Recreational Diving Fatalities Workshop Proceedings
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RECREATIONAL DIVING FATALITIES WORKSHOP PROCEEDINGS APRIL 8-10, 2010 DURHAM, NORTH CAROLINA Recreational Diving Fatalities Workshop Proceedings April 8-10, 2010 Richard D. Vann, Ph.D. Michael A. Lang, B.Sc. Editors Recommended Citation: Vann RD, Lang MA, eds. Recreational Diving Fatalities. Proceedings of the Divers Alert Network 2010 April 8-10 Workshop. Durham, N.C.: Divers Alert Network, 2011. ISBN #978-0-615-54812-8. Copyright © 2011 by Divers Alert Network 6 West Colony Place Durham, NC 27705 This book is available for download at no cost as a PDF file from the Divers Alert Network website: www.DAN.org. Opinions and data presented at the conference and in these proceedings are those of the contributors and do not necessarily reflect those of Divers Alert Network. Design by Diana Palmer, DAN Communications. ISBN #978-0-615-54812-8 2 • Recreational Diving Fatalities Workshop Proceedings CONTENTS Acknowledgments ......................................................................................................................................................... 4 Recreational Diving Fatalities Workshop Summary ........................................................................................................ 5 Richard D. Vann, Michael A. Lang INVESTIGATION On-Scene Diving Accident Investigation ...................................................................................................................... 11 Steven M. Barsky Equipment Testing ........................................................................................................................................................ 22 Jeffrey E. Bozanic, David M. Carver The Forensic Investigation of Recreational Diving Fatalities ........................................................................................ 34 James Caruso Legal Issues Associated with Diving Fatalities: Panel Discussion ................................................................................ 41 David G. Concannon Collecting Data and Investigating a Diving Accident: Focus on the European Law ...................................................... 58 François Jaeck DIVING FATALITY DATA Developing and Evaluating Interventions Using Surveillance Data .............................................................................. 63 Kristen L. Kucera, Stephen W. Marshall Annual Fatality Rates and Associated Risk Factors for Recreational Scuba Diving ..................................................... 73 Petar J. Denoble, Alessandro Marroni, Richard D. Vann Diving Deaths Down Under ........................................................................................................................................... 86 John Lippmann A Review of the Nature of Diving in the United Kingdom and of Diving Fatalities, Jan. 1, 1998–Dec. 31, 2009........... 99 Brian Cumming, Clare Peddie, Jim Watson Training Scuba Divers: A Fatality and Risk Analysis ................................................................................................... 119 Drew Richardson Models for Estimating the Diver Population of the United States: An Assessment ..................................................... 165 Al Hornsby TRAINING AND OPERATIONS .................................................................................................................................... 170 Michael A. Lang, Richard D. Vann CARDIOVASCULAR FITNESS The Cardiovascular System and Diving Risk .............................................................................................................. 174 Alfred A. Bove The Cardiovascular Risks of Diving ............................................................................................................................ 185 Paul D. Thompson Cardiovascular Screening in Asymptomatic Adults: Lessons for the Diving World ..................................................... 195 Pamela S. Douglas Medical Screening of Recreational Divers for Cardiovascular Disease: Consensus ................................................... 208 Simon J. Mitchell, Alfred A. Bove Appendix A: Workshop Schedule ................................................................................................................................ 217 Appendix B: Workshop Attendees ............................................................................................................................... 219 Appendix C: What’s Your Dive Safety IQ? .................................................................................................................... 223 Appendix D: On-Site Fatality Investigation Checklists ................................................................................................ 225 Appendix E1: Open-Circuit Scuba Equipment Evaluation Forms ................................................................................ 233 Appendix E2: Rebreather Evaluation Protocol............................................................................................................. 267 Appendix F: Autopsy Protocol for Recreational Scuba Diving Fatalities ..................................................................... 277 Appendix G: Personal Assessment of Cardiovascular Risk for Diving ......................................................................... 281 Recreational Diving Fatalities Workshop Proceedings • 3 Acknowledgements Naval Sea Systems Command Office of Naval Research Additional thanks to Patty Seery for skillful logistics management. Special thanks to Dr. Simon Mitchell for preparation of the cardiovascular session summary. Editors: Richard D. Vann, Ph.D. Divers Alert Network Center for Hyperbaric Medicine and Environmental Physiology Duke University Medical Center Durham, N.C. USA Michael A. Lang, B.Sc. Smithsonian Institution Washington, D.C. USA 4 • Recreational Diving Fatalities Workshop Proceedings Recreational Diving Fatalities Workshop Summary* Richard D. Vann, Ph.D. Divers Alert Network Center for Hyperbaric Medicine and Environmental Physiology Department of Anesthesiology Duke University Medical Center Durham, N.C., USA Michael A. Lang, B.Sc. “Common factors associated Smithsonian Institution with diving fatalities included Washington, D.C., USA running out of gas, The risks of dying during recreational diving are small. The purpose of this workshop entrapment or entanglement, was to consider how the risks might be reduced further. Topics included investiga- buoyancy control, equipment tion, surveillance, training and operational safety, and cardiovascular disease. misuse, rough water and Investigations involve on-scene inquiry, forensic examination of the deceased and emergency ascent.” life-support-equipment testing. These are essential to determine causes but are often inadequate. Independent annual fatality rates were presented and reviewed for diving, jogging and motor vehicle accidents and for divers in training. Common factors associated with diving fatalities included running out of gas, entrapment or entanglement, buoyancy control, equipment misuse, rough water and emergency ascent. Asphyxia by drowning, air embolism and cardiac events were the principal injuries or causes of death. About one-quarter of the deaths were associated with cardiac events, mostly in older divers. Revised procedures were recommended for identifying occult cardiovascular disease in candidate divers who warrant further investigation, but older, previously certified divers may be at greatest risk. Introduction The risk of dying during recreational diving is small, but no activity is completely *This summary and the four cardiovascular risk-free, and deaths occasionally occur. Improved countermeasures might be papers listed below are reprinted with devised if contributing factors were identified. Studies of the causes and annual rates permission from Undersea and Hyperbaric of recreational diving fatalities suggested this might be feasible (Denoble, Caruso Medicine. et al. 2008; Denoble, Pollock et al. 2008), and this workshop was convened to Bove A. The cardiovascular system explore the possibilities. Topics addressed included investigation, surveillance and and diving risk. Undersea Hyperb Med. data analysis, training and operations, and cardiovascular disease. The workshop 38(4):261-269; 2011. findings are summarized below. The four cardiovascular papers published in these Douglas P. Cardiovascular screening in proceedings (Bove 2011; Thompson 2011; Douglas 2011; Mitchell, Bove 2011) were asymptomatic adults: lessons for the diving world. Undersea Hyperb Med. 38(4):279- reprinted with permission from Undersea and Hyperbaric Medicine.* The proceed- 287; 2011. ings (Vann, Lang 2011) and presentation videos from the workshop are available on the DAN website (www.DAN.org) at no cost. Mitchell S, Bove A. Medical screening of recreational divers for cardiovascular disease: consensus discussion at the Workshop participants were encouraged to base their comments on evidence Divers Alert Network Fatality Workshop. rather than opinion, and this approach was generally observed. During planning, Undersea Hyperb Med. 38(4):289-296; one individual offered to present his opinion but declined to attend when asked 2011. to provide supporting data. The absence of evidence makes judging the validity of Thompson P. The cardiovascular risks of opposing opinions difficult, can lead to personal animosity and is counterproduc- diving. Undersea Hyperb Med. 38(4):271- tive to useful public discussion. 277; 2011. Vann R, Lang M. Recreational diving Participants