REVIEW ARTICLE
Scuba Diving and Snorkeling Safety on
Australia’s Great Barrier Reef
Jeffrey Wilks
The Great Barrier Reef is one of the world’s most
popular marine tourism destinations. In 1997, there were
1.5 million visitors to the reef, with marine tourism
contributing around $650 million to the regional econ-
omy.1 Major tourist activities on the reef include snor-
keling, scuba diving, fishing, swimming, glass bottom
boat rides, reef walks and sailing.2 Industry figures show
that in excess of one million recreational scuba dives are
made from commercial vessels on the reef each year.3,4
Up to 80% of commercial reef visitors participate in snor-
keling activities.5 International visitors consider snorkeling
(19.6% mentioned) and diving (12.1%), to be the best
feature of their trip to the Great Barrier Reef.5
Figure 1 shows the dimensions of the Great Barrier
Reef Marine Park, and its position in relation to the
Queensland coast. According to Windsor,4 the most
concentrated scuba diving areas are in the Cairns Sec-
tion of the reef, and the Whitsunday Islands off Mackay.
At the level of individual dive sites, among the most pop-
ular, and internationally well known locations are, the Cod
Hole (Cairns Section), Yongala wreck (Central Section
off Townsville), and Heron Island in the Mackay/Capri-
corn Section off Gladstone.4,6 Snorkeling is undertaken
throughout the Great Barrier Reef, especially on the
islands, and from a range of commercial vessels. In June
1997, there were some 660 commercial operations in the
Great Barrier Reef Marine Park, using 900 vessels.7
Diving and Snorkeling Safety
Safety has always been a concern for the Queens-
land marine tourism industry. However, as in other areas
of tourist health and safety,8 very little reliable research
is available on the incidence of illness and injury in the
Jeffrey Wilks, PhD, LLB (Hons): Consultant Psychologist and
Principal Research Fellow, Centre for Accident Research and
Road Safety, Queensland, Australia.
Reprint requests: Dr. Jeffrey Wilks, CARRS-Q, School of
Psychology, Queensland University of Technology, Beams
Road, Carseldine, Queensland 4034, Australia.
J Travel Med 2000; 7:283–289.
283
marine environment.9 For scuba diving, the overall safety
record in Queensland appeared commendable for many
years.10 Government sources suggest that only 1 in
430,000 Queensland dives results in a fatality, compared
to 1 per 120,000 dives in the rest of Australia. In the
United States, the rate is 1 death per 100,000 dives,
while in Japan there are 6.5 deaths per 100,000 dives.11
Since there has never been a comprehensive audit
of diving and snorkeling activity in Queensland, these
fatality ratios are only best estimates. As noted by Har-
garten12 in the context of international travel and motor
vehicle crash deaths:
It is difficult to assign risk to a cause of death
and nonfatal injury if the numerator is incom-
plete and the denominator is virtually
unknown.
The same epidemiological constraints apply to div-
ing and snorkeling fatalities. When it comes to nonfatal
injuries the picture is even less clear. Early reports from
the Queensland Dive Tourism Association13,14 showed a
total of 27 accidents (including 3 fatalities) in 1989, and
34 accidents (including another 3 fatalities) in 1990.
Unfortunately, this industry series was discontinued after
the second report. However, information collected by the
government’s Division of Workplace Health and Safety,
from various sources, identified a further 14 deaths, and
260 injuries, resulting from underwater diving in Queens-
land between 1990 and 1996.15
The Division acknowledges that these figures prob-
ably underestimate the true level of morbidity, since
some injuries may be missed in official reporting pro-
cedures, due to limitations on access to information held
by hospitals and medical surgeries. This conclusion has
been confirmed in other studies, which show that hos-
pitals do not routinely distinguish between commercial
and recreational dive injury treatments.10 In addition, apart
from decompression illness, it is difficult to identify scuba
diving related injuries, from general hospital records. In
a recent study of seven Queensland coastal hospitals, 69
cases of decompression illness in tourists were identified
over a 12-month period. For overseas tourists in Queens-
land, decompression illness was the second most fre-
284
quent type of injury requiring hospitalization (follow-
ing fractures).16
Where information is available, it appears that many
of the dive injuries officially reported tend to be serious
injuries, including decompression illness, SCUBA related
drowning,or CAGE (cerebral arterial gas embolism).13,14,17–19
No reliable figures exist for the number of snorkeling
injuries in Queensland,20 though media reports periodi-
cally highlight snorkeling injuries, and fatalities, involving
overseas tourists.21,22
While it can be argued that Queensland scuba div-
ing and snorkeling are relatively safe, considering the large
number of participants each year, a series of recent deaths
and injuries, including the disappearance of American
scuba divers Thomas and Eileen Lonergan,23 has again
J o u r n a l o f Tr a v e l M e d i c i n e , Vo l u m e 7, N u m b e r 5
Figure 1 The Great Barrier Reef.
(map courtesy of the Great Barrier Reef
Marine Park Authority, used with per-
mission)
raised questions about overall safety standards in this
area of marine tourism.24 For travel medicine practitioners
it is important that these questions be addressed. As
Behrens and his colleagues25 note:
A crucial prerequisite for giving balanced
advice and assessing health risks is accurate epi-
demiological data on travel morbidity and
mortality, preferably related to geographical
risk.
In order to understand the relevant risk factors, and
to comment on current government safety initiatives, the
following analysis of scuba diving and snorkeling fatal-
ities in Queensland was undertaken.
Wilks, Scuba Di ving and Snork eling Safety
Scuba Diving and Snorkeling Fatalities
Based on internal statistics provided by the Division
of Workplace Health and Safety, Table 1 presents the num-
ber of fatalities recorded in Queensland for the period
1995–1998. A total of 13 scuba diving and 20 snorkel-
ing deaths were reported, as required under the Work-
place Health and Safety Regulation 1997, sections 52 and
53, which provide for the notification and recording of
injuries, illnesses and dangerous events.26
Table 2 describes the scuba diving fatalities accord-
ing to national group and age. A majority of the diving
deaths involved Australians (7/13). All fatalities occurred
on the Great Barrier Reef. Ages ranged from 19 to 58
years, with a mean (average) age of 40 years. There were
10 male and 3 female fatalities. The cause of death most
frequently recorded was drowning. Unfortunately, no spe-
cific details of the contributing factors could be provided
by the Division of Workplace Health and Safety. This lack
of detail is an ongoing problem for researchers and pol-
icy makers, stemming from the nonstandardized report-
ing formats used by police, coroners, and marine transport
authorities. However, discussions with officers from the
Division of Workplace Health and Safety confirm that
medical conditions, inexperience, failure to dive accord-
ing to a set plan, and panic, are the major contributing
factors to scuba fatalities.20
Table 3 presents the snorkeling fatalities according
to national group and age. A majority of the snorkeling
deaths involved overseas visitors (18/20), especially older
people. Ages ranged from 14 to 78 years, with a mean
(average) age of 52 years. All fatalities occurred on the
Great Barrier Reef. There were 14 male and 6 female
fatalities. The cause of death most often recorded was
drowning, but again specific details were not available.
Discussions with officers from the Division of Workplace
Health and Safety confirmed that preexisting medical con-
ditions, notably epilepsy, and cardiac disease, as well as
fatigue, and panic, were the major contributing factors
to snorkeling fatalities.20
Government Safety Review
In response to the worldwide media publicity sur-
rounding the disappearance of scuba divers Thomas and
Table 1 Recreational Diving and Snorkeling Fatalities in
Queensland: 1995–1998
Year Diving Snorkeling
1995 3 1
1996 2 6
1997 1 10
1998 __7 __3
13 20
285
Table 2 Scuba Diving Fatalities in Queensland by National
Group and Age: 1995–1998
National Group Number Age(s)
Australian 7 26, 30, 40, 45, 47, 49, 54
American 3 29, 34, 58
British 2 19, 45
Asian 1 45
Eileen Lonergan, and other incidents occurring around
the same time, on 6 February 1998, the Queensland
government commissioned a taskforce to review the
appropriateness of workplace health and safety standards
relating to recreational diving and snorkeling. The task-
force’s final report27 has recommended increased statu-
tory regulation of the industry, and in particular, that more
emphasis be given to certain safety procedures, especially
site supervision, people counts, activity briefings, and med-
ical and physical fitness to undertake recreational diving
and snorkeling.
As part of the review process, the government’s
Division of Workplace Health and Safety has drafted new
industry Codes of Practice for both scuba diving,28 and
snorkeling.29 These Codes are currently available for
public comment, and if approved by the parliament, will
become law in Queensland. For the travel medicine
physician advising patients about safely undertaking
scuba diving and snorkeling activities on the Great Bar-
rier Reef, or in other holiday locations throughout the
world for that matter, a few important points can be high-
lighted from the Queensland experience.
Health and Fitness
Scuba Diving. In a recent report it was noted that scuba
diving is generally not a physically demanding activity,
but that it does require a reasonable level of health and
fitness.30 In their review of 100 consecutive scuba div-
ing deaths in Australia and New Zealand, Edmonds and
Walker,31 found that in 25% of the cases there was a pre-
existing medical contraindication to scuba diving. In
9% of cases, the deceased had been specifically advised
by a diving medical practitioner, and sometimes by a dive
Table 3 Snorkeling Fatalities in Queensland by National
Group and Age: 1995–1998
National Group Number Age(s)
British 6 29, 46, 67, 67, 72, 78
American 5 64, 65, 69, 72, 75
Asian 4 21, 24, 31, 51
European 3 21, 46, 60
Australian 2 14, 70
286
instructor, that they were unfit for scuba diving. The lead-
ing causes of death for the 100 dive fatalities were drown-
ing, pulmonary barotrauma, and cardiac disease. Also
noteworthy were eight cases of asthma, and seven cases
of respiratory disease. Edmonds and Walker31 concluded:
Physicians and dive instructors are still con-
fusing physical fitness (needed for many sports)
and medical fitness (a freedom from medical
diseases incompatible with safe diving). Both
are required.
To address the issue of medical fitness to dive, the
Draft Code of Practice for Recreational Diving28 pro-
poses that any person doing resort diving (alternatively
known as introductory diving),32 must complete a med-
ical declaration prior to starting the course. The Med-
ical Declaration for Resort Diving, from the Draft Code
of Practice, is presented in Appendix 1. If any medical
condition is disclosed on this form, the draft code sug-
gests that medical advice should be sought from a div-
ing medical practitioner, before any diving takes place.
An interesting item on the Declaration concerns
alcohol use. If the information on the form indicates the
prospective diver has consumed alcohol within 8 hours
prior to the diving, the draft code recommends that he
or she should not dive. Given that holidays are often a
time of increased alcohol use, especially among young
people,33 it is important for intending divers to know that
drinking alcohol may preclude them from participating
in scuba diving activities.
In relation to certified divers, that is, divers who have
completed a full open water training program,3 the
draft code proposes that if the dive operator “has seri-
ous concerns regarding the medical fitness of a poten-
tial diver,” then the diver should be advised not to dive.
In some situations, the diver’s fitness will be fairly obvi-
ous. For example, in the 100 fatalities reported by
Edmonds and Walker,31 there were eight cases recorded
as “gross obesity,” and a further four cases described as
“very physically unfit.” However, in other situations, such
as with asthmatics choosing not to disclose their con-
dition,34 it remains extremely difficult for a dive oper-
ator to discover medical conditions that could be
problematic.
The types of medical conditions that preclude a
person from participating in scuba diving are well doc-
umented. These include asthma, respiratory tract infec-
tions, poor lung function, pneumothorax, previous chest
surgery, severe scarring of the tympanic membrane, car-
diovascular disease, epilepsy, and diabetes.35,36 The advan-
tage of knowing in advance about the Medical
Declaration screening measure proposed for use on the
Great Barrier Reef, is that travel medicine physicians can
J o u r n a l o f Tr a v e l M e d i c i n e , Vo l u m e 7, N u m b e r 5
better advise their patients about health requirements
before they leave home. This in turn may avoid disap-
pointment and embarrassment, if a patient is refused an
opportunity to participate in scuba diving when they
arrive at the marine destination.
In a Queensland study on the legal content of
adventure tourism brochures,37 it was clearly demonstrated
that travelers cannot rely solely on tourist literature for
health information. In that study, none of the 23 oper-
ators offering resort scuba diving courses mentioned, in
their brochures, the requirement that candidates would
need to complete a medical questionnaire to determine
their fitness before diving for the first time. Similarly, Aus-
tralian standards require a full medical examination of each
candidate wishing to take a full scuba diving certifica-
tion program.38 Only 6, of the 11 dive schools in the sam-
ple, mentioned this requirement. Since some studies
show that approximately 20% of candidates fail a diving
medical examination,35 appropriate medical advice prior
to leaving home will greatly assist the traveler intending
to scuba dive.
Snorkeling. The Draft Code of Practice for Recre-
ational Snorkeling29 also recognizes the possible risk
posed by medical conditions:
Snorkeling can be a strenuous exercise and
some people may panic while snorkeling,
especially if they are not experienced and they
get into difficulty. Panic or strenuous activity
can aggravate some medical conditions and cer-
tain medical conditions such as heart disease
may result in cardiac arrest and death. Simi-
larly, epilepsy may lead to unconsciousness
and drowning, and some medical conditions
are made worse through exposure to cold
water or salt water mist.
The draft code recommends that operators should
ensure that people are advised not to snorkel if they have
any medical condition which may be made worse because
of strenuous activity. Heart disease, epilepsy, and asthma
are specifically identified. Recognizing that some peo-
ple will still go ahead with snorkeling despite a medical
condition, the draft code further advises operators to
request that the customer snorkel in an area that can be
closely supervised, and that they wear a flotation device
which is able to support them.
While operators have a clear responsibility to increase
site supervision, and people counts, to further enhance
safety on the reef,39 at the same time travelers must take
some responsibility for their own behavior. In particu-
lar, travelers must be encouraged to ask questions, seek
help, and follow all directions given by staff at the marine
destination.30 This includes the recommendation not to
Wilks, Scuba Di ving and Snork eling Safety
scuba dive or snorkel, if there are serious concerns about
their fitness to participate in these activities.
Recommendations and Conclusions
Scuba diving is often presented as a high risk adven-
ture activity,40 whereas snorkeling is generally perceived
as a low risk form of recreation.20 For all adventure
activities Brown41 suggests that:
The best time to influence participants is dur-
ing their choice and preparation phase—before
they arrive.
This early preparation and educational approach
has been adopted by the Australian Water Safety Coun-
cil,42 which recently recommended that all inbound
tourists be provided with water safety information, and
identification of appropriate aquatic locations and activ-
ities. According to the Council, the current drowning rate
for overseas tourists is 13 per year (based on a 5 year aver-
age), and this represents 3.9% of all drownings in Aus-
tralia each year. Similar figures have been provided by
Mackie,43 who reports that 88 tourists, from 12 coun-
tries, drowned in Australia during 1992–1997. A total of
1,551 people drowned in that 6 year period. Whereas the
total number of international visitors to Australia is
increasing each year (from 2.9 million in 1993 to 3.7 mil-
lion in 1995 to 4.3 million in 1997),44 the Council
acknowledges that there is still little accurate statistical
information to provide a true picture of the difficulties
overseas tourists experience in the water.
Scuba diving and snorkeling appear to be making
a disproportionate contribution to national drowning fig-
ures, especially considering that many fatalities are occur-
ring in supervised workplaces. Clearly, some preexisting
medical conditions are being aggravated by panic, or
strenuous activity, leading to life threatening situations.
Two strategies are required to prevent morbidity and mor-
tality in this area of marine tourism. The first is adequate
medical advice, and preparation, before the patient leaves
home. This is the domain of the travel medicine practi-
tioner. The second strategy is to develop a high level of
supervision, and support, for travelers in the marine set-
ting. Current legislative reforms in Queensland are aimed
at delivering “best practice” in marine safety, with stan-
dards and procedures that can be adapted for snorkeling
and scuba diving at other destinations.
For the travel medicine practitioner, the Queensland
Codes of Practice for Recreational Diving and Snorkeling
provide a useful framework for advising patients about
water safety issues prior to departure on their vacation.
The common types of medical conditions that preclude
287
a person from participating in scuba diving are covered
on the Medical Declaration for Resort Diving. This
form can be used as a basic screening measure for patients
intending to either dive or snorkel, and also as a tool for
initiating general discussion about water safety issues at
the marine destination. Snorkeling, in particular, has
been identified as an activity that may pose difficulties
for some overseas visitors to the Great Barrier Reef, espe-
cially older tourists. Based on current research findings,
and the government’s draft Codes of Practice, it is rec-
ommended that patients with any medical condition
which may be made worse through strenuous activity,
should be advised not to snorkel.
Acknowledgments
An earlier version of this paper was presented at the
6th Conference of the International Society of Travel
Medicine, Montreal, Canada, 9 June, 1999. Data provided
by the Queensland Division of Workplace Health and
Safety is gratefully acknowledged. Special thanks are
extended to Anne Quinnell for advice and assistance.
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Wilks, Scuba Di ving and Snork eling Safety 289

Appendix 1 Medical Declaration for Resort Diving

Surname Given name

Address Phone

Date of birth / / . Sex: Male or Female

Have you suffered from, or do you now suffer from, any of the following -
Yes No
Asthma or wheezing
Brain, spinal cord or nervous disorder
Chest surgery
Chronic bronchitis or persistent chest complaint
Chronic sinus conditions
Collapsed lung (pneumothorax)
Diabetes mellitus (sugar diabetes)
Ear surgery
Epilepsy
Fainting, seizures or blackouts
Heart disease of any kind
Recurrent ear problems when flying
Tuberculosis or other long-term lung disease

Are you currently suffering from -

Yes No
Breathlessness
Chronic ear discharge or infection
High blood pressure
Other illness or operation within the last month
Perforated eardrum

Yes No
Are you currently taking any medicine or drug (excluding oral contraceptives)?
Have you ingested any alcohol within the 8 hours prior to diving?
Are you pregnant?
Do you understand that concealment of any condition incompatible with safe diving might put my
life or health at risk?

Signature Date

Witness
(Appendix 1 reproduced from reference 28, with permission)