RIU-T-73-009 C, 2

ReportNo. URI-SSR-73-8 ~

United States Underwater Fatality Statistics-1972

NOAA Grant No. 4-3-158-31 December 1973

ByHilbert V. Schenck, Jr,,Professor ofOcean and Mechanical Engineering, andJohn J. McAniff, Research Associateand Diving Officer, University of RhodeIsland, Kingston, R.l. 02881 Preparedforthe U.S. Department of Commerce, National Oceanic and Atmospheric Administration; U.S. DepartmentofTransportation, CoastGuard; and U,S. Navy, Bureau ofMedicine andSurgery

Farcate by the Superintendent ofDocuments, U.S.Qoverntnent PrintlnyOflice, Washington, D.C.,20402. Price $0.90 Mention of a commercial company or product does not constitute an endorsement by NOAA. Use for publicity or advertising purposes of information from this publication concern- ing proprietary products or the tests of such products is not authorized. CONTENTS

Abstract ~ ~ ~ vi

PART 1 History and source analysis Section 1.1 Introduction 1.2 The 1970 survey 1 1.3 The 1971 survey 1 1 1.4 Sourceanalysis for 1972cases 1.5 ~ ~ ~ ~ 2 ~round rules for inclusion in the accident census 1.6 Conclusions 4

PART 2 Generalscuba fatality statistics- Section 2.1 Fatality totals 2.2 Geograph i c vari at i ons ~ ~ ~ 6 2.3 Distribution by weekdayand month 7 2.4 Environmental factors ~ t o 10 2 ' 5 Viork-related fatalities ll 13 PART 3 Thescuba victim: trainingand medical aspects Section 3.1 Age distribution 3.2 Experience,training, andcertification 15 3.3 Diving partners and their activities 16 3.4 Medical aspects 17 3.4.1 Cause of death 19 3,4,2 Medicalcauses of the accident ~ 20 3.5 Search and rescue . 20 21

PART 4 Equipmentaspects Section 4.1 Regulatorsand air supplies 4.2 Entanglementsand ditching 22 4.3 In fl at ab 1 e ves ts 22 4.4 Gas explosion . 23 23 PART 5 Fatal and nonfatal scubacase summaries Section5.1 Fatalscuba case summaries . . . , ...... 24 5.2 Nonfatalaccident survey based on U.S. Coast Guard Data . . . 25 PART 6 General summaryof skin diving fatalities

28 Section 6.1 Skin diving fatality totals Geographi c variations ~ 28 6,2 28 Environmental data . 6.3 . 30 6.4 Age distribution and other data

PART 7

Re ferences Section7.1 Citedreferences...... ,,....., .. 37 7.2 Noncited,but useful refex'ences...,...... 3 7

FIGURES

1 Instant Alert postal reply card 3 2 Scubadiving fatalities by State, 1970, 1971, and 1972.... 9 3 Cumulativedistribution curveof scubaaccident depth for the years 1970, 1971, and 1972 . . . . ~ , 12 . 32 4 Underwater accident report form

TABLES

1 Primarysource of 1971and 1972 fatality data bothskin and 4 ! 2 Summaryof diving fatalities, 1970,1971, and 1972 ~ ~ ' ~ ~ 6 3 Scubadivers trained, pre-1971,1971, and 1972 7 4 Scubadiving fatalities by State and foreign area, 1970, 1971 , md1972 . 8 5 Distributionof fatal scubaaccidents by weekday, 1970, 1971, md 1972 . 10 6 Distributionof fatal scubaaccidents by month, 1970, 1971, and 1972 . 10 7 Locationof scubafatalities, 1970, 1971, and 1972 ...,...... 11 8 Fatal;cuba casesinvolving weathex and sea conditions, 1972 . 11 . 14 9 Work-related diving fatalities, 1972 10 Agedistribution of scuba diving victims, 1970, 1971, and 1972 .... 15 11 Experienceof scuba divers lost in fatal accidents,1970, 1971, and 1972 .. e ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ t ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ . 16 12 Scubatraining activities during a fatalaccident, 1970, 1971, and 1972 . 17 13 Scubadiving paxtners during a fatalaccident, 1970, 1971, and 19 72 , . 17 14 Buddyactivity duringa fatal accident,1971 and 1972 ~ 18 15 Multiplescuba fatalities, 1970,1971, and 1972 . 18 xv 16 Results of , 1970, 1971, and 1972 19 17 Elapsed t'me between start of scuba accident and body recovery, 1970, 1971, and 1972...... ~ . 21

18 Performance of inflatab1e vests, 1970, 1971, and 1972 23

19 Proximate starting causes of scuba fatal accidents, 1972 24

20 Fatal cases identified by SAR and U.R.I. methods, 1970 and 1971 26

21 Nonfatal diving accidents from SAR reports, 1970 and 1971 26

22 Skin diver fatalities by State, 1972 28

23 Location of skin diver fatalities, 1972 28

24 Distribution of skin diver fatalities by weekday, 1972 29

25 Distribution of skin diver fatalities by month 29

26 Age distribution of skin diving victims, 1972 30

27 Partners-buddy relationship of skin diving victims, 1972 30 28 Elapsed time between accident onset and recovery of skin diving vi ct im, 1972 31 ABSTRACT

Information is summarizedon knownunderwater fatal accidents during 1972that involved U.S. citizens whereverthey mayhave been diving andnon- U.S. citizens diving in U.S. waters. Informationfor 1970and 1971 accidents is included for comparison. Therewere 118 scubadiving fatalities and 16 skin diver fatalities dur- ing 1972. Thesedeaths are reportedand tabulated separately because it' s difficult to obtain information on skin diving fatalities that is as complete as on scubadeaths. In addition there weretwo scubadeaths associated with a compressedair depth record attempt, two deaths involving the useof surface-suppliedair, andone fatality causedby anexploding air cylinder in a compressorroom. Thesefatalities are also treatedseparately because of their "specialnature." A smallsubmersible was involved in twodeaths that are not included becausethey havebeen extensively investigated else- where. In comI>arisonthere were 112 scuba diving fatalities in 1970and 114 in 1971,but twofactors must be considered;First, majorrecreational organizationsagain reported a significantincrease in training, fromabout 165,000 persons in 1971to about226,000 in 1972. Theactual numbersmay be somewhatless becauseof individuals'being certified by more thanone organization.! Secondly, there would have been a modestdecrease in the absolute total of deathsbetween 1971 and 1972if it werenot for a suddenincrease in multiple-victim accidents two triple deathsand nine double deaths in 1972as comparedwith four doubledeaths in 1971!. With someminor fluctuations, patterns remainedrelatively consistent fromyear to year,for instancewith the 16-to 30-yearage group suffering the greatest numberof fatalities. Initial reports of fatal accidentsare usually obtainedfrom a newspaper clippingservice. Theyare also obtained from the CoastGuard, local cor- onersand law enforcementofficials, cooperatingdiver organizations,and individuals. Additional informationto documentthe accidentas fully as possibleis obtainedby mail and telephone. Data on commercial underwater fatalities are moredifficult to obtain becauseof limited press coverage andbecause of insuranceinvestigations, possible litigation, andsimilar factors that limit the release of information. Alsoprovided are the findingsof a Navysubmarine medical expert who reviewedautopsies for 31fatalities whichoccurred during 1970. Nonfatal accidentsto whichCoast Guard units respondedare also analyzed. PART 1

HISTORY AND SOURCEANALYSIS

1.1 Introduction

During 1970 and 1971, the ScubaSafety Project collected data on fatal diving accidentsinvolving U.S. citizens plus a fewcases in whicha foreign national died while diving in V.S. waters. This effort has been continued for the 1972calendar year. Althougheach year's efforts have resulted in a report Schenckand McAniff 1971, 1972a, b!, location efforts for prior years have continued for two reasons; First, to be certain that statistical trends andconclusions are basedon the total fatality populationfrom each year; and, second,to ensurethat the location methodsare completeand ex- haustive. This portion of our report will discussthe questionsof data acquisition and completenessand also outline the groundrules for inclusion of a fatal event in the survey. 1.2 The 197I7Serve The 1971 fatal accident survey found 21 fatal skin and scuba acciden!s that had not been reported for 1970. The 1970 total increased from 122 to 143 deaths. During 1972, two more skin diving deaths in 1970 were found during a checkof nonfatal pressureaccidents involving recompressiontreat- ments of Florida divers suffering bends. The 1972 study found no new 1970 scuba cases; 'therefoxe, we believe that the scuba numbers for 1970 are rela- tively complete. As has beennoted before, skin diving accidents are much less "visible" in the press and amongdivers than those involving tanks and compressed air.. This report treats scubaand skin diving statistics separately. We recognizethat skin diving fatalities share manycommon aspects with scuba deaths,including use of belts, suits, inflated vests, andother itemsplus similar dependenceon weather, buddy, and experiencefactors. However,we feel that it i' desirableto keepthe statistics separate,because complete data on skin diving casesare moredifficult to get than for scubacases,

1.3 The 1971

The 1972study located one additional 1971scuba death. Wespent con- sidexable effort in mail queries, phonecalls ta police and divers, and appeals in magazines such as Skin Diver; therefore, this modest addition of one death suggeststhat the 1971methods were relatively comprehensive.Dur- ing the first 2 years, we learned there are areas, such as the Monterey coastal region in central California, where diving activity is important, but wherenewspaper coverage and accident reporting are relatively modest. Spe- cial efforts tc collect information must be madein that region. The 1970 survey was incomplete by 25 fatal cases Schenckand McAniff 1971!; ho~ever, there is no indication that the 1971effort is deficient to a similar degree. We feel that the 1972 census is probably as good as the 1971 census. In addition to the l970 and 1971 fatal cases, we obtained and studied V,S. Coast Guard records for a large number of nonfatal cases that were suf- ficiently serious to require response by Coast Guard units. These rescue cases will be analyzed and discussed in a separate section.

A skilled submarine medica' specialist from the Naval Submarine Medical Research Laboratory in Groton, Conn., reviewed the findings in 31 cases in 1970 for which autopsy documents could be obtained. This effort, which is planned to cover additional later cases, yields information on the credibility of autopsies and interpretations for diving accidents,

The project now has filed c~se reports on almost 1,000 diving deaths, plus accounts of many hundreds of nonfatal accidents. There seems little doubt that this mass of data has a. number of important lessons still to be detected and studied.

1.4 Source Anal sis for 1972 Cases

The methods for locating fatal cases were similar to those successfully used in 1971. They included one dependable clipping service; mailing of queries with return stamped envelopes and accident report forms! to over 1,000 active divers and persons involved with diving; phone queries to high- risk areas; Coast Guard SAR Search and Rescue! reports; and very great assistance from regional specialists in scuba accident work including Tom Ebro of Los Angeles County, Dave Desautels and the Florida Asso- ciation, and Roy Damron of the Governors Committee on in Hawaii. After 3 years of effort, we are receiving unsolicited accident reports from police and coroners in high-risk areas and many letters and phone calls from divers who have become aware of this work. Hundreds of people are involved in a study of the numerous cases, and their interest and cooperation are essential to this sort of effort. "Instant Alert" postal reply cards were first used early in 1973 and are proving very helpful. See figure 1.! Table 1 shows the "primary" source of 1971 and 1972 accident data. We define a "primary" source as one that is planned and regular in character, such as the press-clipping service, SARreports, or reports from regional investigators who study diving accidents. In other words, if data on a fatal accident are received through the clipping service and then letters from local divers or a coroner are received, the clipping service data are regarded as primary.! Excellent cooperation was also received from the U.S. Coast GuardUnder- water Safety Project Office, which alerted the project by phone as soon as it had any word of a diving accident. Twenty-two fatal cases were noted in this manner.

The newsclipping service appears to have been about as effective in 1972 as in 1971. Clippings were located through other sources for 11 fatal cases that the clipping service had missed in 1972 and 8 such cases in 1971. Our only method of judging the number of missed cases is based on com- paring the University of RhodeIsland U.R.I.! effort with other lists, such Figure 1.--Instant Alert postal reply card. Table I.--Primary sourceof 1971and 1972fatality data both skin and scuba diving!

Fatal cases

Source 1971 1972 Skin Scuba Skin Scuba

Newsclipping service: ll 91 8 92 Off~cial sources coroners, police! 2 6 8 Sol;icited and unsolicited letters 1 17 Located while investigating another case 0 1 4 0 2 Not available

16 123 Total 17 116 as the SARCoast Guard records or the Los Angeles County accident census, All SARcases were in the files. The U.R.I. list of casesfrom the Los Angelesarea showed three more cases than the LosAngeles County list. On the basis of suchevidence, and in commonwith the 1971survey, it appears that the numberof missedscuba cases is very small, probably less than 10 andvery likely less than5. In short, it is doubtfulthat additionaldata on 1972will significantly alter the conclusionsand statistics.

1.5 Ground Rules for Inclusion in the Accident Census Thegreat bulk of the victimsin this compilationwere U.S. citizens diving in U,S. waters. Exceptionswill be notedhere as follows: Twelvescuba victims were diving outside the country; the locations are shownin a later table. Thesevictims wereall involvedin .. Oneof the 12was a Jamaicancitizen who died during a recordat- tempt with his partner, a United States citizen. Twocitizens of other countries were included becauseboth died in U,S. waters andboth victims had learned diving in the United States. Onewas under instruction at the time,! A depthrecord attempt in 1971in Jamaicaled to a doublefatality that wasnot inct.udedin the 1971census because both participants wereJamaican. Also,the 1971census included one non-U.S. citizen who was trained in the United States and died in California waters.

1.6 Conclusions Onthe basis of the foregoing data, this report is believed to be a reasonablycomplete census of U.S~ -relatedfatal diving accidents.The very greatimprovement in the redhction of missedcases between 1970 and 1971 suggeststhat the location methodshave improved over the first year of ef- fort andthat the conclusionspresented in this reportwill not bechanged in any important way by future case acquisitions. It shouldbe notedthat promptawareness of an accidentis importantto a thoroughinvestigation. A caseI or 2 yearsold is veryhard to document, especially if the victim wasvisiting out of his ownarea. If a fatal case canbe locatedin a reasonabletime after it occurs,then its studybecomes mainlya matterof. constraints in timeand funding. If investigatorssimply missa groupof deaths,as U.R.I. did in the Montereyarea in l970, the re- sulting statistics andanalysis may be biasedto sucha degreethat theywill affect importantconclusions and cautionary advice to the divingcommunity. The Monterey exampleis apt, becausea study of these deaths over the past 2 years reveals the important statistic tkat most victims lived a con- siderable distance from the ocean. Six 1970Monterey cases were documented as a result of this followup, and a lack of familiarity with local conditions was found to be a contributing cause of death. PART 2

GENERAL SCUBA FATALITY STATISTICS

2.1 In table 2, two deathsduring a 1971attempt to set a scubadiving depth record are not included since both victims werenon-United States citizens diving in the Bahamas.

Table 2.--Summaryof diving fatalities, 1970, 1971, and 1972

Fatalities

Activity 1970 1971 1972 Male Female Male Female Male Female

106 12 Scuba diving 104 107 Scuba diving, record attempt Skin diving 26 17 Diving with surface- 2 0 supplied air Compressedair explosion 1 0

133 139 Total 145 Assuggested later, the1972 data would have shown a modest decrease in the absolutetotal exceptfor a suddenincrease in multiple-victimaccidents. Table3 impliesthat traineddivers increased by 37percent in 1972when comparedwith 1971; however, a number of factors must be considered. Many instructors issue certification for morethan oneagency. A personcomple- ting a singlecourse may receive a "C"card for YMCA,PADI, and NAUI, thus distorting the total figures. Thetotals for at least twoof the instructor agenciesinclude training outsidethe UnitedStates, e.g., in Canadaand Japan, further reducingthe validity of the totals. Finally, the majortraining organizationsestimate the "dropout"rate in recreationaldiving to be as muchas 75percent. Nevertheless,the 1972 totalsprobably indicate a decreasein the rate of fatalitieswhen all is considered. Table 3.--Scuba divers trained, pre-1971, 1971, and 1972

Divers trained Training group Pre-1971 1971 1972 Thousands!

National Association of Underwater Instructors NAUI! 212 54 67

National Association of Skin Diving Schools NASDS! 133 52 55

Professional Association of Diving Instructors PADI! 47 37

Young Mens Christian Association YMCA! 172 12 42

Los Angeles County LAC! 140 10 10

Total 704 165 226

2.2 Geo ra hic variations

The geographic data in table 4 and figure 2 show the variation of fatal accidents within a given State over the 3-year period. In the group of high-activity States California, Florida, Hawaii, New York, and Washington!,only California showsa reasonablystable pattern, and even here the variance is much greater than the national statistics in table 4~ Thepatterns in Washingtonand NewYork changeddramatically year to year; there is no explanation for such fluctuations. Thus, one "bad year" in a State wouldnot appearto be a valid basis for special regulation of scuba sports. Three years is insufficient for drawing any firm statistical conclusions, and the numberof deaths in a given year maybe due primarily to fluctuations encountered with small numbers. Anotherpossibility that the data modestlysuggest is Chat a "bad year" and its attendant publicity induce caution amonglocal divers during the next year, whichbecomes "better." This certainly seemsto havehappened in cave diving in Florida, where1970 had a numberof well-reportedmultiple disas- ters and 1971was muchquieter. 1971 was not only a bad year in NewYork, but a year in whichpress coverageof several spectacular accidents boat rundownsand a doubledeath in the Niagarabypass tunnel! musthave reached manyactive divers in NewYork. If so, the return in 1972to the 1970pat- tern could lead to a hypothesisthat public exposureof scubaaccidents may havesome social utility on a regionalbasis. However,this andother hy- pothesesfrom accident data are hard to drawand prove because in dealing with suchsmall numbers one or two additional accidentscan changesigni fi.- cantly both absolute numbersand percentages. Only the continued accumula- tion and analysis of data over an extendedperiod maylead to valid conclu- sions.

Figure 2 presents the 3-year data for the remaining States; it shows no significant changes or trends. Table4.--Scuba diving fatalities by State andforeign area, 1970, 1971, and 1972

Fatalities

Location 1970 1971 1972

State: 1 2 0 Alabama California 260 0 311 0 2512 Colorado Connecticut Florida 130 Georgia 9 Hawai i !llinois !ndiana Kentucky Louisiana 013 10I Maine 2600242 521041 Maryland Massachusetts Michigan Missouri 4304 30 Nebraska New Hampshire New Jersey New York Ohio 223203510112021 60523221I01 Oklahoma Oregon Pennsylvania Rhode Island 020131 22210 South Carolina Tennessee Texas 11210430 0I14 Utah Virginia Washington 101 1 152 0 Wisconsin West Virginia

Foreign area: 0 1 Australia 0 0 Bermuda 0 1 Canada 5 5 01 18 Caribbean area 3 1 Mexico 2 0 Okinawa. 116 116 118 Total 4P a

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2. 3 Distribution b Weekda and Month

Table 5 shows remarkable stability with regard to the days of the week in which fatalities occur. In each of the 3 years, over 60 percent of the fatalities were on weekends Saturday and Sunday!. At the same time, table 6 showsonly a slight seasonal trend. If the year is divided into quarters, the second and third quarters which include the summer!only record slightl> over 6C percent of the total, Howevex, befoxe drawing conclusions it will be necessary to review seasonality's relation to place of death, day of the week's relation to distance from 's home to place of death, and other similaz possible relations.

Table S.--Distribution of fatal scuba accidents by weekday, 1970, 1971, and 1972

Accidents Day 1970 1971 .1972

Percent!

Monday 2 7 Tuesday 6 7 7 Wednesday 12 8 4 9 Thursday 6 4 Friday 10 9 5 Saturday 25 20 27 Sunday 39 45 39

Table 6.--Distribution of fatal scuba accidents by month, 1970, 1971, and 1972

Accidents Month 1970 1971 1972

Percent! January 6 3 2 3 February 37 3 March 9 7 April 6 8 10 May 11 19 11 June 9 10 ll July 16 18 6 August 9 8 15 14 September 11 October 3 7 November 107 5 10 December 4 5 11 11

2.4 Environmental Factors Table 7 showsthe location of the scubafatal accidents over the 3 years. Table 7.--Location of scuba fatalities, 1970, 1971, and 1972

Fatalities iocation 1970 1971 1972

Ocea~, bay, sea 73 69 73 Minor lake, pond, slough 18 258 19 Cave 11 River Quarry, pit, open mine 41 7 1923 I Great Lakes 90 50 Swimming pool 2 1 Major lake, pond 0 0

Total 116 116 118

Note.'The five "special nature" fatalities are not in- cluded here.

Figure 3 showsthe cumulative depth distributions for the 3 years for scuba accidents. These depths were either the depth to which the victim went before his death or the depth at which the body was found. Accidents do seemto be occurring deeper each year: The mediandepth was 45 feet in 1972, compared with 40 feet in 1971 and 30 feet in 1970.

Weather is always a possible in diving activity. Where eyewit- nesses do not mention weather as a factor or where queries elicit no comment about weather or seas, we assumedthat they were not important. Table 8 showsthe breakdownwhere weather was determined to be contributory.

Table 8.--Fatal scuba cases involving weather and sea conditions, 1972

Condition Scuba cases

Moderate -ft or less! waves 11 Heavy over 2 ft! waves Heavy or dangerous surf 5 4 , , river Ice loss of exit hole! 4 3 120

10

~+ 6 UJ %ac/ 7 X I-

9 10020 5010 405060 70 80 90 PERCENTOCCURRING ABOVE THE GIVEN DEPTH

Figure3.--Cumulative distributioncurve of scuba accident depthfor the y 1970, 1971, and 1972. 13

In the Webster966! studyof 1965and in the 1970U.R.I. report Schenckand McAniff 1971!, seas and weather were involved in aboutone quarterof thescuba fatalities. In 1971this proportion had dropped to aboutone-Fifth of thecases, In 1972the figure again appears to lie betweena quarter and a fifth of thecases. However, it should be under- stoodthat weather was a primaryproblem in only11 of thesecases. See final summarytable on starting causes.! Beachsurf is alsoab!e to causea fatal accidentby catchinga diver whois enteringor leavingthe water and driving him into rocksor the bottom.This is a particularproblem along the California coast, and a deadlyone in theMonterey area. In thosewaters, surf 2 or3 feethigh canbuild into hugerollers in lessthan an hour--often in the afternoon. Diverswho have made a safeentry may find it impossibleto make their way throughthe surf to theshore and thus are trapped offshore in a steadily worseningsituation. Lack of knowledgeof this phenomenonis the reason whymost diving deaths in this area have involved divers visiting the area; localdivers are well aware of this life anddeath situation and appear to take appropriate precautions. In mostother cases, the waveand weather situation is not a primary, buta contributory,cause of thefatal accidents.One would assume that weathermight play a greaterrole in a noviceaccident than in a fatality involvinga skilled scuba diver. This supposition is not, however, clearly provedbythe 1972 data. Out of 29fatal cases involving "first dive"or "earlydive" fivedives or less!scuba victims, 8 involvedweather or sea factors.While a slightlyhigher percentage than for thetotal sample,this is not a statistically significant increase. Threedivers were trapped under ice, twotogether. None of thethree hadused lifelines to assistthem in findingthe hole through which they had entered the water.

s :. 2.S Work-Related Fatalities heinvolvement of college students in divingaccidents has definitely ',increased T table 9!. Fourof thesewere students working oncollege projects ~ or thesi;research, A fifth victimwas a collegestudent engaged in "part- 'g'time" . Twoof thethree commercial divers were operating ' onsurface-supplied air, and the third commercial diver"blew-up" from 280 ft .whenhis new style overfilled with air. Thepolice officer and the ; industrialemployee both died while taking scuba instruction. The victim ~'.engagedsamplesinat oceanographicgreat depth." researchThe underwater wasreportedarcheologist tobe "obtainingwho died was biologicala recog- ' ~'niaedexpert in hisfield with long experience in diving. He allegedly had a ratherstrange accident. Leaping into the water from his boat,he received ",:Ia blow from the impact afwater against his face mask. A bonewasfractured "and caused massive hemorrhaging froma rupturedartery. Y Table9.--Work-related diving fatalities, 1972

Occupation Deaths

College student "Part-time"'commercial diver col lege student! 1 Commercial diver 3 Police officer Industrial employee Oceanographic researcher Underwaterarcheologist

Total 12 15

PART 3

THE SCUBA VICTIM: TRAINING AND MEDICAL ASPECTS

3.1 Age Distribution

Table 10 compares the age distribution of the scuba victims for the 3 years:

Table 10.--Age distribution of scuba diving victims, 1970, 1971, and 1972

Victims Age 1970 1971 1972

Years

10-15 5 ! 3 ! 1 16-20 27 ! 31 ! 22 ! 21-25 23 ! 23 ! 36 ! 26-30 18 ! 18 ! 25 !

31-35 12 8

36-40 8! 9 41-45 12 ! 7 ! 46-50 6 ! 7 ! 5 !

51-55 0 4 4

56-60 60-up

Tot a 1 111 8! 109 ! 118 2!

Note: 1. Numbers in brackets refer to number of female divers in group. 2. The five "special nature" fatalities are not included herc'

The 1972 data suggest a slight increase in the median age of scuba divers involved in fatal accidents, but several more years would probably be required to establish such a trend. All three of these distributions are .. quite similar to the age distribution of scuba divers responding to a random- sample questionnaire from Skin Diver ~Maazine Schenck and Mcaniff 1972b!,

The ages and sex of the five "special nature" cases that are not inclu- , ded in table 10 are as follows: one 35-year-old male and one 42-year-old

'~ IVt 16 femalesuppliedinairthe accident, scuba recordand oneattempt, 24-year-old twomales maleagedin 37the and compressed 56 in the airsurface- explo-

sion. 3.2 ~Exerience, Trainin , andCertification Responsesoffamily, buddy divers, andpolice investigators providethe basisfor determining experience tablell!. Ingeneral, if the victim was undergoing"earlyope» awater" training category. dive, he The is placed "early openeither water" in the classification"first open water"isin- or tendedfordivers who have not exceeded fiveor six dives in lakeor ocean. "Somelongerexperience"ata lowrate.implies "Considerable a diver whoexperience" has been divingand "veryfor 1 experienced" or 2 years,orcate- goriescontain similar divers; "very experienced" is reserved forpersons whosediving reputation is established eitherregionally ornationally. Table11.--Experience of scuba divers lost in fatal accidents,1970, 1971, and 1972

Accidents Experience 1970 1971 1972

Percent First dive ever with scuba 12 14 6 First dive in open water 9 12 6 Early open water dive 15 19 21 29 28 29 Some experience 21 20 32 Considerable experience 14 7 6 Very experienced Sincethenumber ofcases onwhich these data were obtained is similar dive"forthe accidents3 years,isita is real reasonable effect. toUndoubtedly,suspect thatre»tersthe reduction andsellers in"first of scuba gearcertification.areexerting Policemorecareare becoming to ensure morethatknowledgeabletheir customers abouthavethissome in high-form of risktions.areas Skin andDiverare M~aatinefollowing hasuponalso sources mounted ofascuba campaign gear toin discourage their investiga- the rentaland"early"and saledive of categories scuba tountrainedmake upabout persons, 25percent Nevertheless,of the totalthe "first"scuba fat: group. Table12suggests that"amateur" instruction maybedeclining, butth<. wasrecognized«nincrease scubaintrainingdeaths associatedprograms. with Bach"regular,"of the nationally thatis, recognizednationally ce~. tifyingcauseoforganizationsthe small numberswas identifiedinvolved, withhowever,at. leastit isoneimpassible student death.!tostate Be-i' 17

Table 12.--Scuba training activities during a fatal accident 1970, 1971, and 1972

Accidents Activity 1970 1971 1972

Open water instruction, regular 12 Open water instruction, friend Died while instructing another, regular 2 Died while instructing a friend Taking instruction in pool

Total 19 17 there is an increasing problem or if this is merely a fluctuation. It should also be noted that all of these agencies are reporting Targe increases in enrollment. Two of those who died taking instruction were in college scuba classes.

3.3 Divin Partners and Their Activities

The use of the "buddy system" remains as one of the first rules of div- ing, but concerted efforts must be madeto develop accident managementtech- niques, e.g., what to do in an emergency. There does appear to be a significant increase in accidents an group dives in 1972. In a number of these cases witnesses noted that the victim "was not missed for a while" or that he became separated from the group table 13!. Thus, a diver becoming separated from a group remains a problem.

Table 13.--Scuba diving partners during a fatal accident, 1970, 1971, and 1972

Accidents Number with victim 1970 1971 1972

Zero diving alone! 13 12 ll One other buddy! 47 54 41 Two others 11 20 204 Three others 10 10 Several others 19 17 33

Total 100 113 99

Note: The five "special nature" cases are not included here. 18

There is no overlap in the categories in table 14. Whenbuddy breath- ing was attempted, even if the buddy lost his manlater, the case was counted as a "buddy " case.

Table 14.--Buddy activity during fatal scuba accident, 1971 and 1972

Accidents Activity 1971 1972

Buddy stayed with victim 25 27 Buddy lost victim underwater 24 25 Attempted 159 14 Buddy left water ahead of victim Buddy lost victim on surface 12 15

Total 83 86

Note: The five "special nature" cases are not included here.

Multiple fatalities increasedsubstantially in 1972. In 1970there were 10 multiple events, 9 double, and 1 triple for a total of 21 victims, about one-fifth of the scuba total table 15!. In 1971 there were only four double fatalities for a total of eight victims, less than one-tenth of the scuba total. In 1972 there were 10 multiple events, 8 double, and 2 triple for a total of 22 victims, again about one-fifth of the total scuba count, Four of the double fatalities and the two triple deaths occurred in caves, all in the North Florida area. Runningout of air inside the cave was the general cause of these events. Most of these divers were visitors to the caves, and manyhad inadequate equipment for this type of diving.

Table 15.--Multiple scuba fatalities, 1970, 1971, and 1972

Accident cases

Multiple 1970 1971 1972

Double Triple 1

Total victims 21 8 22

Note; The five "special nature" cases are not included here. It is unusualthat four doublefatalities occurredin openwater outside of caves. Onedouble accident occurred in Michiganunder ice when1 ifelines werenot used. Neitherman could find the accesshole, andboth ran out of air. Thesecond pair wereat anopen-water class, but wentdiving before the class assembled.Both were very inexperiencedand had plenty of air when found. Bothdivers in the third casehad "several" beers, andone diver in- correctlymounted his regulatoron his tank. Bothhad defective life vests, andone regulator "breathed hard." This wasa classicexample of howa numberof different problemscombine to producethe final deadlyresult. The final doublecase involved a checkout-divein waterdescribed as very cold and with zero visibility. Anotherfact of someinterest is that four of the doublecases involved a mixeddiving team manand woman forming a buddypair!.

3.4 Therewere 40 autopsieson 1972scuba victims table 16!.

Table 16.--Results of autopsies, 1970, 1971, and 1972

Autopsies Primary complaint 1970 1971 1972

Asphyxiation or 25 26 22

Lung overpressure 9 12 9 Injury to head often plus "drowning"! Heart attack Aspiration of stomach contents Explosive Intestinal disorder

Thethree heart attackvictims were 40, 45, and24 years old. The24- year-oldhad had no warning of his condition,but the coroner seemed quite definite that he hadsevere arteriosclerosis. Therewere no boatrundown fatalities of scubadivers in 1972;the headinjury casesresulted from div- ingin heavysurf. Severalvictims had traces of alcohol,but none of those autopsiedwere "officially" drunk. Thecredibility of autopsieshas always been a troublesomeone in diving, especiallyin areaswhere coroners are unfamiliar with the unique character of pressureinjuries. To explore this questionfurther, the records for 31 autopsiedcases from 1970 were sent to CaptainJohn H. Baker,Officer in Chargeof theNaval Submarine Medical Research Laboratory in Groton, Conn. Dr. Bakerreviewed these cases as follows; Heread all the casedocuments 20

and the autopsy material and then responded to the general question as to whether the official "cause of death" followed from the case description and the post mortem documents. He also attempted to note any medical problem that might have started the accident or drastically contributed to it. From 31 cases examined, he found the following.

3.4.1. Cause of Death. Baker agreed with the official cause of death on 25 of the cases, questioned 3, and disagreed on 3. In one "disagree" opinion, he noted that the autopsy protocol suggested an , but that the prosector failed to recognize the signs. In one "questioned" case, he felt that the victim had embolized during retrieval, not. during the acci- dent. In another "questioned" case, he felt that the prosector had again missed an air embolism. There were four detected air embolisms in the group of cases to which Baker added two and took away one. Clearly this sample is too small to warrant large conclusions, but. it does suggest that a substan- tial fraction of overpressure cases may be missed by autopsy, and, of course, many are probably never autopsied at all. It should be noted here that of the nine 1970 overpressure cases noted in table 16, actual documents could be obtained for only four.!

Baker considered one of the "questioned" cases might have been an embol- ism, but noted that there was no recorded medical evidence for this possi- bility.

He also noted that one of the diagnosed embolism cases had the possi- bility of "an air trapping anatomical variant" in the man's lungs. This situation can arise when air gradually into the lung past an obstruc- tion during bottom time, but then is unable to escape when the man rises to the surface, thereby blowing through the lung wall into the bloodstream. This condition was detected in 2 submarine trainees out of some 130,000 who underwent the escape drill in the New London escape training tower. Since this type of overpressuze accident cannot be prevented by exhaling during the rise, it is important that coroners understand this possibility and how to find it. In addition, ways of detecting the condition by external examina- tion may be necessary.

3.4.2. Medical Causes of the Accident. Of the 31 cases, Baker detected 4 in which a medical condition contributed to the accident, not including those in which an embolism was involved. Two of these cases involved heart disease, one involved a victim with a history of pneumonia, and the fourth case involved a boat rundown in which the head injury caused the death. In other words, 3 of these 31 victims were diving with serious physical disa- bilities that led ta their deaths.

In a final case, involving an epileptic who suffered a seizure under- water, Baker felt that the emergencytriggered the seizure rather than vice versa, although he noted. that diving is contraindicated for epileptics. Certainly these small numbersmake any statistical conclusions of doubt- ful worth. As time permits, all autopsy documents over 120! in our files will be submitted to scrutiny and firmer conclusions may then becomepossi- ble. 21

3.5 Search and Rescue In 61 of the scubacases, rescuerswere awarethat the victim wasin trouble within 15 minutesof the onset of the accident table 17!. However, recovery often took a great deal of time. Therewere 34 casesin which someform of resuscitation wasattempted. In the 3 years,resuscitation was tried in virtually everycase in whichsome hopeexisted. Of course,it wasusually impossible to establishhow effec- tively this was carried out. Table17.--Elapsed time betweenstart of scubaaccident and body recovery, 1970, 1971, and 1972

Recoveries Time range 1970 1971 1972

Immediate, victim alive, died later 4- Immediate, victim dead 15 17 20

5 minutes or less Over 5 to 10 minutes Over 10 to 15 minutes Over 15 to 60 minutes 14 14 Over 1 hour to 4 hours 10 13 Over 4 hours to 12 hours Over 12 hours to 1 day 18 Over 1 day to 2 days 10 More than 2 days Victim never found

:oastGuard assistance was involved in 34 casesin 1972,usually in a searchor medivaccapacity, In twoadditional cases, a Navyand an Air helicopter were involved. 22

PART 4

EQUIPMENTASPECTS

4.1 Re ulators and Air Su lies

The 1972 year was the third year with no verified case of regulator failure. Furthermore, in about one thousand fatal scuba cases dufing 1946- 72, «very case of "regulator failure" has been due to improper disassembly or clogging by weeds or bottom material.

In one fatal 1972 case the reserve assembly had been improperly assem- bled so that the reserve air was available when the valve was up and off when the valve was down. The diver pulled his valve down when breathing became difficult and shut off the air completely, thereby precipitating an emergency that resulted in his death. This error resulted in a memorandum from the Navy warning against this type of assembly error this diver was treated in a Naval facility!.

In a second fatal case, the reserve lever had become clamped under the straps holding the tank to the back-pack. The resulting lack of reserve air precipitated the fatal acc ident.

The account of a third case involving regulator action is sketchy. The diver reportedly ran into the bottom with such vigor that his regulator was jammed by bottom material.

Two regulators were reported as "hard breathing" by investigators, but, of course, this condition should be readily ascertained in advance or during the initial phases of the dive, All in all, there were 28 cases in which a witness noted that the regulator had been checked and found in good working order. However, it should be noted that this type of check is usually not made or noted unless the character of the accident suggests a failure of the air supply with air still in the tank.

There were 22 cases of "no air" in 1972 compared with 16 in 1970 and 19 in 1971, which reflects the several multiple cave accidents in which suffi- cient air was critical'

4.2 Entan lements Ditchin

In 1972 there were 8 fatalities in which tanks were ditched and 18 in which the belt was ditched. These 26 ditching cases compare with 26 in 1970 and 10 in 1971. In about half the cases, the buddy diver accomp- lished the ditching. Only two victims were entangled in kelp in 1972 com- pared with eight in 1970 and eight in 1971; in one 1971 case, it appears that the tangling occurred after the accident. There were three 1972 cases of entanglementsin external lines, the samenumber as in 1971. In two of these cases, safety or descendinglines were involved; in the third case, a fish line. 23

4.3 Inflated Vests

In two of the 1972 cases in which the vest inflated, witnesses specifi- cally noted that the vest failed to support an unconsciousdiver table 18!. In one of these cases, the victim floated with his face underwater.

Table 18.--Performance of inflatable vests, 1970, 1971, and 1972

Cases Sit uat ion 1970 1971 1972

Vest worn, not used, not checked 16 14 Vest worn, inflated during accident Vest worn, not used, checked OK later

Vest worn, mal function during accident

Vest worn, no cartridge 0

Total 38 34 40

4.4 There were two air station explosions in 1972; one killed a scuba in- structor, and another severely injured the operator of a diving shop. In the fatal case, a compressorstation in a roomadjacent to a swimmingpool utilized old oxygencylinders 20 cubic feet! for an air bank. The com- pressorwas reportedly set to vent at 2,200psi; however,on the dayof the explosionits popvalve hadeither failed or hadbeen reset, becausethe gageswere locked at 2,900psi after the explosion. Theoxygen tank contain ing compressedair that explodedat this Midwestlocation wasfound to have lost half its wall thickness at somepoints. Its last DOTstamp was 1961, and its history wasunavailable. This accident focusesattention on probler. that presentair stations mayhave since 3,000psi cylinders wereintroduced for diving. Also, the dangerouspossibility of pumpingpresent scubacylin- ders to this high will then exist. In any case, the accident stresses the need for frequent internal visual inspection of all tanks used in scuba work, not just those carried on the diver's back. The second accident, also in a Midwest dive shop, involved an air filte explosionthat seriously injured the owner. Hereagain, a pressurevessel associated with scuba activity failed, possibly as a result of oil residue ignited by the high-pressureoxygen. Oil filtered from breathing air must collect someplaceand can constitute an explosive menaceunder the high oxy- genpartial pressure associatedwith scubawork. 24

PART S

FATAL AND NONFATAL SCUBA CASE SUMMARIES

5.! Fatal Scuba Case Summaries

As has already been noted in the section on weather involvement, many accidents result from a chain of events, none of them inherently deadly alone, but all together leading to a tragic outcome. There are a number of cases each year in which it is simply impossible to assign any cause whatever to the accident. These often involve a never-found victim or a victim diving alone and found floating hours or days later. Table 19 attempts to summarize what is defined as the "proximate starting cause" of those accidents for which sufficient data allow an opinion. As the reader will note, manyof these "starting causes" should not lead to death; other problems and failures were needed to complete the event.

Table 19.--Proximate starting causes of scuba fatal accidents, 1972

Estimated cause Cases

Possib'le embolism, , or exhaustion 26 Diagnosed air embolism Diagnosed air embolism with alcohol involvement 61 2 Diagnosed air embolism during free ascent exercise Out of air in cave 1S Out of air on deep dive 2 Diving in rough or dangerous water 11 Deep dive, apparent narcosis and confusion Diagnosed heart attack Head injury Trapped under ice Tangled in external line Tangled in kelp Aspiration of stomach contents Overweighted Possible drinking involvement 4321 3121 Reserve valve jammed or inoperative Reserve rod jammed unit malfunction Air storage tank explosion Blowup in inflated dry suit Drowned assisting panicked buddy ~ 1 Jumpedin water with tank valve off . Life vest failure during swim to dive area Lost in cave, air remaining . Piece of steel pinched hose 1 1 Vascular spasm in cold water Victim had fasted 2 days before dive It is evident that the category, "possible embolism, panic, etc.," is,a catchall in this table. Virtually all of these 26 cases involved a diver at the end of his dive on the surface, unable to reach a boat or shore, and eventually sinking or becoming unconscious. Without competent medical inves- tigation, it is impossible to separate simple exhaustion from an overpressure event, because each simulates the other. Furthermore, even the buddy diver is usuall.y unable to judge how hard the victim had been exerting prior to the final problem. This classic accident pattern of failure on the surface fol- lowing a dive runs through all scuba safety work and strikes experienced divers as well as novices.

S.2 Nonfatal Accident Surve Based on Coast Guard Data

No doubt much can be learned about scuba safety by studying nonfatal accident reports. Equipment, training, and medical difficulties can be explored with the living victim rather than inferred from the accounts of witnesses. On the other hand, it is impossible to draw statistical conclu- sions from a random collection of this type of data. Some accidents, especi- ally those in which a diver is stupid or careless, tend to be forgotten or suppressed.

One source of data on diving accidents, fatal and nonfatal, are Coast Guard Search and Rescue SAR! reports. These documents are filled out for every Coast Guard rescue mission and eventually the information is put on computer retrieval tapes in Washington. Until 1970, these records had very little use for scuba accident studies, because scuba accidents were listed under the heading "swimmer in water." Officers of the Coast Guard Underwater Safety Project who attended the U. R. I. Ocean Engineering Program made efforts to provide a means of differentiating scuba diving accidents from the other types of acCidents in this category. As a result of their efforts, a set of special code numbers on the SAR forms were assigned in 1970 to scuba accident.; these numbers cover such classification as "stranded," "bends," and "overdue-missing." These numbers in turn allowed the Underwater Safety Project to search periodically through the SAR records for diving accidents. Indeed, the 1970 SAR data enabled us to locate the several missing scuba diver deaths in the Monterey area.

The advantage of examining the nonfatal picture through SAR documents is that a level of importance is immediately established; the accident was bad enough, or seemed bad enough, to require Coast Guard assistance. However, the SAR computer retrieval is not complete, and it is necessary to examine its credibility.

Fortunately, the U.R.I. fatality census is an independent source of data on Coast Guard involvement in scuba cases. Almost every case investigated permits easy determination of Coast Guard involvement, either through news- clips, police reports, or eyewitness descriptions. Therefore, all 1970 and !971 SAR scuba cases were cross-checked against the U.R.I. case files and then checked through the files for cases in which Coast Guard involvement was not indicated by the SAR computer search. Because the Coast Guard operates on a fiscal year rather than a calendar year basis and all SAR reports on 1972 will not be filed until summer 1973, the analysis for 1972 cannot be 26 completeduntil fall 1973.Table 20 shows the results of the1970 and 1971 fatality checks: Table 20.--Fatal casesidentified by SARand U.R.I. methods, 1970 and 1971

Cases Condition 1970 1971

Fatal cases involving C.G., U.R.I. 32 34 Fatal cases involving C,G., SAR 24 17 Cases not in SAR computer file 8 14 Additional cases identified by C.G. 0 3 The"additional cases" in the table includetwo Coast Guard documents: the"Situation Report" and the "Daily Operations Highlights." These two items abstractitems of interestfrom Coast Guard message traffic andactivity. The1970 SAR's found two-thirds of the fatal casesin whichthe U.R.I. files show,Coast Guard involvement, but by 1971less than half the caseswere retrieved.Also, the SAR system missed at leastthree cases that were in the otherCoast Guard files. Thesefindings were counter to theexpectation that lesscases would be missed the year after field unitsbegan using new diver codes. Table21 shows the reverse of table20; that is, thenonfatal SAR search seemsto havelocated about five timesmore nonfatal cases in 1971than in 1970.Also, the U.R.I. newsclip survey turned up several Coast Guard rescues notin theSAR group in -1970,but only three in 1971,Until datafrom a year or twomore are assembled, it does not appear possible to determinethe rea- son for this. Table 21.--Nonfatal diving acci.dentsfrom SAR reports, 1910 and 1971

Accidents Condition 1970 1971

Pressure-related accident 19 Diver located by Coast Guard 8 Diver located by others ll False alarm diver left in water or not in water! 1 5 Other diving accidents 1 15 57 Total nonfatal SAR cases 12 Nonfatal Coast Guard cases not in SAR reports 26 completeduntilfall 1973.Table 20 shows the results of the1970 and 1971 fatality checks: Table20.--Fatal casesidentified by SARand U.R.I. methods, 1970 and 1971

Cases Condition 1970 1971

Fatal cases involving C.G., U.R.I. 32 34 Fatal cases involving C.G., SAR 24 17 Cases not in SARcomputer file 8 14 Additional cases identified by C.G. 0 3 The"additional cases" in thetable include two Coast Guard documents; the"Situation Report" and the "Daily Operations Highlights." These two items abstractitems of interestfrom Coast Guard message traffic andactivity. The1970 SAR's found two-thirds of thefatal cases in whichthe U,R.I. files showCoast Guard involvement, but by 1971 less than half thecases were retrieved,Also, the SAR system missed at least three cases that were in the otherCoast Guard files. Thesefindings were counter to the expectation that lesscases would be missed the year after field units began using new diver codes. 'Iable21 shows the reveIse of table20; that is, thenonfatal SAR sqarch seemsto have located about five times more nonfatal cases in 1971than in 1970.Also, the U.R.I. newsclip survey turned up several Coast Guard rescues notin theSAR group in -1970, but only three in 1971.Until data from a year or twomore are assembled, it does not appear possible to determinetherea- son for this. Table21.--Nonfatal diving accidentsfrom SAR reports, 1970 and 1971

Accidents Condition 1970 1971

Pressure-related accident 19 Diver located by Coast Guard 8 Diver located by others 11 False alarm I'diver left in water or not in water! 1 5 Other diving accidents 1 15 Total nonfatal SAR cases 12 57 Nonfatal Coast Guard cases not in SAR reports 27

The apparentincrease in pressure accidentsbetween the 2 years in 1970 and 19 in 1971! appears to be partly reflected in commentsby persons involved in recompressionchamber work, Casesof bends, though sometimes crippling, are less often fatal, especially whenthey involve a sport diver. Thus an increase in cases of bends could actually occur at the same time that fatal accidents were stable or declining, Bends also may involve an entirel.y different sort of' personthan fatal events, e.g., an experienced, stable,. deep-diving "professional" who takes chanceswith decompression,to get a iob done. As time permits, a survey of treatment facilities might verify or refute',I the trends suggested by the SARdata, 28

PART 6

GENERAL SUMMARYOF SKIN DIVING FATALITIES

6.1 Skin Divin Fatalit Total As mentionedpreviously, this study probably doesnot cover all skin diver fatalities for a number of reasons. Somesuch cases are probably missedbecause of loss of equipment mask,, fins! during or immedi- ately following the accident. Othercases are probablymissed because they havebeen noted as "swimmer", With this in mind, little in the wayof conclusionscan be drawnfrom so smalla numberof cases. Neverthe- less, we present the data for the 16 cases in 1972.

6.2 Geo ra hic Variations Table 22 showsthat half the skin diver fatalities were in California waters eight cases!and that aboutone-fifth of the caseswere in Hawaii.

Table 22.--Skin diver fatalities by State, 1972

State Fatalities

Cal i fornia Hawaii North Carolina Michigan New York Florida

Total 16

6. 3 Environmental Data Table 23 showsmore fatalities in ocean water than in freshwater.

Table 23.--Location of skin diver fatalities, 1972

Area Fatalities

Ocean, bay, sea 14 Minor lake, pond, slough 2

The next two tables, 24 and 25, follow closely the pattern that seems to emergeas far as weekendand summer popularity is concerned,We do not havea tableshowing the weatheror seacondition involvement in fatal skin divingaccidents, butrather note that such conditions definitely contributed to 6 of the reported 16 cases,

Table 24.--Distribution of skin diver fatalities by weekday, 1972

Day Fatal ities

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Table 2S.--Distribution of skin diver fatalities by month, 1972

Month Fatalities

January February

March April May

July August September October

November

December

Somecase notations of interest wereas follows: "Attemptingto reach shore through heavy surf, victim disappeared." 30

"Caught in undertow and swept seaward,"

"Very rough, strong current, victim 'crampedup' and went under."

6.4 A e Distribution and Other Data

Table 26 showsthe age distribution of skin diving fatalities in 1972 and requires no further comment.

Table 26.--Age distribution of skin diving victims, 1972

Age Victims

Years

10-15 16-20 1 2 21-25 26-30 31-35 36-40 501 21 41-45 46-50 51-55 56-60 0 2

The experience of the 16 skin divers who died in 1972 was difficult to ascertain, but was determined in 6 cases. Three of these victims were con- sidered "good to expert," and the remaining three included one "novice" and two "weak swimmers."

Some insight can be gained from the data obtained on these 16 cases whenone looks at table 27, which showsthe relationship of partners in the water versus those cases in which the buddy system was used. Of the 16 fa- talities, 5 were diving alone, Eleven victims were in the water with other persons, but in only four cases could a buddy relationship be established. Thereseems to be a tendencyto abandonthe buddysystem when snorkel diving.

Table 27.--Partners-buddy relationship of skin diving victims, 1972

Number in Buddy system Victims water used Diving alone One other Two others Three others Several others Little can be concluded from table 28, which lists elapsed time to recoveryof the victim exceptto notethat in abouthalf the caseselapsed time wasmore than that in which successful resuscitation might reasonably have been expected. Of the 16 fatal skin diving casesinvestigated in 1972,Coast Guard involvementwas noted' in 7 casesonly. The CoastGuard advised this office of two of the sevencases. Just as in the scubafatality cases,data on the five remainingskin diver casesshould be forthcomingwhen the CoastGuard computersummary becomes available later in 1973. Orrefinal observationcan be maderegarding these 16 skin diver deaths: Only1 of thevictims was established as usingan inflatable vest that proved later to be unused,but workable. Twoothers had inner tube floats at hand, but still succumbed.

Table 28.--Elapsed time between accident onset and recovery of skin diving vic- tim, 1972

Time Victims

5 minutes or less 10 to IS minutes 21 51 15 minutes to 1 hour 1 to 4 hours Over 12 hours to one day ~ ~ % 2 Not recovered 2 3 Unknown .

Figure4 depictsthe newly approved American National Standards Insti- tute 2-86.2Underwater Accident Report Form, officially designated"ANSI Z-86.'!,1973," All readersare urged to cooperatein advisingof anyunder- water accident. 32

UNDERWATER Forw srd report to; NATIONALUNDERWATER ACCIDENT DATA CENTER ACCIDENT REPORT P.O. Box68 Kingston, R. I. 02881

CODE FOR NON FATAL INCIDENT A, Incapacitatinginjury rendering person C. Possible inJury indicated bycompte ning CtrC!~ one On,y A. B, C, Cr D! which best unableto perfOrmnormal activities as of pain, blackout,lbnping, nausea, etc, desCribesSeriousness of incident. Important'. wa!kingor divingOr to leavesecor with- D. Incidentwith noapparent injury, near Report all "incidents", howeverminor. De. out assistance. m se,etc.! scribe ln detid! on page 4, Include equip- B. Nonincapacltating evidentinJury es loss ment factors, of blood,abraslons, lump on heed,etc.

Description of all dives within previous Ig hOurs At time of tncideot, At t me of incident, includingaccident dive, Activttlesengaged ln: Buddy record rests Yimssees lwlaesi slanai Recreational Dlvlng alone Cotamerc a! Diving with buddy Under instruction Buddydistance Ia Instructing Dlvtng with more 0 Cave diving than one Spear f!stdng Distanceto next O 4 nearest diver Photography Type of Dtv ng.' Rxp a n if Necessary! Scuba.... Skin ...... Other ..... Unknown.. Vessris involved Yslw He! Others in accident U.S. Coast Guard atd Soiight Ywer as! Yesw Hs! Separatereport gled, Give Dotal!s ln "Decor pt onol Accident", Yww S!~ ! Netnr, Captain, Address, Phone,etc.! Name

Retiorfed by: Oi!her Coo acts. Name,...... Nstoe Address Address City City Phone

Figure 4.--Underwater accident report form. 33

Illustrate all vtalb!s Injuries cuts, abraslona,fractures, etc.! s! d Pre~ ix

Swtmm ngExper tenne: Years Coursesend Affexoy Sklndtv!ng Experience: Years Certification Date -DO Scuba Experience; Years ! !

Houis Of sleep in past 2t heura Time of last meal Whnt nnd how mu<'ht Time of last alcoholic drink What snd how much'. Any known physical at ments,disability or impairment?

Figure 4.-- cofttinued! EQUlP!dENT DATA

NWE: Equip»is»t Breed, Type o»d ger o Ru«sber date «es» be »eluded o«ly t/ »so /u«ot o» or failure sees eo»tr be ory o the i»oide«t.

P otat onDevlee; Used Tank: Air Lu t....., . NFG.. Date vn er us! rslu! Last Hydro.Test Date Testedatter event? Y«er us! Last Visual Inspection Date . tuterual CondNon: Clean RegulatorTested? vsmer Hs slight Corros on Results Euteustve Corrosion

By: »As t Aooaass r»OIIK Specie Comments on Equ pment

Equipment Inspectedby: Aooasss ~ uo»t

Equipment:Released toior Held by: . »Ant Aosusss ~ »ONS

Figure 4. -- Il'Continued! DETAILED DESeftIPTTON Ofr AOOT DRAT Dewribs in detailhow the accident happened, Including what the person wae doing, any speCIfic marine life or ob!sets andthe action or movement which led to theevent. lncludr details of Itrst aid or resuscitation efforts, Describe any "Dwmmpreesfon"and/or "ltecompreeslon-Trrwtment"ln description of accident.

Figure 4. -- Continued!

37

PART 7

7.1 Cited References

Schenck, H. V., Jr., and McAniff, J, J., "Skin and Scuba-Diving Fatalities Involving U.S. Citizens, 1970," U.R.I. Scuba Safet Re ort No. 2, 37 pp., July 1971 '

Schenck, H. V., Jr., and McAniff, J. J., "Skin and Scuba Diving Fatalities Involving U.S. Citizens, 1971," U.R.I. Scuba Safet Re ort No. 6, 39 pp., January 1972a.

Schenck, H. V., Jr., and McAniff, J. J., "Mortality Rates for Skin and Scuba Divers," U.R.I. Scuba Safet Re ort No. 7, 11 pp., April 1972b.

Webster, D., "Skin and Scuba Diving Fatalities in the United States," Public Health Re orts 81, No. 8; 703-711, August 1966.

7 ' 2 Noncited, But Useful References

Bayliss, G. J. A., "Diving Fatalities in Australia-Illustrative Cases," Medical Journal of Australia, 1262-1264, December 31, 1966.

Cooperman,'E. M., et al., "Mechanisms of Death in Shallow-Water Scuba Diving," Canadian Medical Association Journal, 99, 1128-1131, December 14, 1968.

Denny, '4., and Read, R., "Scuba Diving Deaths in Michigan," Journal of the American Medical Association, 192, April 19, 196S.

Desautels, D., "A Ten Year Survey of Skin and Scuba Diving Fatalities in the State of Florida," Published by the author, 1970.

Kindwall, E., Schenck, H. V,, Jr,, and McAniff J. J., "Non-Fatal, Pressure- Related Scuba Accidents, Identification and Emergency Treatment," U. R.I. Scuba Safet Re ort No. 3, 1971.

Lansche, J., "Deaths During Skin and Scuba Diving in California in 1970," California Medicine, 116: 18-22, June 1972.

Leggiere, T., et al., "Sound Localization and Homing of Scuba Divers," Marine Technolo Journal 4, No. 2, 1970.

Noguchi, T. T., and Moore, S, M., "Scuba Diving Fatalities," Medical Arts and Sciences, Third arter, 81-87, 1962.

Peyser, R., et al., "Corrosion of Steel Scuba Tanks," U.R.I. Scuba Safet ~Reopt No. 1, 1970.

Schenck, H, V., Jr., and McAniff, J. J., "Diving Accident Survey, 1946-1970, Including 503 Known Fatalities," U.R.I. Scuba Safet Re ort No. 5, 1971. 38

Singer, R., "A Studyof SouthernCalifornia's Scubaand Free Diving Fatali- ties," County of Los Angeles CA!, Parks and Recreation Department, August 12, 1971, Tenney,J. B., "2400Hours of , A Statistical Analysisof Tektite II," U.R.I. Scuba Safet Re ort No. 4, 1971. Wailer, S. D., "Autopsy Features in ScubaDiving Fatalities," Medical Journal of Australia, Vol. 1, 57th Year, No. 22, 1106-1108, May 30, 1970. Weeth,J. B., "Managementof UnderwaterAccidents," Journal of the American Medical Association, 192, No. 3, April 19, 1965.