How important is armchair incident analysis?

[AquaHump]

There are a lot of people out there that seem to think there is something of urgent importance to be gleaned from each and every incident that occurs. Another thread is currently running that asks whether such analysis might lead one to give up diving. That would certainly be a solid result of incident analysis. Are there any others?

I am asking three things:

1) Can you list anything you have changed in your diving as a result of armchair incident analysis?

2) Have you ever helped clarify, resolve or bring about any good by armchair analysis?

3) If the answer to both 1 and 2 are no, isn't this form of armchair analysis the cyber equivalent of freeway rubbernecking?

Oh my god. I am a DOD paramedic. When EVER we have a big incident we brake it down tear it aprt make new policy run new policy threw a preplan the drill based on last incident and others that could happen. It is of great value to brake down a incident even if you find nothing new you always review you skills. and it always gives room to hear from others that might have a difrent view. This brings us to lurning from others mistakes.
That being said, there should never be a witch hunt. When fingers start getting pointed and people look to blame then you run into bad bad problems. No good can come of a witch hunt.

 

[Tom Winters]

...I usually find the truth in the street, not the official reports, with the exception of autopsy reports.

This sure is the truth down here in Floriduh. The official versions of what killed whom has been a little off the reported official version, usually released "at the request of the family".
That's about all I'm going to weigh in on here - plus I totally skipped the Coast Guard thread in the Hawaii forums since that gets real touchy real fast.
Surprisingly enough, all the dive fatalities and accidents in Hawaii that happened while I was there were all pretty much fairly reported.

 

[H2Andy]

However, if you take the attitude that I believe in; using an accident

ok, stop right there. how do you know about the accident? how do you know
what you know is correct? how do you know what facts are at issue?
how do you know you have the right sequence of events? or even just
a rough approximation that is not totally wrong?

you just can't theorize in a vacuum. that's not accident analysis.

would you not agree with me that at the very least you need *some* information
about the accident to go on?

and that sometimes that information is just not enough to tell you what happened?

my question is one of the foundation of the process you will do, call it accident
analysis or speculation, or whatever. the foundation to that process is knowlege
about the accident in question.

when that knowledge is insufficient or mistaken, then the entire process
based on that knowledge is by default insufficient or mistaken.

garbage in, garbage out

now, if what you want to do is list the things that *might* have happened,
and think about how you would avoid what *might* have happened, then
that's ok, and useful in its own way. just be aware that you are not engaged in
accident analysis.

 

[lamont]

ok, stop right there. how do you know about the accident? how do you know
what you know is correct? how do you know what facts are at issue?
how do you know you have the right sequence of events? or even just
a rough approximation that is totally wrong?

you just can't speculate in a vacuum. that's not accident analysis.

would you not agree with me that at the very least you need *some* information
about the accident to go on?

and that sometimes that information is just not enough to tell you what happened?

my question is one of the foundation of the process you will do, call it accident
analysis or speculation, or whatever. the foundation to that process is knowlege
about the accident in question.

when that knowledge is insufficient or mistaken, then the entire process
based on that knowledge is by default insufficient or mistaken.

garbage in, garbage out

now, if what you want to do is list the things that *might* have happened,
and think about how you would avoid what *might* have happened, then
that's ok, and useful in its own way. just be aware that you are not engaged in
accident analysis.

I already posted a concrete counter-example to this. All we know about the accident is that they made it back to the 20 ft stop and then both divers were lost. Speculation is that one diver had an issue and lost consciousness and dropped down, the other diver went after them and toxed. Nobody knows if this is really what happened, its not really very good for accident analysis, there's no good way to arrive at the 'truth' as far as this incident goes. Its still useful to discuss it, because having a buddy have any kind of medical / buoyancy issue at a 1.6 ppO2 stop could occur and a technical diver would do well to think through that issue no matter if it really occured or not in this case.

Stop getting hung up on finding out what really happened. This isn't CSI: Dive Police. Its about making the living divers safer divers.

 

[H2Andy]

stop telling me what to do.

we have two different goals, and i acknolwedge that your goal is worthwhile.

i just don't call it accident analysis; that, to me, is something else entirely.

of that which you do not know, say nothing

----------------------------------------------------------

as for your analysis, how do we know they made it to 20 feet?

were the bodies recovered? any gear recovered?

 

[Walter]

What about when the facts are known, but not revealed? What's the purpose?

 

[H2Andy]

the purpose of what?

ok... i guess what you're asking is whether people have an obligation to
reveal what they know about an accident.

only public entities (Coast Guard, local police) have a duty to make
their accident reports public, in some shape or form.

everybody else has no obligation whatsover to talk to the press or
anybody else, or discuss their part in the accident or what they saw.
(of course, if they are deposed in a duly-filed legal action, they have
to answer the subpoena)

hopefully, the investigators interviewed all the relevant people, and
their report will contain the best available information. you can request
the report from the investigative agency under public records laws.

 

[Scuba]

The more reliable facts and evidence one has the easier it is to analyse and reach a reliable conclusion. Unfortunately, in many cases one only has limited evidence of questionable reliability. Fortunately we have the ability to reason in the face of inconclusive evidence, AKA speculation. Reasoning can carry a lot of weight when backed up by vast experience, comprehensive subject knowledge and scenario reconstruction tests, leading to a highly probable conclusion. It's not an all or nothing deal. Otherwise, we get nothing in many cases, possibly even the majority where the evidentiary standards are set strict enough. It's all accident analysis which lead to a conclusions(s). The conclusion, contrary to many belief's, is not always incontrovertibly conclusive.

A comment often heard is: Let's wait for the investigation, conducted by experts, to conclude and in time we will know.

Who should we believe? The plaintiff's investigation? Maybe the defense investigators? How about the legal authorities? Try the insurance company? The medical examiners? These are all self interested parties beholden to their respective duties and obligations. Never mind some of these reports will never be publicly available or very limited in scope.

There is no party responsible for objectively conducting accident analysis in the interest of the diving public. In light of this fact, forums such as this one are a great resource for divers. We try to do the best we can with very limited and questionable information most of the time. And often do a damn good job in my opinion with what we have to work with. For perhaps a significant majority of us, our primary goal is to learn from the mistakes of others. That is our main interest, I'm tempted to say exclusively so for many, and it differs from that of the other parties. And it can hurt, and it's painful, and medicine is bitter - and it works.

Without passing any judgment, we either choose to share dive accident information with the public for public analysis, in SB for example, or we choose to not contribute to the dive community in this manner. The same goes for participating, following the thread, or ignoring the thread. Live and let live.

 

[MXGratefulDiver]

How many of y'all have become better at other endeavors ... such as driving a car ... by analyzing the accidents of others?

Aren't training, experience, and common sense really the tools by which we learn?

Diving accidents, more than most, seem to be chronically short of facts to study. We can reach conclusions based on what we believe probably happened ... but ultimately it's an exercise in reinforcing that which we are already inclined to believe.

I don't see a whole lot of learning going on in any of the conversations that take place around diving accidents ...

... Bob (Grateful Diver)

 

[The Chairman]

I agree Bob... it's usually more of an excersize in one upmanship. Many want to appear to be the most indignant about the way the victim (or their buddy) must have caused the accident. It's just a variation of the "Stroke du jour" syndrome.

Often you get the feeling that they truly feel that "It couldn't happen to them". Which is true right up to the time it actually happens to them.