A survey on the health status of Dutch scuba diving instructors
Prashant Komdeur, Thijs T Wingelaar, Rob A van Hulst
Appendix 1
Survey Diving Instructors Dutch Underwater Federation
1. Demography
Sex: Male/ Female
Birthyear: YYYY
Weight: ……Kg
Length:……. Cm
Alcohol use (Units/week)
- 0
- 1-5
- 6-10
- 10-15
- 15-20
- > 20
Smoking (cigarettes/ week)
- 0
- 1-10
- 10-20
- 20-30
- 30-40
- > 40
2. Dive History
Dive experience (years)
- < 1
- 1-5
- 6-10
- 11-15
- 16-20
- > 20
How long are you an instructor? (years)
- < 1
- 1-5
- 6-10
- 11-15
- 16-20
- > 20
Number of dives last year
- 0
- 1-50
- 51-100
- > 100
Total number of dives
- < 100
- 100-500
- 501-1,000
- 1001-2,000
- > 2,000
Deepest dive (in msw)
- 31-50
- 51-100
- > 100
Diving Equipment
- Scuba
- Rebreather
- Scuba and rebreather
3. Dive incidents
- None
- Pneumothorax
- Pulmonary edema
- Hypothermia
- Decompression sickness
- Ear Nose Throat problems
- Injury due to toxic or dangerous sea-animals
4. Current medical history
Respiratory disease
- Hay fever
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Pneumothorax (spontaneous)
- Pneumothorax (traumatic)
- Sarcoidosis
- Pneumonia
Ear Nose Throat and Eye disease
- Equilibration problems ears or sinuses
- Chronic otitis media externa
- Ear drum perforation
- Inner ear surgery
- Lesion oval or round window
- Eye surgery less than 12 months ago
- Retinal detachment
Cardiovascular disease
- Hypertension
- Heart rhythm disturbances
- Patent foramen ovale
- Coronary heart disease
- Heart valve disease
- Angina pectoris
- Myocardial infarction
Neurologic disease
- Recurrent headache
- Migraine
- Brain- or spinal cord injury
- Meniere’s disease
- Brain tumor
- Epilepsy
- Head trauma > 24 hours unconsciousness
- TIA
- Brain aneurysm
- Neck or back hernia
Psychiatric disease
- Claustrophobia
- Anxiety disorder
- Depression
- Drugs abuse of alcohol abuse
- Panic disorder
- Schizophrenia
- ADHD / ADD
Other Diseases
- Joint related injury or joint surgery
- Diabetes Mellitus 1 or 2
- Stomach Ulcer
- Rheumatoid arthritis
5. Past medical history
Respiratory disease
- Hay fever
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Pneumothorax (spontaneous)
- Pneumothorax (traumatic)
- Sarcoidosis
- Pneumonia
Ear Nose Throat and Eye disease
- Equalizing problems ears or sinuses
- Chronic otitis media externa
- Ear drum perforation
- Inner ear surgery
- Lesion oval or round window
- Eye surgery less than 12 months ago
- Retinal detachment
Cardiovascular disease
- Hypertension
- Heart rhythm disturbances
- Patent foramen ovale
- Coronary heart disease
- Heart valve disease
- Angina pectoris
- Myocardial infarction
Neurologic disease
- Recurrent headache
- Migraine
- Brain- or spinal cord injury
- Meniere’s disease
- Brain tumor
- Epilepsy
- Head trauma > 24 hours unconsciousness
- TIA
- Brain aneurysm
- Neck or back hernia
Psychiatric disease
- Claustrophobia
- Anxiety disorder
- Depression
- Drugs abuse of alcohol abuse
- Panic disorder
- Schizophrenia
- ADHD / ADD
Other Diseases
- Joint related injury or joint surgery
- Diabetes Mellitus 1 or 2
- Stomach Ulcer
- Rheumatoid arthritis
6. Medication Prescribed
Respiratory
- Bronchodilators
- Anti-inflammatory drugs
- Combination of above
- Nasal spray with anti-inflammatory action
Cardiovascular
- Diuretics
- Betablockers
- Lipid lowering therapy
- Calcium channel blockers
- ACE inhibitors
- Nitrates
- Aspirin
Endocrine
- Oral contraceptives
- Insulin
- Thyroid medication
Gastro Intestinal
- Antacids
- Anti-inflammatory medication
Hematology
- Anticoagulants
- Platelet inhibitors
Psychiatry
- Anti-anxiety medication or antidepressants
- Medication for ADHD / ADD
Other
- Painkillers
- Antibiotics
- Antiepileptics drugs
- Antimalaria medication
- Gout or rheumatoid arthritis medication
- Antidiabetic medication (non-insulin)
7. Over the Counter (OTC) medication
- Painkillers
- Nose or eardrops
- Motion sickness medication
- Antihistaminic
- Antacids
- Antidiarrheal drugs
- Antiemetics