Death of a recreational diver after a fall on board MV Elaine

[doctormike]

I don't know that there really is an answer. But the other (admittedly loaded) question is: Which is more important, to make the dive or survive the dive? We preach constantly that no one can be more responsible for your safety in the water than you. I would rather take whatever time is necessary (inlcuding a decision to abort the dive) and if that affects anyone else, I'm sorry, but my safety is more important than your inconvenience. I like to think I'm that way with people I dive with too. Take as long as you like and when you're ready, we'll go. Move to the pace of the slowest diver, not some arbitrary schedule or the pace of the fastest diver.

Well, yeah... but the whole reason that we perform autopsies, do accident analysis, and discuss this here on scuba board is to try to draw some conclusions and make recommendations that will make future dives safe.

Of course it's more important to survive the dive than to make the dive, but it's not like anyone (including the deceased) ever would even consider such a question. We all draw lines at some point and move on with imperfect data. It's not like he was thinking "hmmm... I need 20 minutes to ensure that I don't have a splenic rupture, but my buddies are dropping now, so I'll take the risk and go with them".

So while it's easy to say that your safety is more important than my inconvenience, the real question is at what point will your quest for safety be satisfied?

It sounds from the report like the deceased DID take as long as he liked, thought that he was OK, and went for it. At least, we have no evidence to assume otherwise. And I still don't know why we are considering his fall to be the proximate (or even a contributing) cause of his death, since there isn't much to suggest that is the case, or that waiting longer after the fall would have changed the outcome... Finally it's not like being at 300 feet on a rebreather is such a benign environment that we need to reject one set of possibilities (e.g. hypoxia, hyperoxia, hypercarbia, etc..) out of hand and search for alternate explanations.

 

[boulderjohn]

The report also suggests that there may have been a lot of psychological pressure on him to do the dive. He was on a multiple day dive that must have been very expensive. He had already missed some days of diving for reasons that were not explained, so he did not have much bottom time to show for the trip. As experienced as he was, he was the least experienced diver on the trip--he may have been embarrassed by the fall. I am sure no one consciously pressured him to do the dive, but he may have been feeling pressure nonetheless. That pressure may have pushed him to overlook what he considered minor symptoms.

 

[danvolker]

Some more of my thoughts on this, sure to annoy all the people I normally annoy
When we decide to do a tech dive on a particular site... who we will dive with ( buddies) is not the only choice......the choice of boat is hugely important also.

• It has to be the right Captain, because of the drastic skill differences in perfect drops with minimal time circling around to get in position--when you are geared up and heavy, you dont want to be standing and surfing at the platform for 10 minutes or more...
• It has to have the right crew, because there are some major do's and don't for crew on a tech dive
• The boat has to have plenty of room for us to gear up at our seats, and it should be easy for us to walk and have plenty of handholds to stabilize with....Even one outing with recreational gear can help alot to figure out this last issue. And the Platform or staging area for jumping in....all boats are not equal, either for getting in, or in getting back on the boat.

 

[Hickdive]

I won't let students do that on he pool deck and especially not on the boat. It's too hard to get all the blood out of the tile grout or diamond-plate decking.

flots

Good for you. Well done.

---------- Post added December 17th, 2013 at 11:18 AM ----------

That is the hardest part of the dive for me--handing up tanks, pulling off fins, and climbing up that ladder with steel doubles while it is slamming up and down in the waves.

In the UK for a dive involving twin sets (doubles), multiple stages, suit inflation cylinders etc. you probably wouldn't pick a dive boat that doesn't have a diver lift. Outside of a RIB or similar small craft you wouldn't class a boat that requires divers to de-kit in the water a "dive boat" and any boat of any size that has a boarding ladder that requires removal of fins to get up it simply wouldn't be booked.

 

[MalibuJerry]

While of course this is all speculation, as a surgeon I would be extremely surprised to read of an otherwise healthy adult who fell from a standing position (even wearing heavy dive gear), and subsequently sustained sufficient blunt trauma to cause fatal intra-abdominal hemorrhage or some other fatal injury.

Yes, there is a bell curve for everything. And I'm not saying that something like that has NEVER happened. But if you are trying to make a guess based on statistics, I would say that the dive to 300 feet was more likely to blame for his death than the fall. The lack of significant traumatic injury on autopsy, and the presence of the gas embolism support this hypothesis.

.

DrMike I agree, but my statement was a conditional probability statement, namely; if it were enough to be the cause of death as many posts in this thread assume, then would diving have made a difference relative to going down to the bunk and taking a nap for a few hours? I suspect you would agree that it would have been better were he not underwater, but it might well have made no difference whatsoever.

 

[doctormike]

...my statement was a conditional probability statement, namely; if it were enough to be the cause of death as many posts in this thread assume...

The point of my post was that this assumption (an otherwise healthy guy fell down and died from blunt trauma) is so unlikely to be true that it doesn't seem to be a reasonable part of the accident analysis. So the fact that many posts in this thread assume an extremely unlikely hypothesis doesn't make it true. Especially given the autopsy data.

But sure, if he had been thrown through the windshield in a motor vehicle accident, I agree that it would be best not to do a 300 foot rebreather dive within a few minutes.

I suspect you would agree that it would have been better were he not underwater, but it might well have made no difference whatsoever.

I don't think that there is any evidence that the dive made no difference to the outcome. I think that if he had gone to his bunk, it would have been extremely unlikely for him to die, fall or no fall. At least, based on what I have read...

 

[barrmust]

Not really germane to this conversation but there was a diving fatality the following month on the same dive boat.


Russ

 

[Duke Dive Medicine]

The point of my post was that this assumption (an otherwise healthy guy fell down and died from blunt trauma) is so unlikely to be true that it doesn't seem to be a reasonable part of the accident analysis. So the fact that many posts in this thread assume an extremely unlikely hypothesis doesn't make it true. Especially given the autopsy data.

But sure, if he had been thrown through the windshield in a motor vehicle accident, I agree that it would be best not to do a 300 foot rebreather dive within a few minutes.

If I read the report correctly the two consultants both agreed that the cause of death wasn't the blunt trauma, but there was definitely blunt trauma present. I think it would be interesting if somebody with better physics mojo than I have could calculate the difference in energy (maybe torque?) between an unladen individual who falls and somebody who falls wearing 100-odd pounds of equipment. It would probably be significant.

I know that organ rupture is a concern during vigorous chest physiotherapy. We do a fair number of whole lung lavages here, which involves repetitive filling and draining a lung with saline solution along with chest percussion. It's definitely possible to damage a spleen or a liver in this process - we have to be careful that our physical therapists percuss only over the ribs.

Best regards,
DDM

 

[flots am]

I think it would be interesting if somebody with better physics mojo than I have could calculate the difference in energy (maybe torque?) between an unladen individual who falls and somebody who falls wearing 100-odd pounds of equipment. It would probably be significant.

That would be fascinating. I'm guessing it takes both a lot of physics and medicine to be able to actually calculate.

Do we have any coroners here? It's probably something they do frequently.

 

[boulderjohn]

A near neighbor of mine was playing on his high school junior varsity football team and was tackled by someone who drive his helmet into the abdomen. It was his last play of the game. He went home and died that evening from a ruptured spleen. I wonder how a tackle of that kind from a football player not nearly of the physique even a typical high school player would equate to falling with 100 pounds of gear.

And I suspect it was more than 100 pounds.