Egyptian Red Sea (Sharm) Diving Fatality

[broadreach]

59 year old women declared dead.

short version of the story published on Jerusalem Post:
Israeli woman dies after Sinai accident

Additional details available in Hebrew on Ynet.co.il
ynet ?????? ??????? ?? ??: 17 ???? ????? ????? - ?????
here's a rough translation:
Sue's Last Dive - 17 minutes turned into a nightmare

Sue and Nachman Kahana (spl?) dived together 69 times. The 70th dive was suppose to take them to a sea mount near Sharm A-Sheikh. But something went awry and Sue stopped responding. From his home in Gush Etzion, Nachman told Ynet about the last moments with his wife, his anguish and some complaints.

by Shmulik Grossman - published Feb 28th 2010 12:25AM Israel Time

"Ten meters from the surface I squeezed her hand - and she responded squeezing my hand back" - Nachman Kahana (spl?), Sue's husband recounted the chain of events to Ynet on Saturday night. Nachman was with his wife throughout the incident and up until her last moments.

"We went diving on Tuesday at 9:00 AM at a wall that descends to a depth of 200 meters. Since there were strong currents we were instructed to descend as soon as we hit the water and so we did" recounted Nachman a resident of Elazar in Gush Eztion. Him and his wife (59) joined a group of religious jews for a dive safari in Sinai. They were considered experienced divers and it was their 70th dive.

"After descending for several meters I checked with Sue that everything was OK and she signaled me to continue diving. When I reached a depth of 30 meters I noticed that she continued descending fast, I tried to signal her but she did not respond." At this stage Nachman started swimming quickly towards his wife. Diving instructor Assaf Shwartz who was leading the group noticed that something was wrong and started heading towards Sue as well.

"At a depth of 50 meters Assaf managed to get a hold of Sue. In what felt like eternity we started ascending with her. We ascended at a slow pace in order to prevent barotrauma" said Nachman. When they approached a depth of 10 meters he said, Sue was still responsive, he squeezed her hand and she squeezed back.

"We almost reached the surface when Sue lost consciousness but continued breathing. I cleaned the foam from her mouth together with Assaf and we commenced administering CPR. CPR continued for ten minutes". According to Kahana the two divers who came to their assistance pulled Sue into a Zodiac boat and continued CPR along with members of the diving group who happened to be military medics. All in all the tragic dive lasted 17 minutes.

Dedicated Treatment in Egypt, Less So in Israel
About half an hour after Sue was pulled out of the water, an Egyptian boat arrived with a doctor and professional equipment. "In record speed we sailed to the coast and there Sue was transfered to a hospital. The Egyptians were amazing and doctor Adel Taher (spl?) the manager of the hyperbaric chamber examined her and concluded that Sue most likely suffered a block in her lung that was causing insufferable pain. When she reached great depth, her lung collapsed and a multi-system damage ensued(not sure about the medical terminology here Broadreach). Later Kahana and Shwartz were questioned by Egyptian police.

Due to her deteriorating condition Sue was evacuated to Israel to Assaf Harofeh Hospital. There she was treated by diving medicine specialist Dr. Avi Mizrachi. At this point Kahana encountered the slow Israeli bureaucracy. According to him the diving insurance company (acquired through the Israeli Diving Federation) refused to fly Sue for treatment in Israel and the shocked family members had to hire a private plane and ambulance at a cost of 40,000 NIS (~US$10,500 -Broadreach).

"This is simply a tragedy. Sue was a good wife who loved her family and loved life. I lost a loving wife, a mother to a son and three daughters and grandmother to twelve grandchildren. We immigrated to Israel 30 years ago from the US. Sue worked at the IT department of Hadassa Ein Karem Hospital," he concluded in sadness.

The head of the Israeli Diving Federation, Eran Laufer responded that the insurance company has already reimbursed the family for the hospitalization and treatment. "An approval was given by the insurance company to fly her to Israel at the expense of the insurance company, but the family did not wait for the final approval which requires certification by a medical doctor and ordered a private plane at their own expense. The federation supported the family at each step in a professional and sensitive manner and we hope they know no further sorrow."

 

[svs]

I am very sorry for the tragedy.

Anybody knows what "block in her lung" on descent could mean? Is it air- or blood- flow block? Do you need preexisting conditions or it just happens?

 

[broadreach]

I don't have any medical training but after doing a Google search I came up with the following sentence:
"A pulmonary embolism (PULL-mun-ary EM-bo-lizm), or PE, is a sudden blockage in a lung artery. "
source: Pulmonary embolism, block in lung artery

I suspect that the Egyptian doctor was merely describing a pulmonary embolism which could have been caused by a failure to exhale during the ascent, resulting in lung over-expansion and a case of PE. If she was unconscious during part of the ascent (even just the last ten meters) and unable to exhale, I would think that would be enough to cause that kind of damage to the lung.
Of course that still doesn't explain why she descended uncontrollably in the first place.

Maybe someone with a dive medicine background can shed some light here.

 

[Crowley]

From the article it sounds more like the problem happened prior to the ascent, and in fact shortly after entering the water. There are a number of conditions which might have caused the problem, a rare one being pulmonary edema whereby the lungs spontaneously flood. I believe this is can be related to high blood pressure problems and cold water. The water is not so cold here - approximately 23 degrees but it's cold enough if one does not have adequate exposure protection.

I am sure medical SBers will have more ideas but that's just one possible cause....

I work here in Sharm and Dr. Adel is a brilliant physician - he's been here for many years and has probably seen it all by now. His approach to treatment is of the highest calibre and cost is a distant secondary to patient care.

Safe diving,

Crowley

 

[broadreach]

Dr. Adel is a brilliant physician

I was introduced to him once (more than 10 years ago) by a former patient of his , who thinks very highly of him as well. I have heard nothing but praise mentioned about him, both of on a personal as well as on a professional level.

From the article it sounds more like the problem happened prior to the ascent

I agree. The question is whether or not pulmonary embolism happened during the descent or was there something else and perhaps the pulmonary embolism came later.
Any thoughts?

 

[Crowley]

Following on about Adel - one of my flatmates is currently in the tank and is very happy about the service and treatment although clearly not so chuffed about being bent in the first place

Gonna have to wait for the medical people to come up with possible answers, pulmonary embolism just means blockage in the lungs; from what I do know of physiology, I suspect this is the result of some underlying condition - emphysema, asthma, spontaneous pneumothorax (collapsed lung) a good old fashioned chest cold or the aforementioned edema are all possible culprits, but I'm not a doctor and just reeling off names of conditions I know can cause blockages of some sort.

Cheers,

Crowley

 

[ROMO DIVER]

I believe that you might need to look at the descent and ascent as two seperate events. The husband states that everything was fine until 30 meters and then the only sign of something not right was the continued descent past that level. This sounds to me like nitrogen narcosis kicking in and spatial awareness problems secondary to this. The ascent then proceeded normally until the diver lost consciousness at less than 10 meters. At this point an overexpansion injury could have very easily taken place. Why the black out took place is anyones guess but could have been related to excessive breathing secondary to the situation and subsequent hypercapnia. Once again, these are only guesses.

 

[alcadhrim]

I'm physician and I quite agree with Romo Diver.
Impossible to be sure of course but :
Nitrogen narcosis and Pulmonary embolism or lung overexpansion could explain everything).

Very sad for the family indeed.

 

[Crowley]

I haven't had the opporunity to speak to Adel but next time I see him I will ask. Narcosis and lung over-expansion may well be the problem but since Adel said pulmonary embolism, I'm inclined to think that the problem occured in the lung(s) prior to the ascent and was caused by some underlying medical condition that was exacerbated by diving. I'll keep you posted.

Cheers

C.

 

[ROMO DIVER]

Since a PE can result from an overexpansion injury I am not sure why it would need to be preexisting.