCI so that relevant treatment procedures can be implemented in accordance with pre-arranged procedures.

Post-dive stand-by periods and minimum periods for bend watches, flying after diving and intervals before the next dive, should be specified according to recognised standards.

MONITORING

Diving operations should be carefully monitored, including as a minimum the data concerning the depth and the relevant diving times. Additional monitoring may be required for specific diving operations such as, e.g. very deep diving, diving in a hot environment or diving in dirty water. In such cases additional monitoring requirements should be defined as a result of a hazard identification and risk analysis study.

DIVING TEAM

The diving team should be able to undertake diving according to the normal procedures as well as handling necessary emergency actions described in the emergency plan.

The team size should be determined on the basis of an assessment of the work to be carried out (e.g. potential hazards, work load, complexity etc.). Hazard identification and risk assessment should be used as one of the methods for defining the necessary team size.

The minimum team for any diving operation carried out in the context of this document should at least be able to cover the relevant functions specified below:

- diving
- tending the diver
- giving emergency assistance (diving) to the diver in the water
- supervising the diving operation
- controlling the life support functions of the deck decompression chambers (where used)
- operating and maintaining the equipment

The function of supervising should not be combined with the function of giving emergency assistance (diving) to the diver in the water.

NORMAL DIVING PROCEDURES

Diving procedures should be prepared in writing for all diving operations, defining measures for the conduct of safe operations.

EMERGENCY PROCEDURES

For all diving operations, regardless of the depth and the duration, emergency procedures (prepared according to pre-defined scenarios) should be prepared in writing, and diving personnel should be trained in their use. The emergency procedures should describe the necessary steps to be taken to bring a nonconforming (non-safe) diving operation back to a safe status.

CONTINGENCY

For all diving operations, regardless of the depth and the duration, a contingency plan should be prepared in writing describing how to proceed if the need for assistance beyond what is available at the dive site should occur. The contingency plan should specify what resources are available and how they should be activated.

SCUBA DIVING

SCUBA equipment should never be used offshore.

The use of SCUBA should be limited to specific work conditions, and two-way communications between the diver and the diving supervisor should always be used when this technique is applied.

SCUBA diving should normally be limited to a depth of 30 metres, and never be used for diving deeper than 40 metres.

The diver should always have sufficient reserve gas available to reach a safe area.

Bottom time should always be limited to comply with no-decompression dives.

SURFACE SUPPLIED DIVING

Surface supplied diving should be limited to a maximum depth of 50 metres.

There should always be two way communications between the diver and the diving supervisor.

The diver should always have sufficient reserve gas available to reach a safe area.

BELL DIVING

Bell/saturation diving should be used when diving deeper than 50 metres but may be used at shallower depths.

The diver should always have sufficient reserve gas available to reach a safe area.

The atmosphere of each compartment of the surface compression chamber should be continuously analysed and controlled within safe pre-determined limits.

The period which a diver should spend in saturation should be determined considering the strain that the diver will be exposed to. The relevance of the planned period in saturation should be assessed during the operation.

The maximum period which a diver should spend in saturation, including the periods spent in compression and decompression, should be limited to 28 days. This recommendation should not prevent the use of shorter periods in saturation.

As far as possible, saturated divers should be dedicated to a fixed work period/shift period during the day in which the actual diving takes place. The shift period should be a maximum of twelve hours per day, and it should, as far as reasonably practicable, be fixed for the duration of the saturation period.

Bell run times should be limited to a maximum of eight hours per shift period.

The time spent in water by a diver should be limited to a maximum of six hours per bell run.

There should be a minimum rest period of twelve hours between two bell dives.

For all saturation bell diving operations (or dive operations where the divers cannot be subjected to immediate decompression), means should be provided to allow for the hyperbaric evacuation of divers.

There should be arrangements defined for the safe decompression of divers following a hyperbaric evacuation.

THE DESIGN, TESTING, EXAMINATION, CERTIFICATION AND MAINTENANCE OF DIVING EQUIPMENT

QUALITY ASSURANCE

Companies (i.e. corporate entities, institutions, bodies or even individuals) who are involved in the design, testing, examination, certification, use or maintenance of diving systems and/or equipment should conduct their work in accordance with relevant standards for quality assurance, e.g. EN 29000 series of quality assurance standards equivalent to the ISO 9000 series of standards.

RISK ANALYSIS

The principles of risk analysis (which should include hazard identification and risk assessment) should be used where appropriate as the basis for design, testing, examination, use and maintenance of diving systems and/or equipment.

The risk analysis may be 'quantitative' or 'qualitative' in form or a combination of both.

Wherever reasonably practicable (taking into account economic implications), no single failure in a system, item of equipment or a component should entail health hazards or life-threatening situations for the user of such systems, equipment or components. This principle should apply to human errors as well as to equipment failure.

USE OF RECOGNISED STANDARDS

Diving systems should be designed, manufactured, tested and maintained in accordance with the requirements of, and in conformity with, safety levels set out in applicable recognised standards which reflect the general principles set down in this chapter.

Verification, including certification of diving systems and/or equipment, should be performed by a competent person or body.

Recognised standards in the context of this general principle include:

- Internationally recognised standards
- National regulations
- Rules published by classification societies
- Standards, guidelines and codes of practice published by industry bodies.

DOCUMENTATION

Documentation should be provided to show that diving systems, equipment and where relevant, components, have been manufactured and function tested in accordance with the general principles.

EARLY WARNING AND DESIGN

Diving systems should, wherever reasonably practicable, be designed so that an early warning is given of abnormal conditions which may be significant to safety. The warning should be such as to allow measures to be implemented to compensate for such conditions before safety is critically compromised.

USE OF MATERIALS

Only substances, materials, liquids or gases which on their own or in combination with other substances, materials, liquids or gases are harmless under foreseeable conditions should be used in diving systems. Whenever reasonably practicable their composition should be documented.

LOCKING MECHANISMS

In a diving system which is intended for human occupancy, any pressurised lock, container or associated equipment under pressure, the opening of which may entail danger to people, should be secured so that an unintentional pressure drop or injury to people cannot occur. The lock should be fitted with an interlock, or interlocks, to prevent either (i) opening when the lock is under pressure or (ii) pressurisation if the lock is not fully secure. It should also be fitted with a gauge to show internal lock pressure

This principle should normally apply to all surface compression chambers, diving bells and their equipment/medical locks as well as to, e.g., life support systems.

HYPERBARIC EVACUATION

Equipment should be provided for the hyperbaric evacuation of divers from diving systems which are intended for saturation diving or diving where divers within the chambers of them cannot be brought back quickly to atmospheric pressure. Such equipment should be compatible with transfer to a safe place for decompression.

This principle does not say that if divers are evacuated under hyperbaric conditions they should be transferred to another place for decompression, but it states that if transfer is planned then the equipment involved should be compatible.

HUMAN FACTORS

Human factors, including ergonomic, personal and environmental factors, should be considered in the design, testing, examination, operation and maintenance of diving systems.

APPENDIX 1

DEFINITIONS

The following definitions should serve as a useful guide.

Bell Diving: A diving operation in which the divers are deployed from an enclosed diving bell.

Bounce Diving: A form of Bell Diving in which the dive is terminated before the dissolved gases in the diver's tissue reach saturation and he is decompressed to atmospheric pressure.

Decompression: The process by which a diver is returned to atmospheric pressure so as to facilitate the safe discharge of dissolved gases in his tissues.

Diver: A person who has been trained and is competent to dive commercially using underwater breathing apparatus.

Diving: An activity in which a diver (as defined above) is exposed to a pressure greater than 130 kpa (= 3msw).

Diving Bell: A submersible pressure vessel in which divers can be transported safely from the surface to the worksite under water and returned to the surface under pressure. The diving bell shall provide necessary life support to the divers using it.

Diving Supervisor: A person trained and appointed by the Diving Contractor, to act as the leader of the diving team and to be in control of the diving operation.

Life Support Supervisor: A person trained, and appointed by the Diving Contractor, to supervise life support functions for a diver or divers in a compression chamber.

Saturation: A condition in which a diver is subjected to an ambient pressure, greater than atmospheric pressure, such that their body tissues and blood become equilibrated with the inert element of the breathing mixture.

SCUBA: Self contained underwater breathing apparatus. (This term is reserved for open circuit demand apparatus. Other self-contained apparatus such as mixed gas closed circuit should not be included in this category.)

Stand-by Diver: A diver who is appropriately positioned and dressed to render immediate assistance to a diver, in an underwater emergency.

Surface Compression Chamber: An appropriately equipped chamber on the surface in which routine decompression or therapeutic recompression can be carried out.

Surface Decompression: A decompression procedure in which a surface oriented diver returns to the surface and is recompressed in a surface compression chamber prior to final decompression.

Surface Orientated Diving: A diving operation, other than bell diving, where the diver enters the water at the surface, descends to his working depth and returns to the surface while fully exposed to variations in water pressure. The primary supply of breathing gas for the diver is supplied from the surface to the diver via an umbilical (surface supplied), or the diver carries all his gas (SCUBA).

Surface supplied diving: A diving operation where the primary supply of breathing gas for the diver is supplied from the surface via an umbilical.

Transfer Under Pressure: A technique by which a diver can be transferred from one compression chamber to another compression chamber in such a way that there is no change in pressure on the diver.

Wet Bell: An open bell which is always at ambient or environmental pressure and which may be equipped with appropriate breathing gas.

Mixed gas: A manufactured mixture of oxygen and one or more inert gases used as a breathing gas for diving. (A predetermined mixture of Oxygen and Nitrogen is not a mixed gas in the context of this definition). Diving using mixed gas should only be carried out from an enclosed diving bell.

Breathing gas: General term for oxygen, air, oxygen-enriched air, nitrox or a mixed gas (see definition above) used in a diving operation for breathing by divers.

APPENDIX 2

FUNCTIONAL REQUIREMENTS FOR FITNESS TO DIVE

The points set out below should be regarded as recommendations. Detailed protocols for medical examinations for fitness to dive still need to be developed.

Chronic disorders, particularly those requiring medication, should be evaluated.

Age

Maximum age alone should not be a disqualification. The minimum age for a person to dive at work should be 18.

Cardiovascular System

The diver should not have any disease which could lead to a significant detriment of work capacity and/or loss of consciousness.

Test of work capacity: any approved test of O2 uptake in accordance with an accepted and established protocol.

Dental

The diver should have healthy teeth.

Dermatology

The diver should have normal, healthy skin. There may be different requirements for different types of diving, e.g. surface supplied, air, or saturation, where the potential for possible aggravation of skin disease may be different.

Endocrine Systems

The diver must not suffer from conditions which might give rise to a risk of loss of consciousness and/or inability to perform sustained heavy work.

Ear-Nose-Throat System

The diver must be able to equalise pressure, have no risk of disorientation and have adequate hearing in order to communicate.

Eyes

Visual acuity and colour vision are more important for the diver's topside work than for work under water. Some specific eye disorders should be evaluated by an eye specialist with respect to fitness to dive.

Gastro-Intestinal System

The diver must have normal gastro-intestinal functions. There are different requirements for different types of diving (some conditions may require medical intervention in saturation).

Chronic intestinal diseases should be evaluated on an individual basis dependent upon extent and the severity of the disorder.

Genito-Urinary System

The diver must have normal renal function. Pregnancy is a contra- indication. A kidney transplant would normally not be accepted

Haematology

The blood must have normal capacity for oxygen transportation and have normal immune status. Certain blood conditions may disqualify for certain types of diving.

Musculo-Skeletal

The diver must have the strength and agility to master foreseeable tasks both under normal conditions and in emergencies. Long bone X-rays should be conducted at the first examination and then later at the doctor's discretion. Aseptic bone necrosis should not normally disqualify.

Neurology

The diver must not suffer from disorders that may lead to the increased possibility of loss of consciousness, diminished co-ordination or orientation, or reduced cognitive functions. EEG changes alone should not be a reason for disqualification. Thorough neurological evaluation by a specialist should be carried out when indicated by the diver's medical history or otherwise.

Psychiatry

The diver must not suffer from psychiatric disorders which may impair his intellectual or behavioural functions. No current substance or alcohol abuse. An evaluation should be carried out of the diver's medical history including social and family factors.

Pulmonary

The diver must have sufficient lung function for maximum work load and exercise and there must be no increased risk of pulmonary barotrauma. Lung function tests: flow-volume loop and diffusion capacity in relevant cases. There is insufficient scientific knowledge of the importance of obstructive lung disease; low values of FEV1/FVC% should not alone disqualify. In doubtful cases there should always be an evaluation by a specialist.

Infections