Written by Al Hornsby
As a dive professional, you’re well aware of the importance of following good diving practices during all dive activities. You teach this in courses, have students sign the Safe Diving Practices form and remind divers of safe procedures during dive activities. From all the attention given, you’d expect that respect for good practices – especially among experienced divers – would be so ingrained that the occurrence of deliberate “violations” leading to dive fatalities would be fairly unusual. Well, “expect” again.
A recent study, “Violations of Safe Diving Practices Among 122 Diving Fatalities,” published in International Maritime Health, carried out and written by Karl Shreeves, Peter Buzzacot, Al Hornsby and Mark Caney, investigated the relationship between intentional deviation from accepted diving practices and diver fatalities. The authors examined 119 incidents/122 diver fatalities in North America and the Caribbean, which did not involve diver training, and identified the presence of violations of accepted safe diving practices, as well as whether the deaths were associated with an acute medical event.
The results were very interesting in a number of ways. First, it was found that 57 percent of fatalities were associated with an acute medical event. Because a large segment of the existing diver population is aging, the incidence of medically related dive incidents has been steadily rising. In fact, it was determined that the odds of a death being associated with a medical condition increased approximately nine percent per year of age, or 2.4 times for every 10 years of age. The study delved as deeply as possible into the specific incident causes and discovered that medically related triggers might be even more frequent than previously assumed, as they might be masked by secondary impacts, such as drowning on the surface following a difficult-to-determine cardiac event.
The Most Interesting Finding
The most interesting finding was that 23 percent of medically related fatalities and 75 percent of nonmedical fatalities involved violations of safe diving practice. The sad aspect of this is it means most of these tragedies were possibly avoidable.
The medically related incident violations often involved diving against a doctor’s orders or with known conditions, such as existing cardiac problems. The nonmedical violation causes ran the gamut of simple, basic issues including:
- Not doing a predive safety check before jumping in with an empty cylinder.
- Having a regulator attached to the diluent cylinder.
- Not doing a pre-breathe with a rebreather.
- Diving deeper than one’s training or experience.
- Diving solo or continuing to dive after buddy separation without being trained or experienced in solo diving.
- Entering overhead environments without the proper training, -experience or equipment
Divers who died from something other than a medical cause were seven times as likely to have one or more violations associated with the fatality.
An Interesting Side-finding
One interesting side-finding, with -surprising frequency, involved this scenario:
It’s a lovely dive, buddies or a group are swimming along, everyone has plenty of air, and one diver calmly signals that he wants to go up. The buddy signals “Are you OK?” and the diver indicates OK, but just wants to go back to the boat. The buddy accompanies him to the surface and signals the boat, which begins heading over (or takes him to just under the boat), then heads back down to continue the dive. In the brief moments before the diver can climb the ladder, he is apparently disabled by a medical event, slumps forward into the water, adding drowning to the incident.
Not only does this complicate rescue efforts, but it appears that sometimes medical evaluation concludes drowning rather than a debilitating medical event as the cause (with unfortunate negative effects on the potential for – and the defense of – litigation).
Divers should be aware of this and consider that someone ending an otherwise normal, fun dive for no clear reason might be experiencing vague, but unclear, symptoms of a medical event. Perhaps a way to avoid the potential for these situations is simply to honor the buddy system, and if one buddy wants to end the dive, they stay together all the way back to the boat or shore.
Whether teaching or supervising, remind your divers that established, good dive practices – much like speed limits and seat belts – do prevent accidents and protect divers. It is not just words and formality to teach and remind divers of these critical skills and procedures. We are all helping to establish patterns of behavior that, as now empirically established, can prevent dive accidents from occurring.
A version of this article that originally appeared in the 4th Quarter 2018 edition of The Undersea Journal®.