IN 2017, WE WILL DISTRIBUTE AN INFORMATION MANUAL OUTLINING THE COMMON RISKS OF HOOKAH DIVING AND HOW TO REDUCE THEM to the fishermen in the Yucatán. By disseminating critical knowledge in the form of a handy booklet that they can carry in their back pockets or on their boat, we hope to help them recognize, respond, and prevent injury or death when these symptoms occur to themselves or their co-workers. If you'd like to help fund this effort, click here!

Decompression Sickness


Decompression sickness is the formation of bubbles in the blood vessel or in the space between cells.

at any point before (effects from a previous dive), during, or after a dive, look out for one or more of the following signs of dcs (NOT EXHAUSTIVE):

  • Muscle or joint pain
  • Dizziness or vertigo
  • Itchy or marbled skin
  • Numbness or tingling
  • Difficulty breathing

if you suspect dcs, do the following:

  1. Breathe oxygen
  2. Go to the hospital and receive recompression treatment in a hyperbaric chamber
  3. Evaluate your dive to reduce the risk of DCS in future dives

what factors MIGHT increase the risk of Dcs?

  • Prolonged bottom time (target species: sea cucumber)
  • Rapid ascent to the surface (target species: lobster); "yo-yo" dives
  • Alcohol consumption
  • Chronic health conditions such as high blood pressure, diabetes, and obesity

how do you practice safe divING?

  • Seek a doctor and get a general check-up. Understand your chronic health conditions, if any, and control them.
  • Stay hydrated by drinking water before and in between dives.
  • Remember to check that you have all the equipment you need each time you descent.
  • Harvest in shallower waters than deeper.
  • Ascend slowly, never faster than 9 meters per minute.
  • Alternate diving with a partner.
  • Use a rope to help demarcate the depths (in meters) at which you need to make a decompression stop.

    Carbon Monoxide Poisoning

    WHAT IS carbon monoxide (co) poisoning?

    Carbon monoxide (CO) is a tasteless, odorless, and colorless gas that is a byproduct of incomplete combustion of gasoline, or other carbon-based fuels. In the air, it is present in less than 10 parts per million (ppm).

    Breathing large amounts of CO prevents the blood from delivering oxygen to various parts of the body, including the brain and the heart.

    at any point before (effects from a previous dive), during, or after a dive, look out for one or more of the following signs of co poisoning (NOT EXHAUSTIVE):

      • Headache
      • Nausea
      • Vomiting
      • Blurry vision
      • Difficulty breathing
      • Weakness
      • Loss of consciousness

      if you suspect CO POISONING, do the following:

      1. Breathe oxygen.
      2. Go to the hospital and receive hyperbaric oxygen treatment in a hyperbaric chamber.


      Evaluate and modify your equipment by raising the air intake of the compressor high enough so that the engine exhaust cannot enter the compressor.

      Lipoid Pneumonia

      WHAT IS lipoid pneumonia?

      Lipoid pneumonia is an inflammation of the lungs caused by inhalation of lipids, such as oil, diesel, and gasoline, among other fuels used in combustion.

      at any point before (effects from a previous dive), during, or after a dive, look out for one or more of the following signs of lipoid pneumonia (NOT EXHAUSTIVE):

        • Dry cough
        • Fever
        • Difficulty breathing
        • Pain or difficulty swallowing
        • In a majority of cases, however, there are no signs or symptoms.

        if you suspect lipoid pneumonia, do the following:

        Go to the hospital and visit a doctor.

        HOW DO YOU PREVENT lipoid pneumonia?

        • Turn off the gasoline-powered air compressor.
        • Use compressors free of oil or dirt on the surface of volume tanks.
        • Avoid oil leaks.
        • Apply oil and other contaminants from entering the volume tank.


        WHAT IS pneumoconiosis?

        Pneumoconiosis is a lung disease caused by inhalation of dust, such as rust, that is then deposited deeply in the lungs.

        at any point before (effects from a previous dive), during, or after a dive, look out for one or more of the following signs of Pneumoconiosis (NOT EXHAUSTIVE):


          • Dry cough
          • Shortness of breath
          • Fever
          • Chills


          • Discoloration of the eyes
          • Impaired lung function

          HOW DO YOU PREVENT Pneumoconiosis?

          Periodically inspect the volume tank for signs of corrosion, or other dust particles, and clean upon detection.


          WHAT IS dehydration?

          Dehydration is a condition in which the body loses more water than it has consumed. You lose water by breathing, sweating, consuming a high amount of salt, exposure to the sun, and urinating.

          at any point before (effects from a previous dive), during, or after a dive, look out for one or more of the following signs of dehydration (NOT EXHAUSTIVE):

            • Fast heartbeat
            • Dry cough
            • Reduced amount of urine or dark urine
            • Weakness or tiredness
            • Muscle cramp
            • Irritability
            • Headache
            • Reduced sense of alertness

            why is it important to stay hydrated?

            Dehydration may not only cause the above unpleasant symptoms, but it also increases your risk of DCS.


            • Wear a neoprene diving suit if the water is cold.
            • Drink water before and between dives.
            • Consume fruits before and between dives.
            • Apply sunblock to the body every two hours.
            • Avoid sports drinks.
            • Do not dive for at least 18 hours after consuming alcohol.


            WHAT IS sunburn?

            Sunburn is caused by excessive exposure of the skin to ultraviolet radiation. The damage caused by sunburn is not always visible. 

            consider the following factors:

            • Pale skin is more susceptible to sunburn, but darker skin can become damaged just as much.
            • The sunlight is the strongest between 10 A.M. and 4 P.M.
            • The ocean's reflection of the sun can intensify the sunburn for people on the boat.

            at any point before (effects from a previous dive), during, or after a dive, look out for one or more of the following signs of sunburn (NOT EXHAUSTIVE):

              • Parts of the skin that has been reddened or hot, painful, or sensitive to touch
              • Blisters
              • Fever (in some cases)

              why is it important to avoid sunburn?

              • Sunburn can cause premature aging of the skin
              • Sunburn can increase the risk of skin cancer.

              HOW DO YOU PREVENT sunburn?

              • Apply sunblock
              • Wear long sleeve shirts.
              • Put up a sunshade on the boat.

               Pinguecula and Pterygium (Eye Disease)

              WHAT damage to the eye?

              Damage to the eye may be caused by excessive exposure to the wind, dust, or sunlight. Pinguecula is a benign, or non-cancerous, tumor that looks like a yellowish spot or bump on the white part of the eye (conjunctiva). Pterygium is a benign tumor as well that shows as a slightly raised area on the conjunctiva with visible blood vessels.

              YOU MAY FEEL:

                • Dryness, pain, heat, or irritation, as if something is in the eye
                • Affected vision, if the tumor grows over your cornea (black part of the eye)
                • In general, there are no other symptoms besides the visible sign on the conjunctiva.

                HOW DO YOU PREVENT damage to the eye?

                • Use eyedrops to keep your eyes from becoming dry.
                • Wear sunglasses.
                • Wash your face with freshwater after diving.
                • After washing your goggles with a commercial detergent, rinse them with freshwater to avoid eye irritants from entering the eye.


                The pressure change during a dive and/or goggles that are too tight or small can cause bleeding from or bruising around the eyes. This condition is not serious and will resolve in 2 weeks. To prevent this from happening, choose goggles with enough space, taking into consideration the size of the nose.

                Recommendations for Safe Diving

                VISIT THE DOCTOR FOR A HEALTH EXAM AND understand your BODY:

                • Do you have diabetes, high blood pressure, or obesity? If yes, ask the doctor how to manage these conditions.
                • Do you have problems clearing your ears during dives?
                • What is your lungs' functional capacity? 

                be prepared:

                • Know how to swim.
                • Learn how to apply first aid for yourself and for fellow co-workers. Be able to do it.
                • Check that there is emergency equipment on the boat on every fishing trip (e.g. first aid kit, oxygen tanks, spare air, and life jackets....).
                • Know how to administer oxygen from an oxygen tank to a diver.
                • Know the location of the hyperbaric chamber and be able to promptly transport a diver with DCS to the hyperbaric chamber.


                The above content is based on experiences with fishermen utilizing the hookah dive system in the Yucatán peninsula of Mexico. Written by the principal investigators Oswaldo Huchim and Walter Chin, the content invited revisions from the doctors who are familiar with the occupational health conditions and/or treat the fishermen in this region on a daily basis.

                We acknowledge some of the most common risks that are putting artisanal fishermen at risk of injury or death each time they dive to harvest. We hope that this knowledge will allow the fishermen more control on mitigating their occupational health risks and enable them to help their fellow co-workers in cases of dive-related disease or accidents.

                Please remember to always consult your doctor about restrictions and conditions specific to your health.


                WHAT IS HOOKAH DIVING?

                Hookah diving is a method of diving in which the diver breathes a continuous source of surface-supplied air through a hose.

                The hookah dive system consists of a gasoline-powered engine that runs an air compressor that compresses ambient air into a volume tank, where air flows to the diver through a plastic hose and a mouthpiece.


                Hookah diving is a method of diving in which the diver breathes a continuous source of surface-supplied air through a hose. Because the air supply is endless, fishermen can stay at depth - as long as their physical strength allows - to continue fishing. This increases the amount of nitrogen that accumulates in their cells and blood, meaning they must make frequent stops on their ascent to the surface to allow for the gas to remain dissolved in their body despite the reduction in ambient pressure.

                Unfortunately, the depth and length of these decompression stops for the types of extensive diving these fishermen practice have not been well established and known among the fishermen. In addition, if the air supply is interrupted due to malfunction of the fragile equipment these fishermen are using, the diver must rapidly ascend, despite the definitive bubble formation.

                Why do artisanal fishermen use hookah diving?

                The hookah dive system is simple to use, cost-effective, and provides an endless supply of air that allows the fishermen to continue fishing as long as they can to harvest as much as they need. It is their primary means of survival to feed their families or generate enough income to sustain their households.

                The alternative, outside breath-hold diving, is self-contained underwater breathing apparatus (SCUBA), which involves highly technical equipment that the diver must carry on his back while holding onto his catch, as well as an expensive source of air that needs to be refilled every hour or so. Thus, hookah dive system has become the most commonly utilized dive system among artisanal fishermen in developing countries.