My understanding is that DSC is in much wider use than just US waters. It is more of a limited range issue. Any VHF radio built in the last decade or so will receive DSC if it is in range, regardless of where in the world it is. A PLB is a good choice if you are in major currents where you could be swept out of range before anyone figures out you are lost.
VHF range is largely “line of sight” and your arm can't reach very far above water. The range will be a lot less if the antenna on your boat is 10' off the water and the swell is 4' compared to an aircraft flying at 500'.
Also note that marine VHF radios are illegal to use on land so it’s not a backup for backpacking.
Edit: It is important to remember that a DSC signal to nearby boats is of much less value if they don't have a GPS onboard. They may get the alarm and look for a vessel nearby but they don't know to look for a diver in the water nor can they accurately find your position.
VHF range is largely “line of sight” and your arm can't reach very far above water. The range will be a lot less if the antenna on your boat is 10' off the water and the swell is 4' compared to an aircraft flying at 500'.
Also note that marine VHF radios are illegal to use on land so it’s not a backup for backpacking.
Edit: It is important to remember that a DSC signal to nearby boats is of much less value if they don't have a GPS onboard. They may get the alarm and look for a vessel nearby but they don't know to look for a diver in the water nor can they accurately find your position.