RESEARCH, EDUCATION & MEDICINE
/ /
I N C I D E N T I N S I G H T
64
|
SPRING 2014
B y D a v i d F . C o l v a r d , M . D .
Panic and Post-
Traumatic Stress
A dive accident’s psychological aftermath
The diver
The diver was a 48-year-old male with four years of div-
ing experience and 10 dives in the previous month. His
medical history included hypertension and gastroesopha-
geal reflux disease (GERD) that were controlled by medi-
cations. He used a prescription sleeping pill as needed.
The Incident
The diver was on a trip to a popular Hawaiian island.
About 10 minutes into his first dive he had a regulator
failure in which his mouthpiece came apart from
his second stage. He thought the second stage was
still in his mouth — though only the mouthpiece
remained — so when he realized he couldn’t breathe
he assumed the first stage had malfunctioned. He had
just finished exhaling and was ready to take another
breath. He began to panic because he did not think
anyone was close enough to share air with him, and he
found himself fighting the temptation to inhale water.
He was without air for about 25 seconds before he
remembered he had a spare air cylinder. He took two
or three breaths from it before he was able to reach his
buddy’s spare second stage.
The diver had just had his regulator serviced, and this
was his first dive with it since then. He was fortunate to
have purchased the spare air a year earlier; things could
have been much worse. He was an emergency-room
physician and knew the consequences of being unprepared.
The Complications
The diver was “shell-shocked after the event and since
the event” as he dealt with the aftereffects. He had
trouble sleeping due to nightmares and had flashbacks
of running out of air.
Discussion
The diver experienced a fairly minor equipment failure
in the unexpected separation of his mouthpiece from his
second stage. The regulator had a proprietary mouthpiece
clamp with a cam latch, and upon reflection he
supposed the clamp was not replaced after the service. A
manufacturer’s representative told me, “It is time-proven,
and we have no known issues with it.” A dive shop service
technician told me that his shop usually just uses a zip
tie to secure the mouthpieces to the second stages as the
last step in servicing a regulator. It is possible that either
the clamp was not properly buckled or the technician
neglected to engage the cam latch at all.
If the mouthpiece was not securely fastened to the
second stage of the regulator, then a forceful or quick
head movement may have pulled the regulator hose
hard enough to dislodge the mouthpiece from the
second stage. If the mouthpiece was loosely attached
to the regulator it’s also possible it was breathing wet.
This might have prompted a forceful exhalation to clear
it that dislodged the mouthpiece completely. It seems
unlikely that a normal exhalation would have caused the
separation since he had already been diving with it for
about 10 minutes without a problem.
When divers pick up their equipment after it’s been
serviced, they should inspect it and review the service with
the technician who did the work. If this diver had inspected
his regulator he might have noticed that the mouthpiece
was not properly fastened to the second stage.
The first adverse event the diver experienced was an
apparent equipment failure. His first- and second-stage
regulators were presumably still functioning. He did not
attempt to breathe directly from the second stage without
a mouthpiece, nor did he attempt to breathe from his
alternate second stage, assuming he had one.
In a study of more than 12,000 recreational divers in
2000, about 40 percent of male divers and 33 percent of
female divers reported having a problem with a regulator
leak or free flow sometime during their dive career.
1
However, only 5 percent of male divers and 3 percent of
female divers related their first experience of underwater
panic to it. Separation of the mouthpiece from the second
stage was not specifically surveyed.
