DAN ANNUAL DIVING REPORT 2018 EDITION A REPORT ON 2016 DIVING FATALITIES, INJURIES, AND INCIDENTS PETER BUZZACOTT, MPH, PHD PETAR J. DENOBLE, MD, DSC EDITORS DIVERS ALERT NETWORK DURHAM, NC Buzzacott P, Denoble PJ (editors). DAN Annual Diving Report 2018 Edition - A report on 2016 diving fatalities, injuries, and incidents. Durham, NC: Divers Alert Network, 2018; pp. 112. ©2018 Divers Alert Network Permission to reproduce this document, entirely or in part, is granted provided that proper credit is given to Divers Alert Network. ISBN: 978-1-941027-79-0 ANNUAL DIVING REPORT – 2018 EDITION TABLE OF CONTENTS ACKNOWLEDGMENTS 2 FOREWORD 3 SECTION 1. DIVING FATALITIES 4 SECTION 2. DIVING INJURIES 23 SECTION 3. DIVING INCIDENT REPORTING SYSTEM 41 SECTION 4. BREATH-HOLD DIVE INCIDENTS 57 SECTION 5. IDAN INJURY SURVEILLANCE 65 APPENDIX A. INTERNATIONAL INJURY MONITORING AND PREVENTION 78 APPENDIX B. DAN OPERATIONAL SAFETY PROGRAMS 89 APPENDIX C. PUBLICATIONS (2017) 96 APPENDIX D. PRESENTATIONS (2017) 100 APPENDIX E. RECENT RESEARCH POSTERS 104 LEARN MORE AT DAN.org 1 ACKNOWLEDGMENTS Data for the 2018 Annual Diving Report was collected and assembled by DAN employees and associated professionals. DAN wishes to recognize the following for their important contributions: EDITOR Peter Buzzacott, MPH, PhD Petar J. Denoble, MD, DSc AUTHORS Caslyn M. Bennett, BS (Sections 1, 3) Peter Buzzacott, MPH, PhD (Sections 1, 3, Appendix E) François Burman, IntPE, MSc (Appendix B) James L. Caruso, MD (Section 1) James M. Chimiak, MD (Section 2) Danilo Cialoni, MD (Section 5) Brian Cumming, MSc (Appendix A) Petar J. Denoble, MD, DSc (Sections 1, 2, 4, Appendix A) Salih Murat Egi, MSc, PhD (Section 5) Hiroyoshi Kawaguchi (Section 5) Akiko Kojima, BA (Section 5) Yasushi Kojima, MD (Section 5) John Lippmann, OAM, MAppSc, PhD (Section 5) Marta Marrocco (Section 5) Alessandro Marroni, MD, MSc (Section 5) Scott C. Meixner, BSc (Appendix A) Asienne J. Moore (Sections 1, 2, 4) Jeanette P. Moore (Section 1, Appendices C, D) Craig Nelson, MD (Section 1) Daniel A. Nord, BFA, EMT-P, CHT (Section 2) Ben Peddie, BSc (Appendix A) Clare Peddie, BSc, PhD (Appendix A) Massimo Pieri (Section 5) Jeff Strang (Appendix A) Mike Torr, MBA (Appendix A) Jim Watson, BSc (Appendix A) Ray Yeates (Appendix A) CONTRIBUTORS David Carver, EMT-P Frances W. Smith, MS, EMT-P, DMT Jonathan Gilliam, NRP, CCEMT-P Scott Smith, DMT Scott Jamieson Lana P. Sorrell, EMT, DMT Matias Nochetto, MD Richard D. Vann, PhD Marty C. McCafferty, EMT-P, DMT-A Travis Ward, EMT Brittany Rowley, BS William M. Ziefle, JD, MBA COPY EDITOR: Dana Cook Grossman DAN thanks all of the individuals involved in the worldwide diving safety network. This network includes many hyperbaric physicians, DAN on-call staff, nurses, and chamber technicians who complete DAN reporting forms. DAN also thanks local sheriffs, police, emergency medical personnel, US Coast Guard personnel, medical examiners, coroners, and members of the public who submit incident data. 2 ANNUAL DIVING REPORT – 2018 EDITION FOREWORD Risk is inherent to diving, whether the diver breathes compressed gas or holds their breath. The diving environment is unforgiving. Fortunately for divers, most incidents can be avoided entirely with safe practices, but incidents still occur. Prior to 1980, divers involved in incidents were largely on their own, but that changed with the establishment of the Divers Alert Network® (DAN®). DAN® is the only organization of its kind. Any diver can contact DAN for expert medical advice from our in-house physicians and medical professionals, and we follow up on and continually monitor diving incidents from around the world. DAN Research works year-round to collect and analyze dive incident, injury and fatality data, and we publish the findings here in the DAN Annual Diving Report. In this 2018 edition of the Annual Diving Report, our goal remains unchanged: to raise awareness of the risks and hazards associated with diving and to promote safer diving practices. Promoting dive safety and injury prevention is essential to cultivating a safe diving community, and with the help of a growing global network of contributors, the DAN Annual Diving Report has become the most widely applicable report to date. This report not only highlights our expanded efforts to monitor and prevent injuries internationally but also provides vital insights for divers, dive professionals, dive businesses and even chamber operators seeking to mitigate risks and prevent injuries. The first step in reducing injuries is to identify them, and the next step is to understand them. In this report, DAN identifies the most critical risks divers face and uses easily interpreted figures, intriguing case studies and informative passages to help divers comprehend those risks. This content is relevant to divers at all levels, shedding new light on diving incidents and allowing divers to learn from the experiences of others without incurring the risks themselves. We encourage you to share this report with your peers, colleagues, superiors and anyone else you know who wishes to learn more about safe diving. Giving divers the knowledge they need to make safe decisions above and below the surface is at the core of DAN’s mission. Understanding how and why injuries occur allows the community to benefit from individual lessons learned. With the support of all the DAN offices and our contributors worldwide, we are committed to providing resources that we hope will resonate with divers everywhere. William M. Ziefle, JD, MBA President and CEO Divers Alert Network LEARN MORE AT DAN.org 3 SECTION 1. DIVING FATALITIES SECTION 1. DIVING FATALITIES PETER BUZZACOTT, JEANETTE P. MOORE, CASLYN M. BENNETT, JAMES L. CARUSO, CRAIG NELSON, PETAR J. DENOBLE. 1.1 INTRODUCTION The 2018 Annual Diving Report presents an analysis diving fatalities that occur in the US or Canada are of recreational diving fatalities that occured in the US tagged as follow-up cases, and all deaths of US or Canada or that involved US or Canadian residents. or Canadian citizens, no matter where they occur, While the recent years have seen a decline in the are also marked for follow-up. Any fatalities that number of fatalities, we are saddened to report that occur outside the US or Canada and that involve 2016 saw an above -average number of recreational citizens of other countries, as well as any fatalities diving fatalities. Many of the circumstances and risks that occur during non-recreational dives (e.g., associated with these fatalities could have been military dives) are classed as no-follow-up. avoided, or at least reduced. By describing what is known about diving fatalities each year, DAN hopes Online news media outlets are monitored for that every diver will consider their diving decisions keywords involving diving and scuba deaths. carefully and will take greater care in the water. Our Other sources for notifications regarding fatalities sport is relatively safe when undertaken responsibly, include families of DAN members and friends and but we can do more, and we must, if we are to strive acquaintances of decedents who are aware of for all dives to be injury- and fatality-free. (Note that DAN’s fatality data collection efforts. The DAN fatalities associated with scuba diving are covered Medical Services Call Center (MSCC) is also a in Section 1 of this report, and that injuries and valuable resource, since the DAN Medical Services fatalities associated with breath-hold diving are Department assists with the management of any covered in Section 4.) diving incident that is called in, whether the victim is a DAN member or not. THE DATA COLLECTION PROCESS INVESTIGATOR AND MEDICAL EXAMINER The data collection process at DAN begins when REPORTS a diving death is identified through internet alerts, news stories, forums, or reports from affiliated Diving-related deaths in the US are frequently organizations, such as county coroners, fish and investigated by local law enforcement agencies wildlife officers, county medical examiners, local or the US Coast Guard (USCG) and a proportion law enforcement agencies, or members of the of them are subject to autopsies. These public. Each death is classified as to whether it investigative and autopsy reports are integral to should be followed up on or not. All recreational DAN’s research into the causes of diving-related 4 ANNUAL DIVING REPORT – 2018 EDITION SECTION 1. DIVING FATALITIES fatalities. Without access to these reports, data-collection process. Family members it would be virtually impossible to compile may complete the Fatality Reporting Form enough data for analysis. and/or provide authorization for the release of the decedent’s autopsy report. The Each state in the US has its own set of incident reporting form on the DAN website regulations regarding the release of personal (https:// w w w. diversalertnetwork.org/r esearch/ health information, on top of the federally incidentReport/) can also be used by family mandated HIPAA (Health Insurance Portability members and/or witnesses to report diving and Accountability Act of 1996) Privacy Rule. fatalities or to provide additional details Some states consider investigative and medical regarding already reported fatalities. examiner reports to be public information and release such documents readily, while others DATA ENTRY AND ANALYSIS have more stringent privacy laws. In addition, DAN Research maintains the diving fatality within a given state, the regulations (and, hence, data on a secure server. Once all pertinent ease of procuring reports) can sometimes vary information has been gathered and entered from county to county. As described in Section into the database, the results are analyzed and 1.2, the majority of diving deaths in the US occur published in the DAN Annual Diving Report. in Florida and California, and these two states have relatively straightforward protocols for requesting and obtaining copies of reports.