First-Aid kit for divers
With 15 years experience as a travelling diver and pharmacist, Anne-Marie Kitchen-Wheeler knows more than most about the precautions that can save a dive trip threatened by ill-health or injury. She explains what you need to carry to put the odds in your favour

THE PLANE DEPARTS AT MID-DAY tomorrow and youve already packed your dive kit, T-shirts, shorts and toothbrush. Your tickets and passport are next to your hand luggage.
So what else Well, have you thought about what happens if you get ill or injured during your trip Have you made arrangements to look after yourself, or are you relying on the medical facilities at your destination

Holiday tummy
Did you know that half of all British visitors to Egypt suffer from sickness or diarrhoea Unfortunately, Egypt tops the list of countries in which you are likely to fall ill on holiday. And as Egypt is UK divers favourite destination abroad, you need to be prepared.
hspace=5 Dehydration is the major problem here. Every activity during a typical diving day will contribute to this: diving, kitting up and moving kit around in hot conditions, sunbathing, drinking alcohol and so on all play a part.
To avoid dehydration, you should drink as much water as you can, with a minimum of 2 litres a day.
If you start to develop a bad stomach, reduce your food intake but drink as much water as possible. If you start having diarrhoea, you can treat it using one of the commonly available remedies such as Imodium, which contains Loperamide.
Most anti-diarrhoeal products in capsule form contain this drug. It works by slowing down the motion through your bowels and has an antispasmodic effect. It works for most people suffering from straightforward holiday tummy. Loperamide does have a central nervous system (CNS) effect, so it is best to stop diving if you are taking this drug!
In addition, drink lots of water and consider taking a rehydration therapy such as Dioralyte sachets, which are a mixture of glucose and salt and help fluid to be absorbed very quickly, while replacing lost salts. Rehydration should be the first treatment you attempt.
It is also worth trying 50/50 fat cola plus water. It acts a bit like the Dioralyte, as the sugar and fizz in the cola help the water to be absorbed. The acidity also seems to help settle the stomach. There is no medical research on this but I know hundreds of divers who swear by it.
If you have very severe diarrhoea and/or vomiting, you have probably picked up an infection or have food poisoning. The diarrhoea and sickness is your body trying to get rid of the problem, but unfortunately the body then stays in shock and you will be very dehydrated.
Treat as above, but if after 48 hours the symptoms are not relenting, seek medical advice. If you are in a remote area a doctor will not be easily available, which is where some advance preparation comes in handy.
An antibiotic called Ciprofloxacin is available for this condition, but you will need a prescription in the UK to get it. If you are travelling to areas where food hygiene is a problem, you might try to persuade your doctor to write a private prescription, as drugs to prevent problems on holiday are not usually supplied via the NHS. You will need a five-day course of 10 tablets.
Ciprofloxacin is available from pharmacies in some countries without prescription. Do not take it as a precaution, as it will provide no protection and may make you feel pretty awful.

Colds and congestion
hspace=5 The usual scenario is that youve spent the winter taking vitamin C and keeping away from people with colds but then get stuck next to someone on the plane who is coughing his head off.
Within 24 hours you feel a sore throat coming on, and then your nose starts to run. Grrrrrr!
5 There are many cold and congestion remedies but you must bear in mind a few things as a diver. Tablets and sprays have a habit of wearing off and the symptoms will come back worse, so remember that your ears may feel clear enough to get you down at the start of the dive, but will they stay clear long enough for coming back up
I got stuck for 20 minutes with a reverse block. My head felt as if it was going to explode for a further 20 minutes before the block cleared, but left me with a real pain. You may be less fortunate and perforate an eardrum or sinus, both of which will stop you diving for the rest of the trip.
hspace=5 If you are really congested, do not dive. Remember that diving on nitrox while on pseudoephedrine (a decongestant found in many cold products and specifically marketed as Sudafed) is contraindicated, because of increased risk of loss of consciousness. So if you have to dive, stick to air.
If you need to use a decongestant, use a spray rather than a tablet. The spray works locally, on the nose and sinuses, so there is less risk of side-effects. Many sprays, including Otrivine and Sudafed spray, contain xylometazoline, thus avoiding the pseudoephedrine contraindication.
Completely natural decongestants include saline nose drops or spray, including a new product containing sterile sea water called Sterimar, which are great to use the day before to unblock stuck sinuses, or use a steam bath with a few drops of Olbas oil.
You can try the steam bath about 45 minutes before the dive or a few days in advance to loosen things up. Also drink plenty of water.

hspace=5 Aches and pains
We all have our favourite painkillers but just check yours for the following: avoid painkillers containing codeine (the packs are often red and called plus or extra) because codeine is a CNS depressant and can increase narcosis.
Paracetamol, Aspirin and Ibuprofen are all safe. Check with your pharmacist if in any doubt.

Ear infections
These are best prevented by careful ear-drying. After each dive, rinse your ears with fresh water, drain your ears onto a towel and then use a tissue wrapped around your finger to encourage the rest of the water to drain out. DO NOT use ear buds or poke anything bigger than your finger in your ear.
hspace=5 Once a day, after the last dive and showering, you can use an ear-drying aid such as Swim Ear. Do not use it more often because it can cause inflammation. Leave your ear wax well alone. Unless you have excessive wax, which the sea water itself will soften and remove, the presence of wax prevents infection.
If the worst happens and you get an ear infection, you will probably not want to dive. If it is an external infection, it can be treated with antibiotic/anti-inflammatory drops. These are available only on prescription, but if you suffer regularly, you could ask your doctor for a prescription in advance. Again, you can buy them without prescription in pharmacies in some countries. Brands include Otosporin, Otomize, Sofradex and Locorten Vioform.
If you have a middle-ear infection, you will probably feel very ill, deaf, giddy etc. Only a course of antibiotics will clear this, and there is definitely no diving for you.

hspace=5 Travel sickness
All travel-sickness tablets will make you drowsy, and should not be used within eight hours of diving because they will significantly increase narcosis. The antihistamine ingredients will also dry you up, so take care if you have to use them. Scopoderm patches last up to 72 hours but still make you drowsy.
Natural non-sedating remedies include acupuncture point bracelets which, if worn correctly, work for most people. Ginger has a soothing, anti-emetic effect. Try a couple of thin slices in hot water about half an hour before you need it.
Ginger is useful on liveaboards when you might otherwise need drugs for much of the time. Some divers swear by nibbling on ginger-nut biscuits! Its worth a try.

hspace=5 Bites and stings
Insect bites are best avoided by covering up and using plenty of insect repellent. This is also the best method to avoid malaria! If you are not bitten, you will not be at risk.
Mosquitoes bite particularly at dawn and dusk, so be very careful at these times. In areas of high risk, insect repellents containing DEET should be used, unless you are allergic to this ingredient.
Other repellents include Bayrepel (in the Autan brand), pyrethrins and citriodiol. Many repellent formulations are available, liquids and sprays tending to be the most concentrated. You dont need to cover every inch of skin, as a light spray or spotting is normally sufficient, but repellent should be reapplied every three or four hours.
If you are visiting a country in which malaria is endemic, you must take the prophylactic treatment to prevent it. Depending on the country, the regimen will vary significantly and it is essential that you check with your GP or pharmacist about up to date information for that area.
Some of the drugs are available only on prescription and can be quite expensive (up to about£40) but it is better to take them than risk catching malaria. If you think this is too much bother, you should seriously consider selecting another country to visit! Government figures show that in the UK, 2000 people return from abroad with malaria every year and last year nine people died from it.
hspace=5 If you get bitten or stung, treatment with an antihistamine tablet and some hydrocortisone cream will help for most situations. The tablets can cause drowsiness and should be avoided while you are continuing to dive, so just apply plenty of cream to the area and take the tablets at night.
First aid for jellyfish and coral stings is the application of dilute vinegar, but firstly make sure that any remnants of the animal are removed by flushing with plenty of sea water. Fresh water will make the stinging much worse.
After initial treatment, use antihistamines and hydrocortisone. Bear in mind that these stings can get really inflamed and may require medical attention, as they are easily infected.
I know one diver who had a common coral scratch, and the infection that followed almost necessitated the amputation of his lower leg. Thats a great incentive for avoiding contact with sea life.

hspace=5 Dressings/wounds
I once cut myself badly enough on a diving trip that the wound needed stitches, but I had none, and no one was available to do the stitching anyway. I survived (with a bad scar) but it made me think about what dressings I carried.
At the very least, all divers should carry their own supply of medium-sized dressing and tape and some waterproof dressing big enough to cover a knee or elbow. Also take some steristrips (to act as temporary stitches) and plasters in various sizes.
If youre not sure what to ask for, Melolin is a great basic dressing. You can buy a big one and cut it to size or buy some smaller ones that will keep sterile.
Micropore tape is invaluable. It is great to reattach plasters, make small and large dressing stick in place and works as general tape! Its a bit like masking tape but thinner. The new soft silicone gel blister and waterproof dressing are superior to the old dressings because they keep the wound moist but covered, which promotes healing and reduces scarring. They stay in place for several days, and actually help the wound heal while proving an air-permeable, waterproof covering. This includes Opsite and Compeed brands.
hspace=5 Dont forget scissors and tweezers, but remember to pack them in your checked-in luggage.
Wounds are best cleaned using plenty of tepid fresh water (use bottled water if in doubt). Apply a dressing and keep the wound covered. Any wound that keeps bleeding, is large or deep, has something embedded in it, has pus coming out, or was made by an animal, requires medical attention. Be particularly aware in tropical countries, as the heat and humidity encourage infections.

Further information
E-Med provides a full first-aid kit including antibiotics and sterile needles called a Medipac. It costs£79.99 from
If you are travelling in European Economic Area countries (the EU plus Ireland, Norway and Liechtenstein) and want to benefit from reciprocal health services, you will need to carry an EHIC card from January 2006. For more information, go to, and click on Policy and Guidance page.
This article does not cover vaccinations but your travel agent will be able to advise you on requirements and recommendations for the countries you are visiting, or contact your GP or pharmacist for advice. You should plan at least two months in advance for any vaccinations required.

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