My NSS report on this incident was based on that excellent and highly detailed report as well as consultation with its author, during which we discussed possible scenarios. I can't figure it out, either.As for a full report after a death in a cave...
Last year there were two german guys who passed away in a cave near Tulum. Lots of speculation on here and on cavediver.net. I understand that we (cave divers and others) want to understand what happened. It took about 1 year for a full report to be published and it was a very good detailed report. I took that report and printed it off - laid it out on my desk - and scrutinized it. ... My point is - a highly detailed and respectful report helps us cave divers understand what can happen and how we need to think to stay alive in a cave.
That is partly what is maddening about writing such reports. You can be 95% sure about something, but....
A few people, including the former training director for the NACD, got on social media and said they could have saved the deceased. The deceased had over 60 minutes of mandatory deco and was 800' from the exit when he died; even if he could have been brought out, he couldn't have been revived before dying from explosive DCS.
...and that is what happens when you are sure of something but turn out to be wrong. You cause a Hell of a lot of trouble, so your wording has to be very, very careful