Tallahassee woman dies diving off Key Largo

[diver 85]

Fatal accidents that occur soon after surfacing may be caused by arterial gas embolism. Proper and timely autopsy may confirm sometimes this diagnosis. In this case it seems that previous dives were shallow and decompression was not an issue. Medical issues in older divers are always of concern but the evidence is not easy to obtain.

whoa now, please define "older".........I do know this, the older I get, the older old age gets......again, sorry to hear about this .......

 

[bsee65]

A couple questionable comments here...

Sorry to hear..Article does state "When she and her dive partner surfaced they both signaled they were OKAY, but Strickland began to struggle on her swim back to the boat. "...sounds like a swimming accident to me??--how were the seas???...

A swimming accident? Are you trying to make a joke? An issue from a dive can show itself on a delayed schedule. If whatever it was didn't hit until they were back on board, would you want to call it a boating accident?

My first questions are, "where was her buddy and what was her buddy doing?"

Often, this matters. In this case, it sounds like the buddy was right there. There was no indication in that story that the diver sank and drowned, or had any other issue in which buddy absence or neglect played a part. It says she "began to struggle on her swim back to the boat," and that "CPR was performed on the boat." For all we know, the buddy was right there when she started to have trouble and aided her in making it the rest of the way back to her ride.

There are so many reports that do suggest bad buddy skills that it becomes an easy target. I just don't see how it would even pop into anyone's head as relevant here without some other information that I didn't get from the article. Normally, I am a fan of speculation to encourage learning and consideration on this board, but there is less info here than usual.

What can we learn? Well, maybe that the dive isn't "over" from a buddy perspective until the team is back on the boat. Your partner could surface fine and then still need your help on the way back, so remain proximate and alert. We can be reminded that overall fitness can be important to a safe and successful dive. While we don't have any information about the cause here, there certainly are plenty of reports where an underlying health issue or lack of fitness is a critical part of an incident while diving.

 

[widget]

there certainly are plenty of reports where an underlying health issue or lack of fitness is a critical part of an incident while diving.

This is my sense exactly, I guess the question to ask is "Would the person have still had the fatal incident were they relaxing in the Holiday Inn coffee shop"?

If, after an autopsy,the medical answer is "No, probably not" - then we have to conclude that maybe, the dive itself was a contributor to the incident.

 

[diver 85]

A couple questionable comments here...



A swimming accident? Are you trying to make a joke? An issue from a dive can show itself on a delayed schedule. If whatever it was didn't hit until they were back on board, would you want to call it a boating accident?




Often, this matters. In this case, it sounds like the buddy was right there. There was no indication in that story that the diver sank and drowned, or had any other issue in which buddy absence or neglect played a part. It says she "began to struggle on her swim back to the boat," and that "CPR was performed on the boat." For all we know, the buddy was right there when she started to have trouble and aided her in making it the rest of the way back to her ride.

There are so many reports that do suggest bad buddy skills that it becomes an easy target. I just don't see how it would even pop into anyone's head as relevant here without some other information that I didn't get from the article. Normally, I am a fan of speculation to encourage learning and consideration on this board, but there is less info here than usual.

What can we learn? Well, maybe that the dive isn't "over" from a buddy perspective until the team is back on the boat. Your partner could surface fine and then still need your help on the way back, so remain proximate and alert. We can be reminded that overall fitness can be important to a safe and successful dive. While we don't have any information about the cause here, there certainly are plenty of reports where an underlying health issue or lack of fitness is a critical part of an incident while diving.

no joke, did you not notice the ??? after the statement...I'm gunna say it's tuff to 'drylab' these accidents over the internet...so what's your dx, doctor?....

also, I noticed you said "can".. I was taught the definition of can is capable, that's a far cry from 'did'..

 

[bsee65]

This is my sense exactly, I guess the question to ask is "Would the person have still had the fatal incident were they relaxing in the Holiday Inn coffee shop"?

If, after an autopsy,the medical answer is "No, probably not" - then we have to conclude that maybe, the dive itself was a contributor to the incident.

I guess I take the longer view. The definition of this as a "diving" accident as opposed to something else matters why? Well, it could matter from a PR view for diving as an activity. Too many "diving" accidents and people will get the idea that diving is dangerous and avoid it or restrict it. These effects could be felt from a media blitz on a particular event, or long term in statistics. I think it is important to characterize accidents as diver error, gear failure, dive-related medical issue, other dive-related mishap, or general issue that just happened to pop up while diving. That can give you more accurate stats in the long run, but generally is classified too late to impact the effect of media coverage.

If someone has a heart attack from over-exertion, it's not a dive-related medical issue in my mind. They could have done the same thing going for a jog or shoveling snow. It probably wouldn't have hit them sitting in the coffee shop, though. It's still going to be reported as a mishap while diving. An unexplained DCS hit would be dive related, as would bad narcosis leading to a fatal error.

In this case, we have a buddy pair that surfaces together, and a few moments later one of them is dying. We don't know anything about their medical histories and issues, recent prior dives, or dive profiles. We don't know if they remained together under water, or if there was some significant variance between their depths. We don't know what they were breathing, how deep, or for how long. There's just too little here to begin a meaningful discussion of this event and expect enlightenment.

 

[JonKranhouse]

Here's an excellent article about Arterial Gas Embolism by Ernest "Ern" Campbell, M.D.
Ern's got a great website with detailed source data at the bottom of his articles.

And a Wikipedia article.

Too often, surface accidents that are written off as a "coronary event" might be related to embolism (this has serious Medico-Legal and insurance payout implications). Aging alveoli are more sensitive to static lung load caused by immersion; sometimes there's an undiagnosed PFO. Since PFOs enlarge as we age (per research), us older divers are at a "double" risk of an "undeserved" event if anywhere near ND limit.

Sometimes, the first PFO-related event when diving is fatal, as it was for a 30 y/o, fit, female tech diver with an undiagnosed PFO. This example is used as part of a seminar to train pathologists and coroners in autopsy procedures after dive accidents. The victim was on a long deep dive, slow ascent, everything normal. Then, when hauling her gear up a hill back to the car, she collapsed from DCS bubbles that had embolised. This sad event is from The Pathologist’s Approach to SCUBA Diving Deaths at the Rubicon-Foundation where you can download two PDFs. (Cave Diving and Paradoxical Embolism - Case #2, the undiagnosed PFO is in the "Handout" PDF).

The above PDF was written by US Navy Capt. James Caruso, MD, who's been sponsored by DAN and the Duke Medical Center to present a one-day seminar to train other pathologists and coroners around the country to lead dive accident investigations.

CT or MRI's are superior vs conventional autopsy technique to diagnose existence and extent of embolism(s) per two papers from Europe:
from 2003, from Swiss researchers,
and
2005, from German and Swiss researchers.

Dr. Caruso's paper makes no mention of CT or MRI imaging, yet these are the definitive tools to use at autopsy as they can resolve much smaller bubbles vs. X-ray.

 

[Thalassamania]

...
There are so many reports that do suggest bad buddy skills that it becomes an easy target. I just don't see how it would even pop into anyone's head as relevant here without some other information that I didn't get from the article. Normally, I am a fan of speculation to encourage learning and consideration on this board, but there is less info here than usual.

What can we learn? Well, maybe that the dive isn't "over" from a buddy perspective until the team is back on the boat. Your partner could surface fine and then still need your help on the way back, so remain proximate and alert. We can be reminded that overall fitness can be important to a safe and successful dive. While we don't have any information about the cause here, there certainly are plenty of reports where an underlying health issue or lack of fitness is a critical part of an incident while diving.

Exactly.

...
If someone has a heart attack from over-exertion, it's not a dive-related medical issue in my mind. They could have done the same thing going for a jog or shoveling snow. It probably wouldn't have hit them sitting in the coffee shop, though. It's still going to be reported as a mishap while diving. An unexplained DCS hit would be dive related, as would bad narcosis leading to a fatal error.

In this case, we have a buddy pair that surfaces together, and a few moments later one of them is dying. We don't know anything about their medical histories and issues, recent prior dives, or dive profiles. We don't know if they remained together under water, or if there was some significant variance between their depths. We don't know what they were breathing, how deep, or for how long. There's just too little here to begin a meaningful discussion of this event and expect enlightenment.

I disagree, the outcome of a heart attack is very likely to be effected by where and under what circumstances it occurs. While a heart attack whilst kicking back to the boat is clearly not in the same category as an AGE, it is still, in my mind, a diving accident.

 

[Divingguy]

The fact that these dives were only 20 - 25 feet deep would certainly seem to be important. However, there are so many unknown facts here such as sea condition, distance from the boat, whether there were any gear or physical difficulties experienced underwater or after surfacing, that it makes it really hard to get beyond speculation. Hopefully word will filter down from the dive buddy or others on the boat to fill in some additional information so that others could learn from this.

 

[bsee65]

no joke, did you not notice the ??? after the statement...I'm gunna say it's tuff to 'drylab' these accidents over the internet...so what's your dx, doctor?....

also, I noticed you said "can".. I was taught the definition of can is capable, that's a far cry from 'did'..

I have no diagnosis - there's no information. This isn''t a Sherlock Holmes story where some tiny fact that most of us would discount unravels the whole mystery. The limited set of facts we have would support way too many possibilities for any conclusion to be drawn. I would say, though, that the time between surfacing and swimming to the boat is likely to be pretty short. It would not be much of a stretch at all to believe that some pressure-related issue was progressing during that time before becoming symptomatic.

With so few facts, all that is available to us is to dicuss things that could have happened. The list of things that we can say "did" happen is fully represented by the article. Even there, we only have the vague statement that she "began to struggle" or "began having trouble" on the way back to the boat. What does that mean? Cramping? Loss of breath? Pain? Disorientation? She probably didn't sink or pass out lest that would have been reported in the article, but we can't even be sure of that.

 

[bsee65]

I disagree, the outcome of a heart attack is very likely to be effected by where and under what circumstances it occurs. While a heart attack whilst kicking back to the boat is clearly not in the same category as an AGE, it is still, in my mind, a diving accident.

Yes, the outcome of a heart attack is more likely to be negative the further away you are from the best medical care, but that would be true of most serious medical issues that would arise. That is why I would leave such an incident listed as a mishap that occurred while diving and sub-categorized as a non diving related medical issue.

Making it clear, though, that we don't know what happened here and no one is saying that heart attack was the cause of this incident.