Malaysian Tribes & Island Conservation Know Before You …staytuned.statravelgroup.com/Documents/product_docs/KBYG _Malay… · [email protected] UK: + 44 (0) 845 3713070

Malaysian Tribes & Island Conservation

Know Before You Go 2013

Orang Asli

Orang Asli

The Orang Asli are the indigenous minority peoples of Peninsular Malaysia. The name is a Malay term which

transliterates as „original peoples‟ or „first peoples‟. It is a collective term introduced by anthropologists and

administrators for the (officially) 18 ethnic subgroups generally classified for official purposes under Negrito,

Senoi and Proto-Malay. They numbered 147,412 in 2003 representing a mere 0.6 per cent of the Malaysian

national population (26.5 million).

Of the 869 Orang Asli communities in the peninsula, 37.2 per cent are in interior/forest areas while 61.4 per cent

are in forest-fringe or rural areas. Only 1.4 per cent of the Orang Asli settlements are in, or close to, urban centers.

Many of the communities living close to, or within forested areas – including Semai, Temiar, Chewong, Jah Hut,

Semelai and Semoq Beri – still engage in swiddening (hill rice cultivation) and do some hunting, fishing and

gathering. These communities also trade in petai, durian, rattan and resins to earn cash incomes.

The poverty rate among Orang Asli is 76.9%. In addition to this high rate, the Statistics Department of Malaysia

has classified 35.2% of the population as being "hardcore poor". The majority of Orang Asli live in rural areas,

while a minority have moved into urban areas. In 1991, the literacy rate for the Orang Asli was 43% compared to

the national rate of 86% at that time. They have an average life expectancy of 53 years (52 for male and 54 for

female). A high infant mortality rate is also evident with 51.7 deaths per 1000 births.

A very small number, especially among the Negrito groups (such as Jahai and Batek) are still semi-nomadic,

preferring to take advantage of the seasonal bounties of the forest. A significant number of Orang Asli also have

salaried jobs or are self-employed.

Nevertheless, one fact remains the same for all Orang Asli: they are the descendants of the earliest inhabitants of

the peninsula and they have retained much of their identity which is distinct from the mainstream society.

The Orang Asli tribes near Mount Korbu are from the Senoi group. The forest where they previous lived and

hunted was flooded after the creation of a 85m high dam completed in 2006. The dam caused the forest valley to

flood and now the large reservoir provides drinking water for the human population of Ipoh. To compensate the

Orang Asli for losing their home the government built a small settlement for them to translocate. However like

many of the Orang Asli in the area they have never settled completely in the new houses and they continue to

work, hunt and gather in the surrounding forests.

To find out more about the Orang Asli please visit the Centre of Orang Asli Concerns - www.coac.org.my

Misc

Injections

Must Have .

Hepatitis A, Hepatitis B,

Typhoid, Measles, mumps,

rubella (MMR), Tetanus-

diphtheria

Malaria

As you will be jungle trekking

we strongly advise you to take

Anti-Malarial tablets.

To think about

Japanese encephalitis, Rabies

Money

We recommend you budget

RM200 for your time spent in

Ipoh, for things such as snacks

etc.

We would like to thank you for your interest in protecting Malsysia. Harbouring tropical coral reefs and tropical rainforests which both hold host to

thousands of species this makes Malaysia one of the most biodiverse countries in the world. You will experience both the tropical rainforests surrounding

Mount Korbu and the coral reefs of Perhentian, both environments are under different threats which you will learn about and see first hand. The camera

trapping project is in it‟s infancy making it exciting because you will be amongst the very few that have helped to collect camera trap data from these

forests, with new local recordings of animals being a regular occurrence. The rainforests of Peninsular Malaysia are the oldest in the world. They harbour

species such as panthers, Malayan Tigers, Asian Elephants, Gibbons, Gaur, Sumatran Rhino and Tapir. The forests of Malaysia are being threatened by

poachers and deforestation with many of these species almost extinct. You will be taken off the beaten track into forests which harbour some of the most

beautiful waterfalls, jungle and mountain scenery in Southeast Asia. Play your part in helping both terrestrial and marine species survive into another

century whilst going on an ADVENTURE OF A LIFETIME.

Camera trapping around Mount Korbu

AIM to collect photographic evidence of the mammals living in the rainforests around Mount Korbu and increase environmental and cultural awareness

amongst the villagers and tourists.

OBJECTIVES

1) to conduct camera trapping trials to help establish a scientifically thorough scientific population census of the large mammals of Mount Korbu;

2) to provide environmental awareness and english sessions for the children living in the native tribes.

3) to assist the economy of the native tribes through encouraging cultural services offered by the villagers.

4) to inspire tourists to make a difference for the rainforests after their experience.

[email protected]

UK: + 44 (0) 845 3713070

Malaysia: +6 012 217 3208

www.destinationcreators.com

http://www.coac.org.my/

mailto:[email protected]

http://www.destinationcreators.com/

[email protected]

UK: + 44 (0) 845 3713070

Malaysia: +6 012 217 3208


The project Misc

The Perhentian Islands are renowned as being the most beautiful islands in Malaysia and welcome troves of tourists and backpackers each year. The

waters are crystal clear and turquoise whilst the forests are lush green and teeming with life. The islands are in the north east of Peninsular Malaysia in the

state of Terengganu. The port to the island is a small village called Kuala Besut, which is only about an hour drive from Thailand. You will be based in the

isolated bay of Tanjung Tukas where Bubbles Dive Resort is located. The environmentally conscious resort occupies the entire beach which boasts the

second highest number of nestling turtles amongst the Perhentian Islands. Ronnie, Pei See and Eric started and still run the resort along with an Australian,

Libby and a host of other characters. The beauty and the isolation of the bay from the outside world attracted them, which is undoubtedly the most pristine

amongst Islands. Another attraction was the Green Turtles, which can be seen nesting on the beaches between March and September. It is important to

note that many of the eggs are not incubated at this beach but are taken to the government turtle hatchery. However Bubbles aim to keep as many of these

eggs as possible and release the hatchlings from June to October.

Aim

To create a sustainable conservation and protection project, doubling the turtle nestling population by 2060 and gradual repair of the Bubbles house reef

over the next 5-10 years.

What we plan for in 2013

Continue on our turtle protection project.

Expand our coral nursery with Reef Check Malaysia.

Expand to include survey, protection and replanting of the Bubbles House Reef.

Expand the in-house hatchery to relocate damaged and threatened natural nests.

Develop a systematic reef-check guideline for the islands.

Month March April May June July Aug Sept Oct

Nesting Low Med High High High Low

Hatchlings Low Med High High Med

Expanding on the turtle protection project already in place, the new and revamped program aims to include re-

growing of the house reef under its arm. Over the duration of the program, you will get to have close-up

encounters with the sea turtle, be part of a nest protection and hatchlings release mission and once a qualified diver

contribute towards coral replanting. You will start with the two weeks by completing a PADI Dive Course (Open

Water Diver, Advance Open Water or Rescue Diver+EFR). Then you will be able to help part take in the coral

nursery by going on shore dives with the task of cleaning the coral fragments as settlement will often settle on the

coral. During the second week in addition to your nightly turtle duties you will be asked to help with water

confidence sessions (helping to teach tourists how to snorkelling responsibly so they don‟t break the coral),

guiding snorkel tours and if required helping with jungle trekking.

PADI Medical

Before you start this project we recommend you complete the PADI Self-Assessed Medical (see back of this

brochure). Please print and complete the medical. If you need to say yes to any of the ailments you will need to

have a check up with your doctor. They will then need to decide if you are able to safely dive. Please email this

medical to [email protected] and also bring the original with you for the dive centre‟s records.

Accommodation

You will be staying in a single sex twin-sharing fan accommodation with an attached bathroom. !e room can get

quite humid in the day but it cool down in the evening and can get quite chilly in the middle of the night. If you

want to have a room upgrade, feel free to contact us.

Upgrades

Single occupancy Fan Room (cold shower) RM40/night

Single occupancy with hot water shower & AC RM60/night

Twin sharing with hot water shower & AC RM30/night

Laundry

Bubbles – can be given to the

resort staff – RM10 per kg

Injections

Must Have .

Hepatitis A, Hepatitis B,

Typhoid, Measles, mumps,

rubella (MMR), Tetanus-

diphtheria

To think about

Japanese encephalitis, Rabies

Malaria

Malaria is not present on the

islands. However if you plan

to visit attractions like Taman

Negara you will need to take

Malaria tablets

Money

It is very important that you

withdraw cash before you

reach the islands, as the

islands do not have an ATM

machine. We recommend

you budget RM100 per week

spending money plus RM100

per leisure dive.


http://www.destinationcreators.com/


[email protected]

UK: + 44 (0) 845 3713070

Malaysia: +6 012 217 3208


How to get here What to bring

The program starts from Ipoh. Below are a few options on how to get to Ipoh. We have bolded the times that we

prefer you to take so please adjust your travel to depart Kuala Lumpur between 10-11am depending on your mode

of transport. We advise you to land in Kuala Lumpur a few days before to allow your body to adjust to the change

in time zone so you are ready and prepared for your adventure. Then take the ETS train to Ipoh on the 1045

service. We will meet you at the train station at Ipoh and will hold a board with “FUZE/Ecoteer” on it so you

know who we are. If you are taking a different mode or time of transport to Ipoh please inform us either by email

or phone. Below are some methods on how to travel to Ipoh from Kuala Lumpur.

By Train

The cheapest and easiest way to travel to Ipoh is by train from KL Sentral to Ipoh. The ETS is the high speed

electric train. The ticket costs RM25 Silver, RM35 Gold and RM45 Platinum service and the journey takes

between 1.30 hours to 2 hours depending on the train service chosen.

The ETS train leaves KL Sentral at 0800, 1045, 1155, 1400, 1735, 1901 & 2100.

You can easily travel to KL Sentral from KUL by following either the KLIA Express or a bus from the airports

which all terminate at KL Sentral.

For more info please visit – www.ets-train.com.my

By Bus

The alternative way to travel to Ipoh is to take the bus either from KL Sentral or direct from the airport. From the

airports the cost will be RM42 per way per person with Star Shuttle Express.

Kuala Lumpur International Airport (KUL) to Ipoh

0900, 1030, 1215, 1430, 1630, 2130

LCCT (Air Asia Terminal) to Ipoh

0830, 1000, 1145, 1400, 1600, 1800, 2100

T shirts (thin ones are the best);

Shorts;

Thin trousers (convertible are best)

Walking socks;

Swim wear;

Sleeping bag or jumpers (it will be cold at

the top);

Wooly Hat and gloves (for warmth at

night);

Travel or thin towels that dry quickly;

Sun block – biodegradable is best;

Sandals or flip-flops;

Day back pack;

Good walking shoes or trainers are a

must;

Insect repellant, (make sure it contains

deet);

Poncho / raincoat

Good torch, (head torch is best) plus

spare batteries;

Zip lock bags and tupperware to keep

things dry;

Large Black plastic bags to cover your

rucksack;

Water bottle or camel back bladder;

A hat to keep off the sun;

Pen knife;

Books and mp3 players - to keep you

occupied during time off;

Optional

Red bulb torch (head torches are very

useful);

Hammock including mosquito net (we

will provide but always handy to have

your own) ;

First Aid kit – Anti-histamines,

sunscreen, after sun, Diarrhoea

medication and antibiotics and anti-

inflammatory for ear, nose and throat

problems. Peroxide and anti-bacterial

Dettol can both be useful for cleaning out

cuts as wounds quickly become infected;

MAXIS (which is also called hotlink)

Malaysian Sim card – this network has

the best coverage at the project site; we

suggest you get RM30 of credit for 4

weeks;

Code Of Conduct

1 Before you volunteer

1.1 Before you come to Malaysia you must research about traveling in Malaysia and the Malay culture. If you

have any questions we are more than willing to discuss this with you before you depart;

1.2 You must buy yourself suitable travel insurance;

1.3 If you have to cancel your volunteering, for whatever reason, please contact us as soon as possible;

2 Whilst volunteering 2.1 Listen to, and follow, the instructions of your facilitators and the rules for the jungle trekking and Orang

Asli village.

2.2 On many of the days you will be going to bed and waking up early. It is vital to the that you are always punctual so the group can successfully reach their intended destinations.

2.3 VERY IMPORTANT - You are volunteering in the tropics. The temperature can exceed 40c so ensure

you drink plenty of water and wear sun block; 2.4 VERY IMPORTANT – You will be visiting the Orang Asli village. Please respect their Islamic and

animist beliefs by ensuring you are covered from neck to your knees, ie wear t-shirts and long shorts;

2.5 VERY IMPORTANT – Volunteers must understand some cultural differences may disturb them, but their feelings should be kept under control. If they have a significant problem they should discuss this with the

facilitators who may help to explain more about the issue and act upon it;

2.6 VERY IMPORTANT – do not walk away from the group or the campsites during without a member of staff as it is very easy to get lost in the rainforest.

Emergency Contact Numbers:

KL Contact, Daniel:

+6 012 217 3208

On-site co-ordinator, Pavin:

+6 012 956 4309 or

+6 016 546 3206


http://www.ets-train.com.my/

MEDICAL STATEMENT

Participant Record (Confidential Information)

This is a statement in which you are informed of some potential risksinvolved in scuba diving and of the conduct required of you during thescuba training program. Your signature on this statement is required foryou to participate in the scuba training program offered

by_____________________________________________________andInstructor

_______________________________________________located in theFacility

city of_______________________, state/province of _______________.

Read this statement prior to signing it. You must complete thisMedical Statement, which includes the medical questionnaire section, toenroll in the scuba training program. If you are a minor, you must havethis Statement signed by a parent or guardian.

Diving is an exciting and demanding activity. When performedcorrectly, applying correct techniques, it is relatively safe. When

established safety procedures are not followed, however, there areincreased risks.

To scuba dive safely, you should not be extremely overweight orout of condition. Diving can be strenuous under certain conditions. Yourrespiratory and circulatory systems must be in good health. All body airspaces must be normal and healthy. A person with coronary disease, acurrent cold or congestion, epilepsy, a severe medical problem or who isunder the influence of alcohol or drugs should not dive. If you haveasthma, heart disease, other chronic medical conditions or you are tak-ing medications on a regular basis, you should consult your doctor andthe instructor before participating in this program, and on a regular basisthereafter upon completion. You will also learn from the instructor theimportant safety rules regarding breathing and equalization while scubadiving. Improper use of scuba equipment can result in serious injury.You must be thoroughly instructed in its use under direct supervision ofa qualified instructor to use it safely.

If you have any additional questions regarding this MedicalStatement or the Medical Questionnaire section, review them with yourinstructor before signing.

Please read carefully before signing.

The purpose of this Medical Questionnaire is to find out if you should be exam-ined by your doctor before participating in recreational diver training. A positiveresponse to a question does not necessarily disqualify you from diving. A positiveresponse means that there is a preexisting condition that may affect your safetywhile diving and you must seek the advice of your physician prior to engaging indive activities.

Please answer the following questions on your past or present medical historywith a

YES

or

NO

. If you are not sure, answer

YES

. If any of these items applyto you, we must request that you consult with a physician prior to participating inscuba diving. Your instructor will supply you with an RSTC Medical Statementand Guidelines for Recreational Scuba Diver’s Physical Examination to take toyour physician.

_____ Could you be pregnant, or are you attempting to become pregnant?

_____ Are you presently taking prescription medications? (with the exception ofbirth control or anti-malarial)

_____ Are you over 45 years of age and can answer YES to one or more of thefollowing?• currently smoke a pipe, cigars or cigarettes• have a high cholesterol level• have a family history of heart attack or stroke• are currently receiving medical care• high blood pressure• diabetes mellitus, even if controlled by diet alone

Have you ever had or do you currently have…

_____ Asthma, or wheezing with breathing, or wheezing with exercise?_____ Frequent or severe attacks of hayfever or allergy?_____ Frequent colds, sinusitis or bronchitis?_____ Any form of lung disease?_____ Pneumothorax (collapsed lung)?_____ Other chest disease or chest surgery?_____ Behavioral health, mental or psychological problems (Panic attack, fear of

closed or open spaces)?_____ Epilepsy, seizures, convulsions or take medications to prevent them?_____ Recurring complicated migraine headaches or take medications to pre-

vent them?_____ Blackouts or fainting (full/partial loss of consciousness)?_____ Frequent or severe suffering from motion sickness (seasick, carsick,

etc.)?

_____ Dysentery or dehydration requiring medical intervention?

_____ Any dive accidents or decompression sickness?

_____ Inability to perform moderate exercise (example: walk 1.6 km/one milewithin 12 mins.)?

_____ Head injury with loss of consciousness in the past five years?

_____ Recurrent back problems?

_____ Back or spinal surgery?

_____ Diabetes?

_____ Back, arm or leg problems following surgery, injury or fracture?

_____ High blood pressure or take medicine to control blood pressure?

_____ Heart disease?

_____ Heart attack?

_____ Angina, heart surgery or blood vessel surgery?

_____ Sinus surgery?

_____ Ear disease or surgery, hearing loss or problems with balance?

_____ Recurrent ear problems?

_____ Bleeding or other blood disorders?

_____ Hernia?

_____ Ulcers or ulcer surgery ?

_____ A colostomy or ileostomy?

_____ Recreational drug use or treatment for, or alcoholism in the past fiveyears?

Divers Medical Questionnaire

To the Participant:

The information I have provided about my medical history is accurate to the best of my knowledge.

I agree to acceptresponsibility for omissions regarding my failure to disclose any existing or past health condition.

_______________________________________ _________________ _______________________________________ _________________Signature Date Signature of Parent or Guardian Date

PRODUCT NO. 10063 (Rev. 9/01) Ver. 2.0 © International PADI, Inc. 1989, 1990, 1998, 2001© Recreational Scuba Training Council, Inc. 1989, 1990, 1998, 2001Page 1 of 6

STUDENT

Please print legibly.

Name__________________________________________________________________________ Birth Date ________________ Age ________First Initial Last Day/Month/Year

Mailing Address __________________________________________________________________________________________________________

City________________________________________________________________ State/Province/Region ________________________________

Country ____________________________________________________________ Zip/Postal Code _____________________________________

Home Phone ( )________________________________________ Business Phone ( )______________________________________

Email _____________________________________________________ FAX_______________________________________________________

Name and address of your family physician

Physician __________________________________________________ Clinic/Hospital ______________________________________________

Address________________________________________________________________________________________________________________

Date of last physical examination ________________

Name of examiner____________________________________________ Clinic/Hospital_______________________________________________

Address ________________________________________________________________________________________________________________

Phone ( )___________________________________ Email ________________________________________________________________

Were you ever required to have a physical for diving? Yes No If so, when?________________________________________________

PHYSICIAN

This person applying for training or is presently certified to engage in scuba (self-contained underwater breathing apparatus) diving. Your opinion ofthe applicant’s medical fitness for scuba diving is requested. There are guidelines attached for your information and reference.

Physician’s Impression

I find no medical conditions that I consider incompatible with diving.

I am unable to recommend this individual for diving.

Remarks

___________________________________________________________________________________________________

___________________________________________________________________________________________________________

___________________________________________________________________________________________________________

__________________________________________________________________________ Date ___________________________Physician’s Signature or Legal Representative of Medical Practitioner Day/Month/Year

Physician_____________________________________________ Clinic/Hospital_________________________________________

Address____________________________________________________________________________________________________

Phone ( )___________________________________ Email ________________________________________________________________

Page 2 of 6

Recreational

SCUBA

(Self-Contained Underwater BreathingApparatus) can provide recreational divers with an enjoyablesport safer than many other activities. The risk of diving isincreased by certain physical conditions, which the relationship todiving may not be readily obvious. Thus, it is important to screendivers for such conditions.

The

RECREATIONAL SCUBA DIVER’S PHYSICAL EXAMINA-TION

focuses on conditions that may put a diver at increased riskfor decompression sickness, pulmonary overinflation syndromewith subsequent arterial gas embolization and other conditionssuch as loss of consciousness, which could lead to drowning.Additionally, the diver must be able to withstand some degree ofcold stress, the physiological effects of immersion and the opticaleffects of water and have sufficient physical and mental reservesto deal with possible emergencies.

The history, review of systems and physical examination shouldinclude as a minimum the points listed below. The list of condi-tions that might adversely affect the diver is not all-inclusive, butcontains the most commonly encountered medical problems. Thebrief introductions should serve as an alert to the nature of therisk posed by each medical problem.

The potential diver and his or her physician must weigh thepleasures to be had by diving against an increased risk of deathor injury due to the individual’s medical condition. As with anyrecreational activity, there are no data for diving enabling the cal-culation of an accurate mathematical probability of injury. Experi-ence and physiological principles only permit a qualitativeassessment of relative risk.

For the purposes of this document,

Severe Risk

implies that anindividual is believed to be at substantially elevated risk of decom-pression sickness, pulmonary or otic barotrauma or altered con-sciousness with subsequent drowning, compared with the gener-al population. The consultants involved in drafting this documentwould generally discourage a student with such medical prob-lems from diving.

Relative Risk

refers to a moderate increase inrisk, which in some instances may be acceptable. To make adecision as to whether diving is contraindicated for this categoryof medical problems, physicians must base their judgement onan assessment of the individual patient. Some medical problemswhich may preclude diving are

temporary

in nature or respon-sive to treatment, allowing the student to dive safely after theyhave resolved.

Diagnostic studies and specialty consultations should be obtainedas indicated to determine the diver’s status. A list of references isincluded to aid in clarifying issues that arise. Physicians andother medical professionals of the Divers Alert Network (DAN)associated with Duke University Health System are available forconsultation by phone +1 919 684 2948 during normal businesshours. For emergency calls, 24 hours 7 days a week, call +1 919684 8111 or +1 919 684 4DAN (collect). Related organizationsexist in other parts of the world – DAN Europe in Italy +39 039605 7858, DAN S.E.A.P. in Australia +61 3 9886 9166 and DiversEmergency Service (DES) in Australia +61 8 8212 9242, DANJapan +81 33590 6501 and DAN Southern Africa +27 11 2420380. There are also a number of informative websites offeringsimilar advice.

NEUROLOGICAL

Neurological abnormalities affecting a diver’s ability to performexercise should be assessed according to the degree of compro-mise. Some diving physicians feel that conditions in which therecan be a waxing and waning of neurological symptoms andsigns, such as migraine or demyelinating disease, contraindicatediving because an exacerbation or attack of the preexisting dis-ease (e.g.: a migraine with aura) may be difficult to distinguish

from neurological decompression sickness. A history of headinjury resulting in unconsciousness should be evaluated for riskof seizure.

Relative Risk Conditions

• Complicated Migraine Headaches whose symptoms orseverity impair motor or cognitive function, neurologicmanifestations

• History of Head Injury with sequelae other than seizure• Herniated Nucleus Pulposus• Intracranial Tumor or Aneurysm• Peripheral Neuropathy• Multiple Sclerosis• Trigeminal Neuralgia• History of spinal cord or brain injury

Temporary Risk Condition

History of cerebral gas embolism without residual where pul-monary air trapping has been excluded and for which thereis a satisfactory explanation and some reason to believe thatthe probability of recurrence is low.

Severe Risk Conditions

Any abnormalities where there is a significant probability ofunconsciousness, hence putting the diver at increased risk ofdrowning. Divers with spinal cord or brain abnormalities whereperfusion is impaired may be at increased risk of decompressionsickness.

Some conditions are as follows:• History of seizures other than childhood febrile seizures• History of Transient Ischemic Attack (TIA) or Cerebrovas-

cular Accident (CVA)• History of Serious (Central Nervous System, Cerebral or

Inner Ear) Decompression Sickness with residual deficits

CARDIOVASCULAR SYSTEMSRelative Risk Conditions

The diagnoses listed below potentially render the diver unable tomeet the exertional performance requirements likely to beencountered in recreational diving. These conditions may leadthe diver to experience cardiac ischemia and its consequences.Formalized stress testing is encouraged if there is any doubtregarding physical performance capability. The suggested mini-mum criteria for stress testing in such cases is at least 13METS.* Failure to meet the exercise criteria would be of signifi-cant concern. Conditioning and retesting may make later qualifi-cation possible. Immersion in water causes a redistribution ofblood from the periphery into the central compartment, an effectthat is greatest in cold water. The marked increase in cardiacpreload during immersion can precipitate pulmonary edema inpatients with impaired left ventricular function or significant valvu-lar disease. The effects of immersion can mostly be gauged byan assessment of the diver’s performance while swimming on thesurface. A large proportion of scuba diving deaths in North Amer-ica are due to coronary artery disease. Before being approved toscuba dive, individuals older than 40 years are recommended toundergo risk assessment for coronary artery disease. Formalexercise testing may be needed to assess the risk.

* METS is a term used to describe the metabolic cost. The MET at restis one, two METS is two times the resting level, three METS is threetimes the resting level, and so on. The resting energy cost (net oxygenrequirement) is thus standardized. (Exercise Physiology; Clark, PrenticeHall, 1975.)

Guidelines for Recreational Scuba Diver’s Physical ExaminationInstructions to the Physician:

Page 3 of 6


• History of Coronary Artery Bypass Grafting (CABG)• Percutaneous Balloon Angioplasty (PCTA) or Coronary

Artery Disease (CAD)• History of Myocardial Infarction• Congestive Heart Failure• Hypertension• History of dysrythmias requiring medication for suppres-

sion• Valvular Regurgitation

Pacemakers

The pathologic process that necessitated should beaddressed regarding the diver’s fitness to dive. In thoseinstances where the problem necessitating pacing does notpreclude diving, will the diver be able to meet the perform-ance criteria?* NOTE: Pacemakers must be certified by the manufacturer as ableto withstand the pressure changes involved in recreational diving.

Severe Risks

Venous emboli, commonly produced during decompression,may cross major intracardiac right-to-left shunts and enterthe cerebral or spinal cord circulations causing neurologicaldecompression illness. Hypertrophic cardiomyopathy andvalvular stenosis may lead to the sudden onset of uncon-sciousness during exercise.

PULMONARY

Any process or lesion that impedes airflow from the lungs placesthe diver at risk for pulmonary overinflation with alveolar ruptureand the possibility of cerebral air embolization. Many interstitialdiseases predispose to spontaneous pneumothorax: Asthma(reactive airway disease), Chronic Obstructive Pulmonary Dis-ease (COPD), cystic or cavitating lung diseases may all cause airtrapping. The 1996 Undersea and Hyperbaric Medical Society(UHMS) consensus on diving and asthma indicates that for therisk of pulmonary barotrauma and decompression illness to beacceptably low, the asthmatic diver should be asymptomatic andhave normal spirometry before and after an exercise test.Inhalation challenge tests (e.g.: using histamine, hypertonicsaline or methacholine) are not sufficiently standardized to beinterpreted in the context of scuba diving.

A pneumothorax that occurs or reoccurs while diving may be cat-astrophic. As the diver ascends, air trapped in the cavityexpands and could produce a tension pneumothorax.

In addition to the risk of pulmonary barotrauma, respiratory dis-ease due to either structural disorders of the lung or chest wall orneuromuscular disease may impair exercise performance. Struc-tural disorders of the chest or abdominal wall (e.g.: prune belly),or neuromuscular disorders, may impair cough, which could belife threatening if water is aspirated. Respiratory limitation due todisease is compounded by the combined effects of immersion(causing a restrictive deficit) and the increase in gas density,which increases in proportion to the ambient pressure (causingincreased airway resistance). Formal exercise testing may behelpful.


• History of Asthma or Reactive Airway Disease (RAD)*

• History of Exercise Induced Bronchospasm (EIB)*

• History of solid, cystic or cavitating lesion*

• Pneumothorax secondary to:

-Thoracic Surgery-Trauma or Pleural Penetration*-Previous Overinflation Injury*

• Obesity

• History of Immersion Pulmonary Edema Restrictive Dis-ease*

• Interstitial lung disease: May increase the risk of pneu-mothorax

* Spirometry should be normal before and after exercise

Active Reactive Airway Disease, Active Asthma, ExerciseInduced Bronchospasm, Chronic Obstructive PulmonaryDisease or history of same with abnormal PFTs or a positiveexercise challenge are concerns for diving.


• History of spontaneous pneumothorax.

Individuals whohave experienced spontaneous pneumothorax should avoiddiving, even after a surgical procedure designed to preventrecurrence (such as pleurodesis). Surgical procedures eitherdo not correct the underlying lung abnormality (e.g.: pleurode-sis, apical pleurectomy) or may not totally correct it (e.g.: resec-tion of blebs or bullae).

• Impaired exercise performance due to respiratory disease.

GASTROINTESTINALTemporary Risks

As with other organ systems and disease states, a process whichchronically debilitates the diver may impair exercise performance.Additionally, dive activities may take place in areas remote frommedical care. The possibility of acute recurrences of disability orlethal symptoms must be considered.

Temporary Risk Conditions

• Peptic Ulcer Disease associated with pyloric obstruction orsevere reflux

• Unrepaired hernias of the abdominal wall large enough tocontain bowel within the hernia sac could incarcerate.


• Inflammatory Bowel Disease• Functional Bowel Disorders

Severe Risks

Altered anatomical relationships secondary to surgery or malfor-mations that lead to gas trapping may cause serious problems.Gas trapped in a hollow viscous expands as the divers surfacesand can lead to rupture or, in the case of the upper GI tract, eme-sis. Emesis underwater may lead to drowning.


• Gastric outlet obstruction of a degree sufficient to producerecurrent vomiting

• Chronic or recurrent small bowel obstruction• Severe gastroesophageal reflux• Achalasia• Paraesophageal Hernia

ORTHOPAEDIC

Relative impairment of mobility, particularly in a boat or ashorewith equipment weighing up to 18 kgs/40 pounds must beassessed. Orthopaedic conditions of a degree sufficient to impairexercise performance may increase the risk.


• Amputation• Scoliosis must also assess impact on respiratory function

and exercise performance.• Aseptic Necrosis possible risk of progression due to

effects of decompression (evaluate the underlying medical

Page 4 of 6

cause of decompression may accelerate/escalate the pro-gression).

Temporary Risk Conditions

• Back pain

HEMATOLOGICAL

Abnormalities resulting in altered rheological properties may the-oretically increase the risk of decompression sickness. Bleedingdisorders could worsen the effects of otic or sinus barotrauma,and exacerbate the injury associated with inner ear or spinal corddecompression sickness. Spontaneous bleeding into the joints(e.g.: in hemophilia) may be difficult to distinguish from decom-pression illness.


• Sickle Cell Disease• Polycythemia Vera• Leukemia• Hemophilia/Impaired Coagulation

METABOLIC AND ENDOCRINOLOGICAL

With the exception of diabetes mellitus, states of altered hormon-al or metabolic function should be assessed according to theirimpact on the individual’s ability to tolerate the moderate exerciserequirement and environmental stress of sport diving. Obesitymay predispose the individual to decompression sickness, canimpair exercise tolerance and is a risk factor for coronary arterydisease.


• Hormonal Excess or Deficiency• Obesity • Renal Insufficiency


The potentially rapid change in level of consciousness asso-ciated with hypoglycemia in diabetics on insulin therapy orcertain oral hypoglycemic medications can result in drown-ing. Diving is therefore generally contraindicated, unlessassociated with a specialized program that addresses theseissues.

Pregnancy: The effect of venous emboli formed duringdecompression on the fetus has not been thoroughly inves-tigated. Diving is therefore not recommended during anystage of pregnancy or for women actively seeking tobecome pregnant.

BEHAVIORAL HEALTH

Behavioral: The diver’s mental capacity and emotional make-upare important to safe diving. The student diver must have suffi-cient learning abilities to grasp information presented to him byhis instructors, be able to safely plan and execute his own divesand react to changes around him in the underwater environment.The student’s motivation to learn and his ability to deal withpotentially dangerous situations are also crucial to safe scubadiving.


• Developmental delay• History of drug or alcohol abuse• History of previous psychotic episodes• Use of psychotropic medications


• Inappropriate motivation to dive – solely to please spouse,partner or family member, to prove oneself in the face of

personal fears• Claustrophobia and agoraphobia• Active psychosis• History of untreated panic disorder• Drug or alcohol abuse

OTOLARYNGOLOGICAL

Equalisation of pressure must take place during ascent anddescent between ambient water pressure and the external audi-tory canal, middle ear and paranasal sinuses. Failure of this tooccur results at least in pain and in the worst case rupture of theoccluded space with disabling and possible lethal consequences.

The inner ear is fluid filled and therefore noncompressible. Theflexible interfaces between the middle and inner ear, the roundand oval windows are, however, subject to pressure changes.Previously ruptured but healed round or oval window membranesare at increased risk of rupture due to failure to equalise pressureor due to marked overpressurisation during vigorous or explosiveValsalva manoeuvres.

The larynx and pharynx must be free of an obstruction to airflow.The laryngeal and epiglotic structure must function normally toprevent aspiration.

Mandibular and maxillary function must be capable of allowingthe patient to hold a scuba mouthpiece. Individuals who havehad mid-face fractures may be prone to barotrauma and ruptureof the air filled cavities involved.


• Recurrent otitis externa• Significant obstruction of external auditory canal• History of significant cold injury to pinna• Eustachian tube dysfunction• Recurrent otitis media or sinusitis• History of TM perforation• History of tympanoplasty• History of mastoidectomy• Significant conductive or sensorineural hearing impair-

ment• Facial nerve paralysis not associated with barotrauma• Full prosthedontic devices• History of mid-face fracture• Unhealed oral surgery sites• History of head and/or neck therapeutic radiation• History of temperomandibular joint dysfunction• History of round window rupture


• Monomeric TM• Open TM perforation• Tube myringotomy• History of stapedectomy• History of ossicular chain surgery• History of inner ear surgery• Facial nerve paralysis secondary to barotrauma• Inner ear disease other than presbycusis• Uncorrected upper airway obstruction• Laryngectomy or status post partial laryngectomy• Tracheostomy• Uncorrected laryngocele• History of vestibular decompression sickness

Page 5 of 6

1. Bennett, P. & Elliott, D (eds.)(1993).

The Physiology and Medicineof Diving

. 4th Ed., W.B. Saunders Company Ltd., London, England.

2. Bove, A., & Davis, J. (1990).

Diving Medicine

. 2nd Edition, W.B.Saunders Company, Philadelphia, PA.

3. Davis, J., & Bove, A. (1986). “Medical Examination of Sport ScubaDivers, Medical Seminars, Inc.,” San Antonio, TX

4. Dembert, M. & Keith, J. (1986). “Evaluating the Potential PediatricScuba Diver.” AJDC, Vol. 140, November.

5. Edmonds, C., Lowry, C., & Pennefether, J. (1992) .3rd ed.,

Divingand Subaquatic Medicine

. Butterworth & Heineman Ltd., Oxford,England.

6. Elliott, D. (Ed) (1994). “ Medical Assessment of Fitness to Dive.”Proceedings of an International Conference at the Edinburgh Con-ference Centre, Biomedical Seminars, Surry, England.

7. “ Fitness to Dive,” Proceedings of the 34th Underwater & HyperbaricMedical Society Workshop (1987) UHMS Publication Number70(WS-FD) Bethesda, MD.

Paul A. Thombs, M.D., Medical DirectorHyperbaric Medical CenterSt. Luke’s Hospital, Denver, CO, USA

Peter Bennett, Ph.D., D.Sc.Professor, AnesthesiologyDuke University Medical CenterDurham, NC, [email protected]

Richard E. Moon, M.D., F.A.C.P., F.C.C.P.Departments of Anesthesiology and PulmonaryMedicineDuke University Medical CenterDurham, NC, USA

Roy A. Myers, M.D.MIEMSBaltimore, MD, USA

William Clem, M.D., Hyperbaric ConsultantDivision Presbyterian/St. Luke’s Medical CenterDenver, CO, USA

John M. Alexander, M.D.Northridge HospitalLos Angeles, CA, USA

Des Gorman, B.Sc., M.B.Ch.B., F.A.C.O.M.,F.A.F.O.M., Ph.D.Professor of MedicineUniversity of Auckland, Auckland, [email protected]

Alf O. Brubakk, M.D., Ph.D.Norwegian University of Science and TechnologyTrondheim, [email protected]

Alessandro Marroni, M.D.Director, DAN EuropeRoseto, ItalyHugh Greer, M.D.Santa Barbara, CA, [email protected]

BIBLIOGRAPHY/REFERENCE

ENDORSERS

Page 6 of 6

8. Neuman, T. & Bove, A. (1994). “ Asthma and Diving.” Ann. Allergy,Vol. 73, October, O’Conner & Kelsen.

9. Shilling, C. & Carlston, D. & Mathias, R. (eds) (1984).

ThePhysician’s Guide to Diving Medicine

. Plennum Press, New York,NY.

10. Undersea and Hyperbaric Medical Society (UHMS)www.UHMS.org

11. Divers Alert Network (DAN) United States, 6 West Colony Place,Durham, NC www.DiversAlertNetwork.org

12. Divers Alert Network Europe, P.O. Box 64026 Roseto, Italy, tele-phone non-emergency line: weekdays office hours +39-085-893-0333, emergency line 24 hours: +39-039-605-7858

13. Divers Alert Network S.E.A.P., P. O. Box 384, Ashburton, Aus-tralia, telephone 61-3-9886-9166

14. Divers Emergency Service, Australia, www.rah.sa.gov.au/hyper-baric, telephone 61-8-8212-9242

15. South Pacific Underwater Medicine Society (SPUMS), P.O. Box190, Red Hill South, Victoria, Australia, www.spums.org.au

16. European Underwater and Baromedical Society, www.eubs.org

Christopher J. Acott, M.B.B.S., Dip. D.H.M.,F.A.N.Z.C.A.Physician in Charge, Diving MedicineRoyal Adelaide HospitalAdelaide, SA 5000, Australia

Chris Edge, M.A., Ph.D., M.B.B.S., A.F.O.M.Nuffield Department of AnaestheticsRadcliffe InfirmaryOxford, United [email protected]

Richard Vann, Ph.D.Duke University Medical CenterDurham, NC, USA

Keith Van Meter, M.D., F.A.C.E.P.Assistant Clinical Professor of SurgeryTulane University School of MedicineNew Orleans, LA, USA

Robert W. Goldmann, M.D.St. Luke’s HospitalMilwaukee, WI, USA

Paul G. Linaweaver, M.D., F.A.C.P.Santa Barbara Medical ClinicUndersea Medical SpecialistSanta Barbara, CA, USA

James Vorosmarti, M.D.6 Orchard Way SouthRockville, MD, USA

Tom S. Neuman, M.D., F.A.C.P., F.A.C.P.M.Associate Director, Emergency Medical ServicesProfessor of Medicine and SurgeryUniversity of California at San DiegoSan Diego, CA, USA

Yoshihiro Mano, M.D.ProfessorTokyo Medical and Dental UniversityTokyo, [email protected]

Simon Mitchell, MB.ChB., DipDHM, Ph.D.Wesley Centre for Hyperbaric MedicineMedical DirectorSandford Jackson Bldg., 30 Chasely StreetAuchenflower, QLD 4066 [email protected]

Jan Risberg, M.D., Ph.D.NUI, Norway

Karen B.Van Hoesen, M.D.Associate Clinical ProfessorUCSD Diving Medicine CenterUniversity of California at San DiegoSan Diego, CA, USA

Edmond Kay, M.D., F.A.A.F.P.Dive Physician & Asst. Clinical Prof. of Family MedicineUniversity of WashingtonSeattle, WA, [email protected]

Christopher W. Dueker, TWS, M.D.Atherton, CA, [email protected]

Charles E. Lehner, Ph.D.Department of Surgical SciencesUniversity of WisconsinMadison, WI, [email protected]

Undersea & Hyperbaric Medical Society10531 Metropolitan AvenueKensington, MD 20895, USA

Diver’s Alert Network (DAN)6 West Colony PlaceDurham, NC 27705