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Overview of Diving Injuries

ByRichard E. Moon, MD, Duke University Medical Center
Diane M. Birnbaumer, MD, David Geffen School of Medicine at UCLA
Reviewed/Revised Jun 2025
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Injuries related to deep-water diving are associated with a relatively high risk of severe injury or mortality, often due to pulmonary effects of compressed air. In the United States, diving-related injuries result in more than1300 emergency department visits annually with 47 deaths for every 1000 of these visits (1). Similar injuries can occur in workers in tunnels or caissons (watertight retaining structures used for construction), in which pressurized air is used to exclude water from work sites.

Many injuries are related to high pressure, which, at depth or in a caisson, results from the water weight above plus the atmospheric pressure at the surface of the body of water. At a depth of 10 m (33 ft), seawater exerts a pressure equivalent to standard sea level atmospheric pressure, which is 1.03 kg/sq cm (14.7 lb/sq in), 760 mm Hg, or 1 atmosphere absolute (ATA); thus, the total pressure at that depth is 2 ATA. Every additional 10 m (33 ft) of descent adds 1 ATA.

The volume of gases in body compartments is inversely related to external pressure; an increase or a decrease in gas volume due to pressure change exerts direct physical forces that can disrupt various body tissues (barotrauma). The amount of gas dissolved in the bloodstream increases as ambient pressure increases. Increased gas content can cause injury directly (eg, nitrogen narcosis, oxygen toxicity) or indirectly during ascent when decompression of the supersaturated blood or tissues releases nitrogen bubbles (decompression sickness). Arterial gas embolism can result from barotrauma or decompression. The term decompression illness refers to either decompression sickness or arterial gas embolism.

In some medical disorders, symptoms become more likely when a patient is at depth, and this may be disabling or disorienting and thus lead to drowning (see table Specific Medical Contraindications to Diving).

Clinicians in the United States caring for patients with diving or compressed air injuries may contact the Divers Alert Network: 919-684-9111 for emergencies and 919-684-2948 for other information. Physician-to-physician consultation can be obtained through Duke Dive Medicine: 919-684-8111.

Other water-related injuries, such as drowning and hypothermia are discussed separately.

Reference

  1. 1. Buzzacott P, Schiller D, Crain J, Denoble PJ. Epidemiology of morbidity and mortality in US and Canadian recreational scuba diving. Public Health. 2018;155:62-68. doi:10.1016/j.puhe.2017.11.011

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