DOCSLIB.ORG

Witness to a Rebreather Fatality

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Witness to a Rebreather Fatality Witness to a Rebreather Fatality Copyright ©2008 by Mark Derrick, IANTD CCR Instructor Permission is granted to copy and/or distribute this document under the terms of the GNU Free Documentation License On a pleasant afternoon in March of 2008, off the coast of Hillsboro Beach Florida, I suddenly found myself at the back of a dive boat kneeling over a fellow rebreather diver and administering CPR. This article contains my opinions and speculation about what happened that day, and is offered to help other rebreather divers understand some of the factors that led to the accident. It assumes the reader is familiar with closed-circuit rebreathers. The boat was a commercial dive charter operation and the itinerary was a light technical dive on a wreck followed by a drift dive on a reef. Among the boat passengers were several divers with instructor level ratings, although none were acting in an instruction capacity. Of particular note, the boat captain was an open-circuit (OC) technical diving instructor, and an instructor for DAN’s Diving Emergency Management course. The dive master was a CPR instructor. Also aboard was an experienced technical closed-circuit rebreather (CCR) instructor (myself), along with a non-diving rider who was an OC technical diving instructor. The victim was an experienced OC instructor and semi-closed rebreather (SCR) instructor who had recently received a CCR instructor rating. The first dive was unremarkable except that at conclusion of the first dive, during exit from the water, one of the divers dropped a bailout cylinder. Once all the other divers were aboard, during the surface interval I did a bounce dive to find and recover the cylinder. The second dive of the day was a reef drift dive. The typical routine is that the boat carefully positions over the top of the reef then the dive master calls for a team of divers to quickly enter the water. A buddy team enters the water together and immediately swims to the bottom. One of the team will carry ‘the flag’, a marker buoy with a dive flag and line towed by the diver. The captain then repositions with some separation between flags and successively drops each of the teams along the reef line. One team elected not to perform the second dive. The other teams had made their entry; the victim and his buddy were the last team to enter the water. Also, my buddy and I had delayed our entry for the second dive in order to extend my surface interval. Shortly after the victim and his buddy entered the water, I was in the process of gearing up when I heard a call of “emergency” and then heard the engine power up to reposition the boat. I removed my equipment and went to the back of the boat at the dive platform to assist. The dive master entered the water and brought the unconscious victim to the dive platform. The victim was extremely blue, much more so than I had observed in other drownings, and there was a slight amount of foaming from his mouth but no blood. The victim was large as well as obese, and there was a struggle with several of us attempting to pull him into the boat. I was concerned the DSV mouthpiece might be open, causing the rebreather to flood and the victim to sink. I eventually got hold of the breathing hoses and found the DSV to be closed. Unable to bring the fully geared diver into the boat, we cut the rebreather free and it was left drifting in the water. Even free of equipment, there was additional delay as it required the combined efforts of several people to bring him on board. Once on board, CPR was begun and oxygen was administered using a bag valve mask. The color of the victim did rapidly improve, but there was no further response to CPR. A marine police boat came along side with the intention of transferring the victim to the police boat in order to more rapidly deliver him to shore based EMS, as is standard procedure. However, the dive boat was close to the inlet, thus the captain elected not to incur the delay of a transfer and drove the victim directly to the EMS waiting at the dock. (The other dive teams were all still in the water and were recovered by another dive boat). CPR was administered continuously until reaching the dock where the EMS personnel took over care of the victim. The victim was transported to hospital and later pronounced dead. The time from the beginning of the emergency to the time the victim was in the care of EMS at the dock was approximately 30 minutes. The rebreather was recovered and brought to the dock about an hour after the accident occurred. It was configured with cylinders containing normoxic trimix diluent and pure oxygen. The diluent cylinder valve was open about two turns, and the gauge indicated over half full. The oxygen valve was closed tight and the oxygen gauge indicated zero. The oxygen cylinder was also found to be over half full. The electronics indicated alarms for low level of oxygen (PO2) on their displays with a breathing loop PO2 of 0.07 ATA. The heads-up-display was configured to indicate the actual PO2 for each of three oxygen sensors. The electronics were set to automatically shutdown after two minutes when the unit was out of the water. The BC wing included a BC integrated alternate air source for on-board bailout to diluent. The off-board bailout cylinder was full, the valve closed, the hose and second stage were stowed in a tidy configuration. Further, the off-board bailout was found to be disabled because the DIN first stage was not fully screwed into the valve and the regulator was flooded. What follows contains some speculation because all the facts will never be known, but it’s a reasonable scenario that fits the information available. The victim was not observed to use a checklist and this suggests at least some pre-dive checks were omitted. With the electronics configured for an auto shutdown value of two minutes, it is unlikely he was routinely performing a three to five minute pre-breathe test. The victim performed his first dive without incident, but probably did not have a working off-board bailout. Upon conclusion of the first dive, he did something typical of SCR divers although unnecessary for CCR divers: he closed the on-board gas supply valves. While preparing for the second dive, he did not perform essential pre-dive checks or a pre-breathe test which would have alerted him to the closed valves. When told to jump for the second dive, like a sport open-circuit diver, he simply stuck the mouthpiece in his mouth and entered the water. Upon entering the water and starting the descent, unable to get a breath he would have discovered one of his two gases was off so he reached back and opened his diluent supply valve. For an SCR diver this would not be entirely out of character, and the victim had recently taught an SCR class. In order to conserve gas, some SCR divers turn their single oxygen rich supply gas on at the last possible moment and turn it off at the first opportunity. However, CCR’s have two supply gases (a low oxygen content diluent and pure oxygen) and he did not turn on his oxygen supply valve. During the descent, the increasing pressure plus residual oxygen in the supply hoses, would have served to delay a severe drop in the oxygen level of the breathing loop. His buddy, slowed in descent by the flag line, reached the bottom a moment later and the victim gave his buddy an “OK” hand signal. The buddy turned his attention to taking up the slack on the flag line. It would have been at this point the victim either checked his PO2 in the HUD, or received a PO2 alarm in the HUD, or looked at his handset PO2 display with the intention of raising the set point. In any case he became aware of a low PO2 and closed his mouthpiece to cease breathing from the CCR. The victim then began swimming toward his buddy. When the buddy looked up from the task of managing the flag line, the victim was swimming toward him with the mouthpiece out of his mouth and reaching for the bailout on the buddy. The buddy began to deploy the bailout, but the hypoxic victim became unconscious adjacent to his buddy. The buddy raised the victim from 50 feet to the surface and alerted the nearby dive boat. A breathing loop PO2 of 0.07 at the surface would have been increased by the effects of pressure at depth to a mildly hypoxic 0.18 at 50 feet. A PO2 of 0.16 is low (hypoxic) and will cause mild symptoms of fatigue and confusion. A PO2 of 0.10 and lower causes unconsciousness and will not sustain life. It is pure speculation why the victim took the actions he did to address a mildly hypoxic loop. He had several options for immediately getting a safe breathing gas. His training emphasizes going off a hypoxic loop and switching to OC bailout. His first choice was switching to his BC integrated alternate air source for on-board OC bailout. Because the off- board OC regulator was undisturbed, I don’t believe the victim attempted to use his second choice off-board bailout.
Load more

Recommended publications
  • Lake Huron Scuba Diving
    SOUTHERN LAKE ASSESSMENT SOUTHERN RECREATION PROFILE LAKE Scuba Diving: OPPORTUNITIES FOR LAKE HURON ASSESSMENT FINGER LAKES SCUBA LAKES FINGER The southern Lake Huron coast is a fantastic setting for outdoor exploration. Promoting the region’s natural assets can help build vibrant communities and support local economies. This series of fact sheets profiles different outdoor recreation activities that could appeal to residents and visitors of Michigan’s Thumb. We hope this information will help guide regional planning, business develop- ment and marketing efforts throughout the region. Here we focus on scuba diving – providing details on what is involved in the sport, who participates, and what is unique about diving in Lake Huron. WHY DIVE IN LAKE HURON? With wildlife, shipwrecks, clear water and nearshore dives, the waters of southern Lake Huron create a unique environment for scuba divers. Underwater life abounds, including colorful sunfish and unusual species like the longnose gar. The area offers a large collection of shipwrecks, and is home to two of Michigan’s 12 underwater preserves. Many of the wrecks are in close proximity to each other and are easily accessed by charter or private boat. The fresh water of Lake Huron helps to preserve the wrecks better than saltwater, and the lake’s clear water offers excellent visibility – often up to 50 feet! With many shipwrecks at different depths, the area offers dives for recreational as well as technical divers. How Popular is Scuba Diving? Who Scuba Dives? n Scuba diving in New York’s Great Lakes region stimulated more than $108 In 2010, 2.7 million Americans went scuba A snapshot of U.S.
    [Show full text]
  • Download the Full Article As Pdf ⬇︎
    AndreaInterview with Donati — Pioneering Technical Diving on Ponza for 30 Years Andrea Donati (left) and his partner, Daniela Spaziani, run Ponza Diving, which is located in the main harbour (above) of Ponza Island in Italy. In my line of work as a dive industry professional, I attend a lot of dive shows and get to meet a lot of people, most of them nice and interesting in various ways. It was also at a dive show in Italy, many years ago, that I first met Andrea Donati and his partner, Daniela Spaziani, of Ponza Diving. I clearly remember my first impression of how sympathetic, unpretentious and genuine the two came across, which scores a lot of points in my book. They appeared competent and organised, and with their operation located in one of the most picturesque locations I have ever seen, it did not take any arm twisting to lure me down there for a visit. Text and photos by Peter Symes future. This profile will be about the virtues driven, and adapting more readily to the accommodate a wider range of requests anchoring it. In hindsight, I now consider of diving Italian-style, as Ponza Diving services we could offer in those times. and needs of customers. mooring essential for a successful dive. The world is dotted with beautiful loca- marks its 30th season. Of course, diving equipment was not We started off with just a 6m dinghy, Year by year, the number of divers tions, and there exist many excellent dive so sophisticated at that time. We dived a compressor and 20 tanks, but already increased, and I kept reinvesting in the operations across the globe that also PS: Please reflect on your three decades only with air, no nitrox, no trimix and no in the first year, I bought another dinghy, operation.
    [Show full text]
  • Diving Safety Manual Revision 3.2
    Diving Safety Manual Revision 3.2 Original Document: June 22, 1983 Revision 1: January 1, 1991 Revision 2: May 15, 2002 Revision 3: September 1, 2010 Revision 3.1: September 15, 2014 Revision 3.2: February 8, 2018 WOODS HOLE OCEANOGRAPHIC INSTITUTION i WHOI Diving Safety Manual DIVING SAFETY MANUAL, REVISION 3.2 Revision 3.2 of the Woods Hole Oceanographic Institution Diving Safety Manual has been reviewed and is approved for implementation. It replaces and supersedes all previous versions and diving-related Institution Memoranda. Dr. George P. Lohmann Edward F. O’Brien Chair, Diving Control Board Diving Safety Officer MS#23 MS#28 [email protected] [email protected] Ronald Reif David Fisichella Institution Safety Officer Diving Control Board MS#48 MS#17 [email protected] [email protected] Dr. Laurence P. Madin John D. Sisson Diving Control Board Diving Control Board MS#39 MS#18 [email protected] [email protected] Christopher Land Dr. Steve Elgar Diving Control Board Diving Control Board MS# 33 MS #11 [email protected] [email protected] Martin McCafferty EMT-P, DMT, EMD-A Diving Control Board DAN Medical Information Specialist [email protected] ii WHOI Diving Safety Manual WOODS HOLE OCEANOGRAPHIC INSTITUTION DIVING SAFETY MANUAL REVISION 3.2, September 5, 2017 INTRODUCTION Scuba diving was first used at the Institution in the summer of 1952. At first, formal instruction and proper information was unavailable, but in early 1953 training was obtained at the Naval Submarine Escape Training Tank in New London, Connecticut and also with the Navy Underwater Demolition Team in St.
    [Show full text]
  • Stepping Into Rebreather Rebreather Diving
    SSteptepping into rebreather diving By Paul Beenaround Alex had always been interested in learning to dive with the new breed of closed circuit rebreather’s that had appeared in recent years, so when he was suddenly faced with the choice of a dance weekend in chilly Munich or a week learning to dive with them in the Red Sea it wasn’t a hard decision to make. He was soon on his way with Easyjet flying over the Swiss Alps en-route for Sharm el sheik. Everything went very smoothly and he had soon settled down in the Camel hotel, a slightly upmarket one in the centre of Sharm which was not far from the Red Sea College where he would be doing his rebreather course. The next day he met Sherif, an impish Egyptian who was going to be his mentor for the combined basic and advanced four day course. After some classroom work he was shown the intricate workings of the Poseidon MK6 rebreather, the only one recognised by PADI for recreational sports divers on their recently introduced rebreather course. It was a very complex piece of kit, largely controlled by computer software, which took away the risk of diver error. This is unlike many other versions on the market that had caused accidents and deaths, usually through the diver making a mistake. As nice as it was to know that it was keeping him alive, the Poseidon rebreather’s had had many software problems that largely prevented you either starting a dive or necessitated aborting a dive halfway through for often non-existent faults.
    [Show full text]
  • Excursionsand Diving Adventures
    Fishing, Water Sports, Excursions and Diving Adventures Come and join us and experience the incredible range of aquatic activities you can enjoy at Niyama Private Islands. We have high-speed exhilarating adventures to excite you. Wind- powered high intensity sports to propel you across the water! Adventurous fishing trips to catch a magnificent fish for your table! Amazing world-class dive sites awaiting your exploration! Sky-scraping excitement parasailing with a breathtaking bird’s eye view of the stunning islands below you! We offer exciting trips and excursions to discover the fantastic marine life and top side beauty of this amazing archipelago. Snorkel near and far reefs with the resident marine biologist, experience the beauty and freedom of scuba diving for the first time or visit uninhabited islands and isolated Maldivian communities on a voyage of discovery. Then later, when you are looking for more sedate water-based activities, why not rent a kayak and paddle gently around our shallow, protected lagoon or relax in the sun as your captain takes you on a private silent journey by catamaran. Whether you are looking for speed, excitement, relaxation, marine beauty or an opportunity to create that private vision of paradise you have in your mind, then if it is water related, FLOAT can provide it for you. Please contact FLOAT on: Ext. 1270 or Ext. 1395 SCUBA diving Diving At FLOAT, we are simply fanatical about scuba diving. Our aim is to ensure you have a fantastic diving experience during your stay here at Niyama Private Islands. We are blessed with all the necessary elements to create this for you – stunning marine life, fantastic dive sites, warm water and wonderful weather.
    [Show full text]
  • Operation Wallacea Dive Standards
    Dive Policy Standards and Procedures 2019 Contents 1. Introduction ........................................................................................................................ 3 1.1 Definition of a dive ......................................................................................................................... 3 2. Operation Wallacea Dive Standards ...................................................................................... 3 2.1 Maximum bottom time ................................................................................................................... 3 2.2 Maximum depth ............................................................................................................................. 4 2.3 Air requirements ............................................................................................................................ 4 2.4 Safety stops ................................................................................................................................... 4 2.5 Surface interval .............................................................................................................................. 4 2.6 Repetitive diving ............................................................................................................................ 4 2.7 Flying after diving .......................................................................................................................... 5 2.8 Over-profiling ................................................................................................................................
    [Show full text]
  • X-Ray Magazine L Issue 63
    Member of the dive team training in a Mexican cenote Text by Sergey Baykov Photos by Sergey Baykov and Anna Loznevaya On August 14 in Dahab this year, our team of three divers dived a distance of 10km in eight hours using rebreathers. The purpose of this experiment was a practical test of human capabilities and the per- formance of rebreath- ers on a long dive, while under the influence of physical activity. It was in autumn 2010 that my colleague, Sergey Gorpinyuk, proposed the original idea to me: to dive a distance of 7km. As to a location for the experiment, we chose the colorful Mexican cenotes (caves) because they have long passages, calm current and stable direction. In addition, they have markup distances and many exits. We needed only to mark the way in the caves with guidelines. The rebreather was chosen as a technical means for the realization of the project. I was already certified as a Full 10k on a Rebreather— Making the Long Dive Cave Diver, but at that time, I SERGEY BAYKOV had just begun to dive on closed- circuit devices. Gorpinyuk, at that a good kit with which to embrace with the apparatus in cold water To Mexico cenotes Mexico were comfortable was But, as fate intervened, a long time, had already acquired some the dream. and in overhead environments. Two weeks later we flew to putting it mildly. The air tempera- dive didn’t happen. Firstly, it good experience diving with a After testing the new rebreather Two days we spent under the ice, Mexico.
    [Show full text]
  • Scuba Basics: the Ins and Outs of Diving
    Scuba Basics: The Ins and Outs of Diving by Noreen Tips for Shore Diving Shore diving offers diver a freedom unlike boat diving, unless of course you own the boat. Apart from not having to take long boat rides to the dive sites a major plus for those that get sea sick easily, you’re not limited to the boats schedule and can dive for as long or short as you and your dive buddy choose. It’s also a cheaper and convenient option for divers on a budget or for those that just like the flexibility of diving when they want. The most exciting part however of shore diving is the element of exploration and adventure. Unlike in boat dives, where you are dropped off at the dive site itself and have a captain or dive guide who knows the site, tides, currents and other considerations, but with shore dives you’re mostly on your own (unless you opt for a dive master to accompany you). Shore diving requires you to start planning more than just the dive at the site. It starts with getting to know the conditions and where exactly the site is, plotting a route to get to it, finding the best entry points and techniques, having what will you need when you get there and keeping your scuba gear to a minimum, but having all the essentials as you carry everything on your back to and from the dive site right to exit routes, in short, shore diving requires a lot of planning and preparation to get it right in order to have a pleasant experience.
    [Show full text]
  • 2018 September;48(3):132−140
    Diving and Hyperbaric Medicine The Journal of the South Pacific Underwater Medicine Society and the European Underwater and Baromedical Society Volume 48 No. 3 September 2018 Subclavian Doppler bubble monitoring Australian snorkelling and diving fatalities 2012 Inner ear barotrauma – a tool for diagnosis Which tooth restoration for divers? HBOT for large bowel anastomosis problems ISSN 2209-1491 (online); ISSN 1833-3516 (print) ABN 29 299 823 713 CONTENTS Diving and Hyperbaric Medicine Volume 48 No.3 September 2018 Editorials 198 Baltic Symposium on Diving and Hyperbaric Medicine 2018 129 The Editor’s offering Fiona Sharp 130 Decompression sickness, fatness and active hydrophobic spots Pieter Jan AM van Ooij Book review 199 Gas bubble dynamics in the human body Original articles John Fitz-Clarke 132 Reliability of venous gas embolism detection in the subclavian area for decompression stress assessment following scuba diving Julien Hugon, Asya Metelkina, Axel Barbaud, Ron Nishi, Fethi Bouak, SPUMS notices and news Jean-Eric Blatteau, Emmanuel Gempp 141 Provisional report on diving-related fatalities in Australian 201 ANZ Hyperbaric Medicine Group waters in 2011 Introductory Course in Diving John Lippmann, Chris Lawrence, Andrew Fock, Scott Jamieson and Hyperbaric Medicine 2019 168 Impact of various pressures on fracture resistance and 201 Australian and New Zealand microleakage of amalgam and composite restorations College of Anaesthetists Diving Elnaz Shafigh, Reza Fekrazad, Amir Reza Beglou and Hyperbaric Medicine Special 173 Meta-analysis
    [Show full text]
  • Divetracker™ Sport
    DiveTracker™ Sport SONAR Navigation System for Divers Owner’s Manual Rev 2B, August 2006 Desert Star Systems, LLC 3261 Imjin Road Marina, CA 93933 Phone: (831) 384-8000 FAX: (831) 384-8062 www.desertstar.com Diving is a dangerous and potentially life threatening activity. DiveTracker™ Sport must only be used by trained divers. Despite all care, DiveTracker™ Sport can fail unexpectedly. To reduce your chances of death, serious injury, and damage to property, never use DiveTracker™ Sport or any other method or instrument as your sole means of navigation. Always have at least one other means of navigation available to you. Your Safety is Your Responsibility; Use Common Sense and Good Judgment! LIABILITY DISCLAIMER By purchasing or using DiveTracker™ Sport, it is agreed and understood that in no event will Desert Star Systems or any of its representatives be held liable for any personal injuries or death or damages to property resulting from its operation or for any other damages whether direct, indirect, or consequential, even if Desert Star Systems has been advised of such actual or potential damages. Desert Star Systems dive products are authorized for use only by properly trained divers. The user must understand that the products are liable to sudden failure. Diving is an inherently dangerous activity, and proper safety procedures demand that the diver never rely solely on just the DiveTracker™ Sport or any other single instrument, method or mechanism for his/her safety or the safety of property. Thank You for Purchasing DiveTracker™ Sport! Your DiveTracker™ Sport is a state-of-the-art underwater navigation product.
    [Show full text]
  • Mise En Page 1
    Tortuga Divers by Red Sail Sports are located on property at Morritt's Tortuga Club andResort on the East End of Grand Cayman. We feel it is the best diving on the island—beautiful shallow reefs and spectacular wall/deep dives. We are on the windward side of the island and subject to a refreshing sea breeze. Prevailing weather conditions determine which dive sites we will visit on any given day. All Stingray City dive and snorkel trips depart from Rum Point (approx. 15-20 minute drive from Tortuga Divers). Golden Turtle Club members must present their membership card at the Dive Shop to obtain 20% owners discount. Tortuga Divers Cancellation Policy: 24 hours notice or more prior to activity: Full Refund. Less than 24 hours notice: No Refund. Cancellation policy for group charters varies by activity. Please contact a sales representative for more details. No refunds on unused portion of packages. Divers must show a certification card prior to diving. Scuba divers are required to have a depth gauge, tank pressure gauge, low pressure inflator, octopus and watch or botom timer. Minimum age for scuba diving is 10 years of age. RESERVATIONS Contact your travel planner or call toll free, 877-506-6368 You can contact the Dive Shop at: Phone 345-947-2097 Fax 345-947-4213 or email: [email protected] www.tortugadivers.com • www.redsailcayman.com Tortuga Divers by Red Sail Sports are proud to offer you an increased SCUBA DIVING range of activities for all the family at the East End. From beach toys and snorkel trips aboard Enjoy pampered diving at some of the world’s most spectacular walls and luxury catamarans to spectucular diving - we’ve got it all covered! shallow reefs on our custom-built dive boats.
    [Show full text]
  • Rebreather Divers
    COMPLETE LIABILITY RELEASE ATLANTIC WRECK DIVING INC. For REBREATHER DIVERS 1. I _______________________________UNDERSTAND THE PURPOSE OF SIGNING THIS DOCUMENT IS TO EXEMPT “ATLANTIC WRECK DIVING INC.” AND RELEASE IT’S EMPLOYEES, ITS AGENTS, IT’S CAPTAINS, IT’S CREWS AND IT’S BOAT SEA LION (WHETHER OWNED, LEASED OR CHARTERED) AND TO HOLD THESE ENTITIES HARMLESS FROM ANY AND ALL LIABILITIES ARISING AS A CONSEQUENCE OF THE FOLLOWING, OR ANY OTHER ACTS OR OMISSIONS ON THEIR PART, INCLUDING BUT NOT LIMITED TO NEGLIGENCE. 2. _______I am a certified REBREATHER diver or a student under the direct supervision of a REBREATHER instructor and have been taught and understand that REBREATHER diving has inherent risks and dangers associated therewith including, but not limited to, risks associated with equipment failure, perils of the sea, acts of fellow divers and I SPECIFICALLY ASSUME SUCH RISKS. 3. _______I have been REBREATHER diving within the past year or am participating in a refresher course with the above REBREATHER instructor. 4. _______I acknowledge that I am physically fit to dive using a REBREATHER and will not hold any of the above named persons or entities; responsible if I am injured as a result of heart problems, lung problem, or other illnesses or medical problems which occur while REBREATHER diving 5. ______I do not have in my possession any illegal drugs, nor am I taking, nor have I consumed any drugs or medicines that would contraindicate REBREATHER diving. I am not under the influence of alcohol nor am I hung over. 6. _______Prior to leaving the dock. 1 will inspect all equipment to be used.
    [Show full text]