Page 57 - AlertDiver_Winter2013

www.alertdiver.com | 55
equipment problems or environmental factors. The most
common diving mishaps are out-of-air scenarios, rapid
ascents, equipment problems and entrapment. Reducing
mishaps, especially human errors and equipment problems,
seems to be the key to decreasing injuries and fatalities.
Checklists
One way to reduce mishaps is to remember important
safety procedures and follow them. Avoiding, omitting,
neglecting or failing to understand the importance of
such procedures leads to human errors. These errors can
compound with increasing stress, difficult-to-operate or
malfunctioning equipment and environmental challenges.
A checklist is a handy tool for reducing errors, improving
performance and meeting safety standards.
Outside of Diving
Checklists have proven effective in high-risk disciplines
including aviation and surgery. In aviation, their use is
well enforced. Pilots and crews of military and commercial
aircraft all have checklists for various procedures they must
adhere to; completion and submission is required.
The World Health Organization (WHO) has promoted
surgical checklists during the past four years. They have been
found to reduce deaths and complications by streamlining
communication among surgical teams and hospital staff.
The benefits of using checklists have also been
demonstrated in recreational settings. A program called
“Bikes, Blades and Boards,” conducted at Hamilton
Health Sciences in Hamilton, Ontario, judged children’s
performance wearing helmets using a helmet checklist and
addressed mishaps related to fit, adjustment and condition
of helmets. Children who participated in the program and
used the checklist scored better in helmet use than children
who did not. The experimental group retained the helmet-
using skills even a year after the intervention.
In Diving
Standard predive procedures include a review of equipment, the
dive plan and responses to unplanned events. We hypothesize
that the use of a predive checklist reinforces these steps and
reduces mishaps related to human error and equipment
problems. Such reinforcement may be especially important in
recreational diving because of the significant intervals between
dives (months or even years) for many recreational divers.
Checklists have a long history in diving. U.S. Navy
divers employ a thorough predive checklist before dives,
and compliance is strictly regulated. The Professional
Association of Diving Instructors (PADI) uses the acronym
“BWRAF” when teaching predive checks to recreational
divers. The acronym stands for BCD, W eights, Releases,
Air and Final OK. Many mnemonics are used, including
the well-known “Begin W ith Review And Friend” and
a colorful variety of others. The National Association of
Underwater Instructors (NAUI) diving manual features
various checklists including one that uses the acronym
“SEA BAG.” The safety topics referenced by this acronym
are Site survey, Emergency, Activity, Buoyancy, Air, and
Gear and go. The intent of this “on-site” checklist is similar
to that of a predive checklist, but it provides a general
review of safety considerations rather than a step-by-
step list of tasks to complete. The American Academy of
Underwater Sciences (AAUS) also advises divers to conduct
a predive check and provides a format in its manual.
Divers are trained to conduct predive safety checks
and may acknowledge the benefits checklists offer, but
compliance is questionable. The extent to which any of
these checklists are actually used is unknown, and no
formal evaluations of their efficacy have been conducted.
Evaluation of a Predive Checklist
There is no gold standard of predive checklists. With input
from dive-medicine researchers, dive instructors, physicians
trained in dive medicine and diver medical technicians
(DMTs), DAN developed a predive checklist for evaluation.
It was pretested on 16 divers in a field setting to ensure
clarity of content, assess the effort involved in completion
and determine the acceptability of the checklist to divers.
To evaluate the checklist’s effectiveness, DAN conducted
an intervention trial in the summer of 2012. The intervention
groups of divers used DAN’s predive checklist, while
the control group did not. At the end of each dive day,
researchers asked all divers to complete a questionnaire
about diving mishaps. The data were collected and are
currently being analyzed; the incidence of mishaps between
the two groups will be compared.
Extreme depth-time profiles and running low on air
are known to increase divers’ risk of injury. To address
these variables, researchers included a dive plan in the
intervention: Participants were asked to plan the depth
of their dive and to estimate their breathing-gas needs at
different stages of the dive. Additionally, the intervention
tool included four safety tips and a postdive log for divers to
record actual dive parameters.
If the checklist promotes closer adherence to safety
guidelines as we hypothesize, the primary benefit will be a
decrease in mishaps related to equipment and human error
and a consequent reduction in the incidence of injuries.
Additional benefits from a public health perspective may
include a decrease in the financial burden of treatment costs,
a reduction in lost productive time due to injury, disability
or death, and safer, more enjoyable experiences for divers.
The checklist and the results from the intervention trials will
be made public once the analysis is complete. AD