Why Divers Die, Part I

Each year, Undercurrent reports on diving fatalities compiled by the Diver's Alert Network, in an ongoing effort to draw lifesaving lessons from these tragedies. DAN recently reported on 89 cases from 2003 involving U.S. and Canadian recreational scuba divers: 24 women and 65 men. Where possible, we've augmented the DAN reports with news accounts that provide additional details.

Panic Kills

Panic has been defined as "a sudden unreasoning terror." The key word here is "unreasoning." Panicky divers often find themselves unable to cope with unexpected stressors such as running out of air or getting entangled beneath the surface. They may forget their training, reject help from others or make improper decisions that worsen the situation. While it may seem to appear suddenly, panic is actually an involuntary response to the culmination of a series of missteps that lead to an increasingly unmanageable situation. A Study of Panic in Recreational Scuba Divers by David F. Colvard, MD, identified hyperventilation (rapid, shallow, irregular breathing) as an early warning sign of panic. Dr. William Morgan, a sports psychologist at the University of Wisconsin, finds good reason to believe that panic can be fueled by heavy physical activity (such as struggling to break free from an entanglement).

Some divers, usually those with higher anxiety levels, are more susceptible to panic than others. Nevertheless, experienced divers are not immune and should not discount the notion that panic might strike them.

Elisa Tricco, an experienced diver, was part of a group on the Peter Hughes live-aboard Star Dancer when she undertook a typical dive in rough seas at Peleliu Cut in Palau. She used her reef hook to latch onto the reef to watch the big fish go by, but couldn't unhook herself. (See sidebar). Struggling in the strong current, Tricco lost a fin and her mask, then passed out. She was brought to the surface and miraculously regained a heartbeat after an hour of CPR, but was breathing only with continued assistance. Another live-aboard, the Galapagos Aggressor, provided a defibrillator. Tricco was eventually stabilized and airlifted to Guam the next day, but she died there three days later. (Ever more live-aboards and resorts have defibrillators which is another thing to check for when you're booking a trip, especially to a remote location.)

A panicky diver may override his own training, unless that training has been thoroughly ingrained by ongoing practice. A 57-year-old male, who had made fewer than 30 dives, drowned after making a dive in strong current to 110 fsw to explore a wreck. It was his first dive of the year, and he struggled during the surface swim. Once on the bottom, he had difficulty breathing and refused to accept alternate air sources from dive buddies. He eventually was taken to the surface, where resuscitation efforts were unsuccessful.

Sometimes, panic sets in before the diver even submerges. Currents, waves and cold can turn pleasant recreation into a struggle for life. A 27-year-old female had been certified for seven years but had fewer than 20 dives. On the surface, before descending to a freshwater wreck 30 feet down, she spit out her regulator, refusing to replace it, an example of classic panic behavior. Even firefighters have been known to remove their face masks (hence air supply) if they experience respiratory distress during a fire fight, according to Dr. Morgan. He points out that firefighters "are sometimes discovered following a fire with their face masks removed though an air supply exists in the selfcontained breathing apparatus."

In this case, the victim also would not release her weight belt, so her buddy did that for her. A large wave caused her to inhale water, and she lost consciousness and drowned.

Scuba diving is supposed to be fun, but some divers push themselves beyond their limits. A 26-year old woman with 11 dives under her belt planning a wreck dive in rough seas and a strong current ignored her own trepidations, making a decision that cost her life. After entering the water for the first time, she stopped and returned to the boat. Then, she tried again. This time, she panicked and grabbed her buddy's mask as he tried to render aid. While her buddy put his own mask back in place, the woman sank below the surface. A dive instructor pulled her up, but resuscitation efforts were unsuccessful.

For the buddy system to work, it takes two able divers, preparation in advance, cooperation and visual contact throughout the dive. An alert buddy can intervene, maybe changing the direction of a potentially dangerous event. A good buddy hangs in there until the victim leaves the water--or becomes dangerously combative, like this 55-year-old diver with 100 lifetime dives. He was making a shore-entry dive and stopped 15 yards from the beach before descending. Attempting to repair his gear, he disconnected hoses as he struggled on the surface. His buddy tried to help him, but the diver grabbed at him so he had to move away. Unfortunately, the diver did not remove his weight belt, and he sank below the surface and drowned.

Anthony Kalinowski, an advanced open water diver from Belmont, MA, with fewer than 20 lifetime dives, exhausted his air supply 20 minutes into a 90 fsw wreck dive off the Gloucester-based dive boat Cape Ann II. He grabbed the octopus of a student diver in his group and then grabbed the student's primary. The student broke away from the distressed diver, who was later found unconscious on the bottom, with his mask off and regulator out of his mouth, according to the Boston Globe.

Tammy Nguyen (San Jose, CA), apparently became entangled in kelp while diving at Point Lobos in northern California's Carmel Bay. Shortly after descent, the 42-year-old got tangled in kelp, panicked and then grabbed at the regulators and masks of other divers who came to her aid. She was brought to the surface and transported to a local medical treatment facility, where the Los Angeles Times reported that she died of complications of near-drowning after being on life support for five days.

Another source of panic-inducing anxiety is poor preparation. Unfortunately, that lesson was lost on a very experienced 40-year-old open water diver who used a new dry suit on a shore-entry dive into a cold water lake with low visibility. At 40 feet and 10 minutes into the dive, her regulator was free-flowing. She panicked and grabbed her buddy. The pair rapidly surfaced, but the buddy, unable to drop her weights for her, could not keep her afloat, and she drowned. Later it was determined that she had configured her weights in a manner that prevented dropping them and her regulator was in disrepair and ill suited for cold water.

One common--and deadly-- manifestation of panic is an unnecessarily quick ascent. Typically, panic ascents occur when a diver runs low on air or develops a problem he can't seem to solve underwater. During a dive from a boat to 55 fsw, an experienced technical diver made an unplanned rapid ascent after seven minutes of bottom time. At the surface, the 47-year-old diver was visibly distressed and then quickly lost consciousness. She died of an air embolism.

The key to avoiding panic is stress reduction, both before and during the dive. Relaxation techniques, such as meditating quietly before suiting up, can result in significant reductions in anxiety, according to Dr. Morgan. However, he also points out that "relaxation training can actually produce anxiety and panic attacks in certain individuals." Morgan finds that "each individual has an optimal zone of anxiety (ZOA) at which performance in sport skills is maximized," so each diver needs to find his own ZOA and stay within it. Taking pauses during a dive to assess and adjust one's exertion level and breathing rate is also highly recommended. Good training, lots of practice and correcting small problems before they escalate all help to keep one's cool.

No way up

Perhaps the most terrifying fate a scuba diver can experience is being trapped underwater with a dwindling air supply.

Northern California kelp proved a fatal attraction for Marie Murray (Salinas, CA). She and her brother made a shore-entry dive off Lover's Point, a popular site in Pacific Grove. When they became entangled in kelp, her brother broke free, but the 51-year-old Murray was not so fortunate. The Los Angeles Times reported that Ryan Masters, an avid diver who lives in Pacific Grove, was walking past when he heard Murray's brother frantically calling for help. Masters dove in, found Murray in the kelp and pulled her ashore. Besides wearing the typical weight belt for a dive, Murray was also wearing ankle weights, which might have contributed to her inability to free herself.

In overhead environments, divers are taught to follow the rule of thirds: use one-third of your air on the way in, one-third on the way out and keep one-third in reserve. An experienced technical diver with cave diving certification made a cave dive to 94 feet using a scooter for transit. A silt-out occurred during the dive, and he and his buddy became separated. The 42-year-old tech diver's body was recovered one hour later, and his gas source had been exhausted.

One certified cave diver with a history of narcolepsy (episodes of suddenly falling asleep in any situation), made a shore-entry solo dive into a freshwater spring system. He used a 34 percent Nitrox mixture and planned the dive to 108 feet for 20 minutes. The 35-year-old diver's body was recovered in a restrictive area within the cave where the current was brisk. It appeared that he had been attempting to exit the cave system. He had plenty of gas available and no obstacle to leave. He may have just fallen asleep.

Throughout these reports, we see that virtually every fatality could have been avoided if the diver had made wiser decisions. Inexperience, panic, peer pressure and arrogance are thieves that can rob us of our better judgment. It's our responsibility to ourselves, our dive buddies and our loved ones to maintain our skills and fitness at levels that allow us to remain sharp and focused whenever we're in or on the water.

Next month we'll examine cases involving shockingly poor judgment by divers, instructors or divemasters.