As scuba divers get older, heart-related problems add to risk
By Scott Dunn
Posted 1 day ago
Esra Samli and other divers battled fear and exhaustion while trying to save a Clinton, Ont., doctor who died scuba diving in waters off Tobermory this summer.
A novice open-water diver herself, Samli, an Owen Sound lawyer, said they did all they could to save the man she'd just met. But she and the other divers who joined the rescue needed help.
Dr. Jan Raczycki, 49, died July 31 at the James C. King, one of 22 shipwrecks in Fathom Five National Marine Park, where there's an estimated 20,000 dives every year.
He was pulled from the water about 3 p.m., police have said. A pre-existing heart condition likely led to his death, his 22-year-old son, Ivan, said shortly after the accident. He spoke with the coroner shortly after his father's death.
The calamity reveals how self-reliant divers are expected to be and that when things go wrong on a routine boat charter, it's up to the dive buddy and any others to effect a rescue regardless of ability or experience.
The sport of scuba diving involves considerable risks, managed by self-reliance, safety training and equipment.
A diver must contend with physical stresses including, depending on depth, Tobermory's cold water, buoyancy compensation and the body's altered physiological responses to the pressure of deep water. There's also the threat of decompression sickness or a potentially fatal embolism if panic takes over and training isn't followed.
Psychological pressures are equally critical to manage, medical dive experts and industry safety experts say.
The doctor's misfortune also suggests the value of hiring a dive master, or diving with a club or a dive shop that organizes group dives with more extensive safety precautions.
The generation that popularized scuba diving in the '60s is aging and that increases health risks. It's an issue dive organizations are starting to target in an effort to cut the number of heart-related fatalities.
Ivan Raczycki said he understood his father's heart condition was the same as killed the doctor's father too, and the death couldn't have been prevented.
The coroner's office can't comment while there's an ongoing investigation.
Given that heart problems are a significant cause of death in diving, having available portable defibrillators, which automatically reset the heart, might be a good idea. At least one quarter of the 80 to 90 Canadian and American fatalities in the sport annually are attributed to heart problems.
Dr. George Harpur, the Bruce Peninsula coroner with expertise in dive-death investigations, pronounced death on Dr. Raczycki in Tobermory after earlier efforts to resuscitate him on the dive boat and back on land failed.
He couldn't comment on Dr. Raczycki's death, but he said fitness to dive has been an apparent problem in the sport for 10 years, due to the advancing average age divers.
"One of the biggest differences we see now is that a number of deaths we see in the park now won't essentially be diving deaths faults related to diving technique they're often deaths while diving because the demographics of divers has changed," said Harpur, who is also medical director of the Tobermory Hyperbaric Facility, used to treat diving-related and other injuries.
"What created the dive industry, at least in North America, were baby boomers," said Dan Orr, president of Divers Alert Network, which runs an emergency hotline and designs dive safety courses. "And now they're getting older and older and along with that they have the diseases of age."
In the early days of the sport the 1960s and 1970s almost all divers were young. Now the mean age of the nearly 250,000 U.S. and Canadian divers who are members of DAN is in the mid-40s. They're also wealthier now and can purchase gear that lets them do riskier things, Harpur said.
There have been great strides made in equipment and training to reduce scuba diving fatalities from the peak level in the mid-1970s, when 150 deaths annually occurred.
But Harpur said two big threats for more divers now are cardiac dysrhythmia where the heart gets out of rhythm, and pulmonary edema of immersion where great forces exerted by water pressure and cold on divers causes fluid to accumulate in the heart and lungs, forcing both to work harder.
Harpur said a majority of Tobermory's dive deaths in the last 10 years were the result of a cardiac incident and all but one were initiated by a disease process that would be more readily survived on land.
Fathom Five has more divers entering the water from a single point than anywhere else in the country, he said. That puts the local marine park on the front lines of the problem.
In the five years covering 2000 and 2004 there were six diving deaths at Fathom Five. Concern about that number led to new protocols, including a pre-dive registration self-assessment checklist. It asks divers to consider their dive readiness and to abort their dive plans if they're not feeling up to it, regardless of how far they've travelled or what the expense. In the last six years, there have been two deaths, including Dr. Raczycki's, Parks Canada says. Still, the initiative may provide evidence that well-targeted safety efforts can make a difference.
When Tobermory's hyperbaric chamber opened in the 1970s, about a dozen cases of decompression sickness, rarely life-threatening, and one or two deaths every year were common, Harpur said.
"Now we can go as long as five or six years without a death and we might see three-four cases of DCS."
But Harpur said there are also fewer divers taking the plunge in Tobermory. The invasive zebra mussel, which has cleared the murkier parts of the Great Lakes, has made wrecks visible elsewhere, he said.
There used to be about 10,000 diver visits per year, each making about four dives, or 40,000 or 50,000 dives per season, estimated by tank fills, Harpur said.
"Now we're down to about 15,000 or 20,000 and now a lot of these (about 25%) are early trainees, but not entirely."
Dive tag registrations are not a reliable measure of dive activity because not everyone registers, park spokesman Scott Currie said. But they do reveal a declining trend, from 4,278 registrations in 2000 to 3,032 in 2010.
So the reduction in diving deaths in Tobermory may also at least partly reflect there are fewer divers visiting Fathom Five National Marine Park.
As Samli learned, Dr. Raczycki's diving death also revealed how quickly responsibility to save a diver in distress falls to the divers nearby, even if they book a dive charter.
She said she booked her excursion with a respected local dive shop, Divers Den, thinking she would be safer than going out on her own. She assumed a dive master would be aboard.
But no dive master typically accompanies charter dive boats anywhere in North America, said dive experts and Tracy Edwards, who captained the Laura J dive boat that took Samli, Dr. Raczycki and the others out to the King wreck.
Edwards called authorities for help but couldn't leave the boat and couldn't move it with other divers in the water.
No government regulation requires charters to bring along dive masters, or stock automated external defibrillators, like those installed in many arenas and public libraries, or even to have medical oxygen aboard. Such safety precautions are left to common sense and the emerging requirements of insurers.
Transport Canada doesn't require AEDs on dive boats or on any other commercial vessels and says it has never considered requiring them.
But the devices are recommended by the Ontario Underwater Council, the nonprofit provincial safety and education association for the sport, by DAN and by medical doctors who specialize in dive medicine.
They're on all Canadian Coast Guard vessels and attempts were made to use one to save Dr. Raczycki when the Coast Guard arrived the day he died.
Diving is a self-regulating industry across North America, almost without exception. There is a culture of self-reliance and a distaste of government regulation.
Transport Canada requires no other crew than a captain aboard most dive vessels, those carrying up to 12 passengers. Its safety equipment requirements are minimal first-aid kit, fire extinguisher, life jackets and little more the same for a dive boat as any other commercial boat its size.
There also appears to be a consensus that the sport is already pretty safe.
"Diving is an outdoor activity and there is nothing you can do anywhere without there being some sort of risk," Orr said from the nonprofit organization in North Carolina.
Nobody knows how many divers there are or how many dives are being taken to know how to calculate the risk compared to other activities, he said.
But 90 DAN member deaths every year "isn't necessarily a crisis in the sport," he said.
The rate of diving deaths "is comparable to what's going on in other sports," agreed Dr. Petar Denoble, research director at DAN.
In jogging there are estimated to be 13 sudden cardiac deaths per 100,000 participants, while nine per 100,000 divers die from cardiac-incidents, he said.
"However, joggers jog year-round and divers dive 20 days per year . . . You still have to admit that for the exposure, the risk in diving is definitely greater than in jogging."
DAN's most recent efforts to reduce that risk is a survey to determine if members should be required to undergo annual medical exams to qualify for the group's medical liability insurance. The survey results should be ready by spring.
Dr. Raczycki was reported by his Tobermory instructor, Michael Marcotte, to be a nervous diver. The doctor was also observed to hesitate four to five metres beneath the surface.
But in the throes of an emergency, it was too late to check his heart health or abort the dive. That left it up to Heather Douglas, who was the doctor's fiancée, her son, Samli and her dive buddy, Daniel Lieb, a 28-year-old Toronto tech consultant who learned to dive in Germany, to rescue him.
There was no dive master, an experienced diver responsible to oversee the dive's safety, let alone rescue divers on hand.
Dr. Raczycki had to be retrieved from almost 30 metres down and brought back to the dive boat before life-saving efforts could begin.
Maybe nothing could have saved the amiable doctor, who chatted with Samli on their 15- or 20-minute boat ride out to the dive site.
Samli remains troubled by his death and by the risk they all faced.
"All I am suggesting is we are lucky that the incident did not get bigger, resulting in more" casualties, said Samli. She snapped a picture of Raczycki and his fiancée just before they all entered the water.
"We needed help ourselves. Not only the patient. We were the victim as well. We were panicked, we were having anxiety attacks, we were trying to help someone else," she said.
"That's our main point. We put ourselves at pretty high risk," said Lieb.
