DAN Report on Diving Fatalities

[boulderjohn]

I am basing my crystal ball on two observations.

1. PADI participated very actively in fatality studies along with DAN this year. In announcing its work (in general terms and without specific data) early on in the journal they send out to members, the implication I read into the message is that they were not going through the effort just to have something to do. Perhaps I was reading into it with more hope than I should have, but my sense was that the purpose was to give them data that they could use to inform instructional change.

2. For the past two months I have been in regular communication with key members of the PADI training department as the spokesman for a group of instructors, many of who are SB regulars, who are seeking to have some changes made in the traditional approach to OW training.We took months working as a group to prepare our case. The immediate response was very positive. In fact, I was almost immediately contacted by phone (and then repeatedly by email) in relation to what we wrote. To give a quick and vague summary, in the very first contact I was told in clear and certain terms that because of what we wrote, they were going to begin immediately to start changing some of the materials used for instructor preparation obviously for future training). Subsequent contacts emphasized a willingness to consider such changes.

I am going to continue to be vague on point 2 because we are not done talking and I don't want to be premature. I will probably have something definitive to say by the end of the month.

 

[Duke Dive Medicine]

All the discussion about instruction and curriculum here got me thinking. Kindly indulge one old hard-hat diving instructor.
First, hats off to John and all the other instructors who care enough about their students to take the initiative to change curriculum, or go the extra mile to teach something about basic diving safety that isn't in the curriculum but should be. Thanks for doing your best to put me out of a job. I appreciate it. Seriously.
I was thumbing through a regional diving magazine a couple of weeks ago, and in it was an article about a dive boat operator who was locally well-known for leading deep technical dives to the Doria and other sites around the northeast. He was also well-known for diving air deeper than 200 feet and was quoted as calling trimix "girlie gas". Clearly diving was part of his machismo, something that's not uncommon in our community, especially in those who end up meeting me professionally.

This fellow was also a poorly controlled diabetic with coronary artery disease. He made a 200-odd foot dive two months after a multiple bypass operation and became a DAN fatality statistic. He left behind a young son.

My questions for the diving instructors, and anyone else who wants to jump in: first, what do you do when you run into someone like the fellow above, especially when that person is in a position to influence the attitudes and behavior of a lot of divers? Second, you can teach gas management and buoyancy control, but how do you get your students to internalize the material and adopt an attitude of safety? Finally, how do you recognize a student who's out to prove something, and once you recognize him, change his fundamental perceptions of himself and what he's looking to accomplish?

 

[Bob DBF]

It seems every year in southern California on opening night of lobster season we have a few fatalities. And the people who die consistently fit a profile. They are overweight middle age men who have not been diving since the last lobster season. In the process of telling people scuba is fun we have forgotten to put enough emphasis on fitness to dive.

In northern California it's April 1 and Abalone divers, granted no SCUBA is involved, but the profile is the same. And they never drop their weight belt.

Personally I SCUBA and free dive year round trying to avoid part of the profile, time will tell if it helps. And yes, I have dropped my weight belt.

When I started SCUBA diving my dad told me "kid you can't breathe water so you better be damn careful when you're screwing around down there". I believe the way that SCUBA is marketed today the inherent danger of diving is glossed over in order to increase the diving public. Granted the equipment is better and more reliable, there is a lot of training available for those that want it, and the casualty rate is "acceptable", but you still can't breathe water.


Bob
----------------------------
I may be old, but I’m not dead yet.

"the future is uncertain and the end is always near"
Jim Morrison

 

[boulderjohn]

My questions for the diving instructors, and anyone else who wants to jump in: first, what do you do when you run into someone like the fellow above, especially when that person is in a position to influence the attitudes and behavior of a lot of divers?

I have never met anyone like that. I would have to guess at what I would do if I did.

Second, you can teach gas management and buoyancy control, but how do you get your students to internalize the material and adopt an attitude of safety?

I have never noticed any students having an attitude that denied safety while in the class. What happens after that I don't know, since I very rarely have the opportunity to dive with former students.

One of the things I do is not gloss over the key safety issues as many people say you should. I especially emphasize the risk of embolism on a rapid ascent. I tell one particular true story of someone I know who had a heart attack while diving, and the autopsy revealed she had had another one not long before. When she had the heart attack, she had the illusion that her regulator was not giving her air, so she discarded it and bolted to the surface. The key lesson is that she almost certainly would have survived the heart attack--it was the breath-holding bolt to the surface and the resulting embolism that killed her.

The next thing I do is emphasize how a CESA should be done far beyond the class materials. I do not agree with the way we have to teach CESA in the pool (swim horizontally, no inhalation allowed at any point), and when we do the exercise, I do at as required, but I explain to them why I disagree with it and why it matters.

1. Swimming horizontally provides no benefit of expanding air, so they must limit their exhalation to nearly the point of holding their breath. This teaches them that CESA is much harder than it really is, and it implies that if they really need to do it from greater depths, they won't be able to. It teaches them the opposite lesson that it should.
2. Nowhere are they taught (until I tell them--repeatedly) that in the normal OOA situation, the tank is not empty--it just can't deliver air at the depth and pressure at which the diver is diving. As they ascend and ambient pressure decreases, the regulator will be able to give them air. Thus, in a real CESA, if the diver really does run out of air to exhale, he or she should inhale and get air. The proper thing to when running out of air to exhale is to inhale, but we are required to fail them on the exercise if they do. Students fail the exercise if they do the right thing!
3. Nowhere are they taught (until I tell them--repeatedly) that their body has no signal that it needs O2. The screaming panic they feel is from CO2 buildup. They have all the O2 they need to reach the surface in their blood stream already. If they can ignore the sense of panic, they will be OK.

Thus, I try to tell them as emphatically as I can that the CESA is a safe and effective way to get to the surface if they can avoid panicking and do it properly. Do they internalize it? I have no idea, since I don't know if any of my students have ever gone OOA.

Finally, how do you recognize a student who's out to prove something, and once you recognize him, change his fundamental perceptions of himself and what he's looking to accomplish?

I have never recognized one, so I can't say. I am getting the impression from your questions that this is a bigger problem than I think it is.

I know people who push their diving beyond what they should in terms of personal health. I know people of people (not personally) who have become complacent because of a long diving history without incident. There have been some recent cave deaths attributed to that, with experienced divers skipping basic safety steps and dying as a result. I am not sure they are trying to prove something as much as they are being complacent and adopting the "it can't happen to me" attitude. We don't see those people in basic training, though. That comes with time.

 

[Diver0001]

My questions for the diving instructors, and anyone else who wants to jump in: first, what do you do when you run into someone like the fellow above, especially when that person is in a position to influence the attitudes and behavior of a lot of divers?

Well.... I think you may be mistaken in thinking that someone like that can influence a large number of people strongly. Large numbers of people are influenced by DIR, for example, which in terms of recreational diving is about as risk averse/containment as it gets. Large numbers are also influenced by their scuba instructors, few of whom would suggest the things you read about. I just don't see divers on the whole as being big risk takers. Some obviously do, and a few of those might think it's cool to hang around someone who takes unnecessary risks and calls trimix "girlie gas" but generally speaking I'd say divers are a little more savvy than that.

Second, you can teach gas management and buoyancy control, but how do you get your students to internalize the material and adopt an attitude of safety?

Getting them to internalize the information is pretty straight forward. In my case I teach it all as elements of "dive planning" and try to bring a number of otherwise disjointed topics into focus for them. Once you do that, most people's proberbial light-bulb goes on and it sticks. It's actually pretty easy to get people to commit things to long term memory if you can hang it up on a context they understand. What you *don't* want to do is just present it as individual things and then leave it at that. If you don't pull it together and hang it up on a context like "dive planning" then many people will simply tune out and it won't stick. That said, I'm not a professional teacher. There are many people in education (like BoulderJohn) who really know how to get people to remember things. I'm just telling you what I've noticed works, most of which I've discoverd by trial and error.

As for an attitude of safety, I use the "mother hen" approach. People will emulate your own behaviour as they're learning. So model what you want to see and most people will just do it. There will always be a few who won't follow through after the course but I don't think that's a function of the course or even something the instructor can control.

Finally, how do you recognize a student who's out to prove something, and once you recognize him, change his fundamental perceptions of himself and what he's looking to accomplish?

Seeing them is easy. They show up on the radar on day 1. During the first module, I do an introduction round and ask people why they want to learn how to dive. The ones who are out to prove something will reveal themselves in the first few minutes. After that it's a matter of talking to them--descretely. The courses are performance based and in principle if they can perform the tasks required of them then they can get their certification even if you suspect they're out to prove something. IN that case if talking to them doesn't help you either have to (a) let it go or (b) refuse to train them. In practice instructors do both of those depending on how uncomfortable the student makes them feel.

R..

 

[Crush]

I am just curious, and this might be the wrong place to ask, but are there any training agencies who teach students to buddy breath? And to clarify that, I do not mean simply grabbing your partners safe second, I mean sharing your partners primary reg.

Legions

Two years ago ACUC (formerly Association of Canadian Underwater Councils, now American and Canadian Underwater Certifications Inc.) required it - not sure about now. We had to swim the length of a pool with one buddy being the donor, and to return with the other being the donor. We also did this with one person being blind, i.e., without a mask.

For information on ACUC, see Home

When comparing different agencies, remember that:

1. PADI is the most prolific dive agency;
2. With the exception of PADI, I believe that all agencies allow their instructors to impose additional requirements above the minimum, as the instructor sees fit.

Summary: while my ACUC instructor required me to buddy breathe while unmasked, this may not have been part of the official curriculum. Under ACUC he is allowed to require this.

 

[Ayisha]

I am just curious, and this might be the wrong place to ask, but are there any training agencies who teach students to buddy breath? And to clarify that, I do not mean simply grabbing your partners safe second, I mean sharing your partners primary reg.

I learned to buddy breathe during the class and pool of my PADI rescue course (2002). The instructor asked the shop owner if it was ok for us to learn it and they discussed it and there was some talk about them not really teaching it, but then the owner said yes. It was a lot easier than I thought it would be. Waiting for my turn was easier than I thought too. Of course, we were kneeling in a pool quite calmly.

During the o/w course, I could see the big poster with buddy breathing listed and read about it, but we never learned how to do it, which I found to be odd. I asked why we were skipping buddy breathing, and they said it is sometimes botched, there are 2 divers without a reg in their mouth at points, and that they didn't want divers to associate getting air with grabbing a reg from someone else's mouth. So I didn't learn it until the next year during the rescue course.

Not sure if buddy breathing is being taught now in PADI or in what course. I have found that quite a few people think buddy breathing is another name for air sharing and don't realize it involves one reg.

 

[MXGratefulDiver]

All the discussion about instruction and curriculum here got me thinking. Kindly indulge one old hard-hat diving instructor.
First, hats off to John and all the other instructors who care enough about their students to take the initiative to change curriculum, or go the extra mile to teach something about basic diving safety that isn't in the curriculum but should be. Thanks for doing your best to put me out of a job. I appreciate it. Seriously.
I was thumbing through a regional diving magazine a couple of weeks ago, and in it was an article about a dive boat operator who was locally well-known for leading deep technical dives to the Doria and other sites around the northeast. He was also well-known for diving air deeper than 200 feet and was quoted as calling trimix "girlie gas". Clearly diving was part of his machismo, something that's not uncommon in our community, especially in those who end up meeting me professionally.

This fellow was also a poorly controlled diabetic with coronary artery disease. He made a 200-odd foot dive two months after a multiple bypass operation and became a DAN fatality statistic. He left behind a young son.

My questions for the diving instructors, and anyone else who wants to jump in: first, what do you do when you run into someone like the fellow above, especially when that person is in a position to influence the attitudes and behavior of a lot of divers?

There is a well-documented fatality here in this forum that occurred in my locale. The casualty was someone I knew and considered a diving friend. He was a DM candidate, working with a NAUI instructor. The casualty occurred because the instructor thought it would be a good idea to go out a bag a 200-foot bounce dive on air with this DM candidate and some less-experienced divers ... three of whom turned out to be AOW students (two had less than 15 total dives). The accident occurred when one of the inexperienced divers failed to leave the bottom, and my friend ... Chad ... went back down and hauled him up. Chad ran out of air at about 160. His last act was to inflate the student's BCD, rocketing him to the surface from 160 feet. The student spent the night in the chamber at St. Joe's. Chad's body was found 10 months later, buried in the mud at 205 fsw.

To answer your question ... myself and a handful of other NAUI instructors contacted our NAUI rep demanding that this fellow be permanently barred from teaching. NAUI complied rather quickly.

If someone wants to be a cowboy, they should never be allowed to be in a position to influence newer divers ... at least not as a representative of any recognized agency.

Second, you can teach gas management and buoyancy control, but how do you get your students to internalize the material and adopt an attitude of safety?

It starts by being truthful with your students from day one ... scuba diving can kill you ... and impressing on them that the key to not becoming a statistic is learning how to make good decisions. Then go about teaching them how to do that.

You cannot instill an attitude of safety by telling students that "diving is safer than bowling". Promoting diving as an inherently safe recreational activity is all well and good, but it hardly gives one the impression that safety considerations are important.

Promoting gas management at the OW level boils down to making a mental shift from thinking about how much gas you have at the end of the dive to thinking about how much you have to begin it ... training the students that a proper dive plan includes the question "am I carrying enough gas to do this dive?" ... and then showing them how to find out.

It's not that hard, really ...

Finally, how do you recognize a student who's out to prove something, and once you recognize him, change his fundamental perceptions of himself and what he's looking to accomplish?

You cannot change someone's perceptions of himself (and yes, it's usually a guy ... women tend to have more sense) ... you can only lay the facts out there for him to accept or reject. I do not candy-coat the risks of diving. I don't try to scare my students, but I do spend some time reviewing local deaths, and what we know about why we think they happened. Most are common enough causes ... people who thought they were better prepared or more skilled than they turned out to be. I tell my students that diving isn't a competition ... it's a recreational activity that can kill you if you are careless or egotistical about how you approach it. I tell them that it's up to each of them to make up their own minds about how they use the knowledge they'll get in this class ... because they're all ultimately responsible for their own safety. I further emphasize that diving over their ability and training can get them dead ... and that they should never ... ever ... do something underwater that they're uncomfortable doing.

Beyond that, it's up to them ... my responsibility for their safety ends when class is completed. All I can do is give them some tools to work with.

... Bob (Grateful Diver)

 

[boulderjohn]

Not sure if buddy breathing is being taught now in PADI or in what course. I have found that quite a few people think buddy breathing is another name for air sharing and don't realize it involves one reg.

Buddy breathing was an optional part of PADI instruction when you took the courses. As of this year, it is no longer supposed to be an option. I cannot say with absolute certainty what they thinking was when they made that decision, but based on things that have been said in the past, it was because of a combination of ideas:

• Pretty much every diver uses some sort of alternate air source today, making it unnecessary except in the incredibly rare event that the OOA situation is coupled with a total failure of the alternate air source. By "pretty much everyone," I mean that I although I have only been diving since the late 1990s, I have never seen anyone without one.
• Research by Edmonds and others indicated that buddy breathing is a very hard skill to learn to do properly (despite what proponents argue). That research also says the skill is lost quickly if not practiced regularly.
• The odds of hitting the trifecta: 1) OOA diver, 2) Alternate air source not working, and 3) both divers skilled in buddy breathing are not good.
• If not done properly, buddy breathing can result in a real emergency for two people rather than one.

EDIT: PADI is not the only agency that feels this way. When I did my last training dive before getting my Tech 2 certification for UTD, my buddy and I were put through a long series of equipment failures that put 7 out of 8 working regulators out of commission, so we had to do our last two deco stops buddy breathing off of the same deco bottle. Our instructor told us that it should take an emergency of that magnitude (and that likelihood) to get us to resort to buddy breathing.

 

[tddfleming]

To add to tddfleming's discussion of CAD and diving: immersion and exposure to cold significantly alter a person's hemodynamics. Blood is shunted away from the extremities and into the core, which increases the load on the heart and stresses it in a way that can't be duplicated on the surface. This elevates the risk of sudden cardiac death in people who are susceptible, so even though a person passes a stress test on the surface, he or she may not be fit to dive, or even snorkel. A person doesn't need to be breathing compressed gas to experience this effect.

The DAN report also provides some insight into the diagnosis of "drowning". An untrained medical examiner may mistakenly conclude that because a person was found underwater, they drowned, when in fact drowning is a secondary effect that has a primary cause. It's impossible to tease out the specific cause of death in some of these ambiguous cases, so the statistics may be off because of that.

Thank you Duke Dive for putting a face on this health related activity accident. Through out this whole thread I never believed that had the person stayed on dry land would they still have the same outcome. I believe it has something to do with what they are currently doing, ie diving, running, etc.