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approximately 26 percent of dive fatalities, or other triggering
events like running out of gas (41 percent), entrapment (20
percent) or trouble with equipment (15 percent), the majority
of dive fatalities stem from human factors.1 This is a recurring
theme throughout the published literature on accidents and
mishaps in other fields such as medicine and aviation, and it
points to the importance of procedures, consistent practices
and a disciplined focus on accident avoidance.
Running out of gas, entrapment and equipment problems
— three human-related triggers — account for about 75
percent of dive fatalities. The common pathway toward
in-water debilitation in most of these cases was asphyxia or
rapid ascent associated with pulmonary barotrauma (lung-
overexpansion injury) and subsequent arterial gas embolism
(AGE). In the unforgiving marine environment, debilitation
or unconsciousness usually results in drowning.
It is important to stress the significance of AGE in the
fatality statistics and differentiate it from DCS. AGE is far
more likely to lead to drowning, as symptoms often occur
while the diver is still in the water, the onset is sudden, and
they often result in loss of consciousness.
DCS in Perspective
Divers spend a great deal of time and money on DCS
prevention; all such efforts are laudable and contribute to
the low incidence rates that we see in recreational diving
(aggregated DCS incidence from all sources is 2 to 4 cases
per 10,000 dives). 2 In addition, DCS is rarely fatal and, at
least among recreational divers, an uncommon cause of
long-term disability.
Although severe symptoms, long-term disability and
death are rarely associated with DCS, this is by no means
an endorsement of unsafe decompression practices or
encouragement to slacken preventive efforts. In fact,
conservative training standards, adherence to established
protocols and diligent monitoring of nitrogen exposure are
essential contributors to the relatively low likelihood and
consequences of DCS.
The point is that divers must not ignore other aspects of
their diving activities, no matter how mundane they seem.
We must, for example, ensure adequate air supplies and
properly configured equipment. On a statistical basis, errors
and omissions in these areas have much greater lethal
potential than DCS.
Shifting the Focus
Decompression-related problems represent only a fraction
of the injuries and medical problems that traveling
divers experience. Dive trips often involve other forms of
recreational activities and thus, additional sources of injury.
Of the calls DAN receives from symptomatic individuals
who receive evacuation or medical-care-coordination,
about 70 percent have injuries that are not related to diving.
This is a powerful statistic that points to other causative
factors. Trauma tops the list as the single most common
injury type about which DAN receives calls for assistance.
From broken legs to car accidents, our evacuation services
spend the most time on injuries acquired out of the water.
Whether cycling, driving, walking or riding a scooter,
the risk of injury while out of the water warrants enhanced
attention. If you’re a diver who wears multiple computers to
ensure adequate DCS prevention, don’t put all your safety
eggs in that basket and forget to watch your footing on boat
ladders. Increase your caution while traveling in areas that
have different traffic patterns than those with which you
are familiar. A focus on injury prevention is of maximal
importance in remote locations; the quality of medical services
is not equivalent around the world, and transportation and
evacuation to higher levels of medical care may take more time
and involve more complications than you anticipate.
Accidents are by definition unplanned. Our best defense
against them is education, which enhances our knowledge
of possible hazards and guides behaviors that reduce their
likelihood. First aid and rescue diver courses are prime
examples of programs that don’t just teach people what
to do when accidents happen, they promote heightened
awareness and a mindset of prevention.
Live safely, dive safely, and may all your dives and travels
be accident- and injury-free. AD
References
1. Denoble PJ, Caruso JL, Dear GL, Pieper CF, Vann RD. Common causes
of open-circuit recreational diving fatalities. UHM 2008, Vol. 35, No. 6.
2. Vann RD, Freiberger JJ, Caruso JL, Denoble PJ, Pollock NW, Uguccioni
DM, Dovenbarger JA, Nord DA. Annual Diving Report. Divers Alert Network:
Durham, NC, 2006; 99pp.
RUURD DANKLOFF/ISTOCKPHOTO.COM
Of the cases DAN manages every year, 70 percent are unrelated to diving.
The attention divers give to minimizing their risk of decompression
sickness should also be given to safety in other aspects of travel and
leisure activities.