DAN Report on Diving Fatalities
- Thread starter Mr Carcharodon
- Start date
Please register or login
Welcome to ScubaBoard, the world's largest scuba diving community. Registration is not required to read the forums, but we encourage you to join. Joining has its benefits and enables you to participate in the discussions.
Benefits of registering include
- Ability to post and comment on topics and discussions.
- A Free photo gallery to share your dive photos with the world.
- You can make this box go away
If only I were an instructor!
In a state of confusion probably associated with great age, I mentally merged your post and Peter's reply and thought I was directly responding to Peter, since his came after yours. This is the sort of thing I would be expecting Peter to jump all over in the I2I forum (in fact, I am surprised it is not there right now), hence my post.
- Messages
- 93,544
- Reaction score
- 91,968
- Location
- On the Fun Side of Trump's Wall
- # of dives
- 2500 - 4999
... what instructions were those?
Gas management isn't generally taught in OW ... certainly the agency materials don't cover it ...
... Bob (Grateful Diver)
tddfleming
Contributor
Bob is correct, I was just certified last month and I can say without a doubt, there was no talk of gas managment. The only thing that might resemble gas mang. would be the inst. telling us to use the 1/3 rule.
Perhaps the low incidence of DCS reflects its greater emphasis in training.
If that is true, then greater emphasis on gas management in training would perhaps make OOG incidents insignificant, leaving the statistics skewed even more toward medical issues.
Perhaps all medical releases should require a PE.
Since each student is required to sign the PADI Standard safe Dive Practices Agreement, it becomes the new diver's responsibilty to adhere to the agreement. Maybe Instructors should make sure that they teach the student all of the minimum standards and at the very least, include all of the aspects of the signed agreement.
STANDARD SAFE DIVING PRACTICES
STATEMENT OF UNDERSTANDING
Please read carefully before signing.
This is a statement in which you are informed of the established safe diving practices for skin and scuba diving. These practices
have been compiled for your review and acknowledgement and are intended to increase your comfort and safety in diving. Your
signature on this statement is required as proof that you are aware of these safe diving practices. Read and discuss the statement
prior to signing it. If you are a minor, this form must also be signed by a parent or guardian.
I,________________________________________________________________________ , understand that as a diver I should:
(Print Name)
1. Maintain good mental and physical fitness for diving. Avoid being under the influence of alcohol or dangerous drugs
when diving. Keep proficient in diving skills, striving to increase them through continuing education and reviewing
them in controlled conditions after a period of diving inactivity, and refer to my course materials to stay current and
refresh myself on important information.
2. Be familiar with my dive sites. If not, obtain a formal diving orientation from a knowledgeable, local source. If diving
conditions are worse than those in which I am experienced, postpone diving or select an alternate site with better
conditions. Engage only in diving activities consistent with my training and experience. Do not engage in cave or
technical diving unless specifically trained to do so.
3. Use complete, well-maintained, reliable equipment with which I am familiar; and inspect it for correct fit and function
prior to each dive. Have a buoyancy control device, low-pressure buoyancy control inflation system, submersible pressure
gauge and alternate air source and dive planning/monitoring device (dive computer, RDP/dive tableswhichever
you are trained to use) when scuba diving. Deny use of my equipment to uncertified divers.
4. Listen carefully to dive briefings and directions and respect the advice of those supervising my diving activities. Recognize
that additional training is recommended for participation in specialty diving activities, in other geographic areas
and after periods of inactivity that exceed six months.
5. Adhere to the buddy system throughout every dive. Plan dives including communications, procedures for reuniting in
case of separation and emergency procedures with my buddy.
6. Be proficient in dive planning (dive computer or dive table use). Make all dives no decompression dives and allow a
margin of safety. Have a means to monitor depth and time underwater. Limit maximum depth to my level of training
and experience. Ascend at a rate of not more than 18 metres/60 feet per minute. Be a SAFE diver Slowly Ascend
From Every dive. Make a safety stop as an added precaution, usually at 5 metres/15 feet for three minutes or longer.
7. Maintain proper buoyancy. Adjust weighting at the surface for neutral buoyancy with no air in my buoyancy control
device. Maintain neutral buoyancy while underwater. Be buoyant for surface swimming and resting. Have weights
clear for easy removal, and establish buoyancy when in distress while diving. Carry at least one surface signaling
device (such as signal tube, whistle, mirror).
8. Breathe properly for diving. Never breath-hold or skip-breathe when breathing compressed air, and avoid excessive
hyperventilation when breath-hold diving. Avoid overexertion while in and underwater and dive within my limitations.
9. Use a boat, float or other surface support station, whenever feasible.
10. Know and obey local dive laws and regulations, including fish and game and dive flag laws.
I have read the above statements and have had any questions answered to my satisfaction. I understand the importance and purposes
of these established practices. I recognize they are for my own safety and well-being, and that failure to adhere to them can
place me in jeopardy when diving.
___________________________________________________________ ________________________
Participants Signature Date (Day/Month/Year)
___________________________________________________________ ________________________
If the BOLD sections of the statement are emphasized in class, pool, and OW sessions, then the issues that we have been discussing can be adressed within the confines of the standard OW course.
Ken Kurtis
Contributor
I don't think it has anything to do with that. I just think it has to do with the fact that the (presumed) rate of bends hits is low, period.
Top of my head, DAN reports 800-900 bends hits annually. Let's assume (worst-case scenario) that only 40-50% of the total number of hits are actually reported to them. So let's put the number at 1500 annually.
In round numbers, let's assume 2 million active divers (US &Canada, the population from which DAN's data is drawn) making an average of 10 dives each. That's a base (denominator) of 20,000,000 dives.
That's one bends hit every 13,333 dives, which is a rate of 0.0075% (if I've done the math correctly).
Point is it's failry rare in general terms. And it's phenomenally rare (almost unheard of) for a bends hit to result in a fatality.
While it would be nice to think we've drilled "Don't get bent" into our student's heads so thoroughly that they don't get bent, I think the reality is - especially with computers nowadays - it just simply doesn't happen that often. There's not necessarily a correlation between what we teach about getting bent and what happens after theyre certified. In other words, the cause/effect relationship may not exist.
To that point, I'm reminded of a scene from an old Marx Brothers film. Chico is leaning up aganst a wall and a cop come along and says, "What are you doing here?" Chico replies, "I'm keeping the elephants away." The cop says, "There's not an elephant within a hundred miles of here." Chico says, "Yeah. I'm doing a pretty good job, aren't I?"
- Ken
Ken Kurtis
Contributor
I think you've raised a very interesting and critically relevant point. I was at the DAN Fatalities Workshop and this is something we discussed at length, as well as I've followed up with some of the DAN and PADI staff about this. I think it's important enough that I'm going to start a separate thread which I'll call "TRIGGERS OF DIVE ACCIDENTS" and invite you all to look at and weigh in with any thoughts.
- Ken
tddfleming
Contributor
Found this article, which is what I was getting at in my post.
Coronary Artery Disease
and Diving
Download pdf
As divers become older, they become subject to the diseases of aging as we all do, developing atherosclerosis (hardening of the arteries), arthritis, cancer and lead a more sedentary life, particularly men. It seems inevitable that all older divers get coronary artery disease to a certain extent and this raises questions regarding their continued participation in scuba. It's important to understand the factors that increase the risk for the condition.
Scope of the Problem
There are about 2.5 million Americans with CAD ( coronary artery disease ) and this number will increase as our population ages. At the present time, the most likely cause for a diver over 40 to die suddenly while diving is a blocked artery to the heart (coronary occlusion) and a fatal ventricular fibrillation (rapid fluttering of the heart). This holds true for almost all other sports as well. The cause of this is the exertion that causes cardiac work beyond the capacity of the heart to obtain oxygen. This lack of O2 produces ischemia which leads to malfunction and arrhythmias (irregularities) following which there is a fatal heart attack. In the latest report on Diving Fatalities over the past ten years put out by DAN, cardiovascular factors were found in 6-14% of diving fatalities, averaging about ten percent. Gas embolism caused an average of 8% while DCS caused an average of 1% fatalities. (Annual Review, 2000 Edition).
In a review of autopsies on recreational scuba divers 1989-1992 the DAN group (Mebane et al) reported 33 cases of sudden death while diving - 31 were attributed to coronary disease. One was from aortic stenosis and 1 was a CVA.
There is also a section on sudden cardiac death syndrome in Edmonds' 'Diving and Subaquatic Medicine', Chapter 26, p. 354. Most autopsies of victims revealed at least 50% stenosis of a coronary artery, with some showing 100% blockage and some had evidence of infarction. Those who did not have substantial arteriosclerosis often had pre-existing hypertension.
The nice part of all this is that the risk factors for CAD are for the most part controllable. Smoking, obesity, elevated blood cholesterol, high blood pressure, lack of exercise and cocaine use are all variables that are under your control; any of these or a combination of them can cause heart attacks in the twenties. Cigarette smoking is the most common risk and is easily the most preventable. Family history is important but the information derived from the knowledge can help you avoid CAD by closer attention to your health.
--------------------------------------------------------------------------------
The Disease Process
The process of atherosclerosis (hardening of the arteries) causes narrowing and finally blockage of the arteries supplying the heart with oxygen. Damage is done to the lining of the vessels in a process poorly understood, a plaque is formed likened to rust in a pipe, and grows until it blocks the flow of blood. This blockage causes the heart muscle to die-and this in essence is a heart attack. About 1 million people have this to happen each year-and about half of them die suddenly from the attack.
Detection of CAD before it causes trouble is done by stressing the heart by exposure to exercise on a treadmill or a bicycle. In this way we can detect loss of blood flow before it is totally lost and find the hidden problem before it presents as symptoms at rest. Actual blood flow distribution to the heart muscle can be measured by adding a small amount of isotope to the test via an intravenous injection. This shows up as a defect in the image on the subsequent scan of the heart. EKG abnormalities and drops in blood pressure can also be detected when there is a decrease in the oxygen to the heart. This stress test is the best way to be sure that the heart is capable of performing during diving. By reproducing workloads similar to those that will be seen during diving, we can see whether the heart can handle the exercise of diving. An abnormal test suggests that you could be at risk for a heart problem while diving, and you should not dive until further evaluation is done.
--------------------------------------------------------------------------------
Prevention
The most important choice for your long term health and diving is prevention. Family history should be a clue that you may be at risk for CAD. If a parent, brother or sister had a heart attack before the age of 55, you are likely at increased risk yourself. You should have your blood lipids (cholesterol, triglycerides, HDL, LDL) checked, and if abnormal, begin some program to get them back to a normal range (cholesterol---less than 200, triglycerides--less than 120, LDL-less than 130). Reduction in weight, saturated fat intake, alcohol intake and increase in exercise will improve these measurements. There are drugs that will also help reduce blood lipids to acceptable levels.
Discontinuance of smoking is probably the most important factor in the reduction of risk for CAD. This holds true for men and women.
Moderate exercise, such as walking, has been shown to contribute to lowering the risk for coronary disease. Exercise helps maintain a normal blood pressure, keep weight down, raises the HDL (good component of cholesterol), all of which lower the risks.
Maintaining a normal blood pressure is important, to do this requires a periodic blood pressure check. Basic non-medical measures to reduce blood pressure include stress reduction, reduction in salt intake, reduction in alcohol intake, and exercising.
--------------------------------------------------------------------------------
Diving With CAD
Most people with CAD should not dive without correction of their problem. The blocked arteries increase the risk of sudden death or unconsciousness due to arrhythmias due to the extra demand of the exercise involved. Exceptions to the rule occur as when successful bypass surgery or balloon angioplasty has totally corrected the problem with a normal exercise test. In these situations, diving can be permitted in warm water where heavy exercise will not be required. The person who has had a heart attack with extensive muscle death should not dive -again because of the inability to meet the pumping requirements of the increased exercise while diving.
Finally, it should be obvious that diving is not the time to find out that you have coronary artery disease-the underwater environment would decrease your chances by almost 100 percent.
--------------------------------------------------------------------------------
Risk Factors for Coronary Heart Disease
Coronary artery disease (CAD), is the leading cause of death in the western world, resulting in close to a million deaths a year in the United States alone. DAN's latest report on diving fatalities shows that about a quarter of the deaths discussed cited heart disease as the primary factor or a significant contributing factor.
The importance of preventing, recognizing and treating cardiovascular diseases in scuba divers should be perfectly obvious. Functioning in an underwater environment in remote places far from advanced medical care, divers dramatically reduce their chances of survival should something happen. Therefore it would seem that prevention is our best weapon.
There are certain risk factors that increase the likelihood of CAD and subsequent problems. These are:
high cholesterol
smoking
high blood pressure
obesity
age (over 45 for men, 55 for women)
diabetes
Anyone who meets the age criteria or who has two or more of the other risk factors should have a complete physical evaluation, including an exercise stress test, prior to beginning or continuing diving.
--------------------------------------------------------------------------------
References
Diving Medicine, A.A. Bove, 1997
Diving and Subaquatic Medicine, Edmonds, 1993
Medical Seminars. Inc. 1989-1991
Report on Decompression Illness and Diving Fatalities, DAN, 2000 Edition
Scubamed (Fred Bove's Web Page)
--------------------------------------------------------------------------------
The contents of this site are copyright © 1996-2010
Ernest Campbell, MD, FACS All Rights Reserved.
Coronary Artery Disease
and Diving
Download pdf
As divers become older, they become subject to the diseases of aging as we all do, developing atherosclerosis (hardening of the arteries), arthritis, cancer and lead a more sedentary life, particularly men. It seems inevitable that all older divers get coronary artery disease to a certain extent and this raises questions regarding their continued participation in scuba. It's important to understand the factors that increase the risk for the condition.
Scope of the Problem
There are about 2.5 million Americans with CAD ( coronary artery disease ) and this number will increase as our population ages. At the present time, the most likely cause for a diver over 40 to die suddenly while diving is a blocked artery to the heart (coronary occlusion) and a fatal ventricular fibrillation (rapid fluttering of the heart). This holds true for almost all other sports as well. The cause of this is the exertion that causes cardiac work beyond the capacity of the heart to obtain oxygen. This lack of O2 produces ischemia which leads to malfunction and arrhythmias (irregularities) following which there is a fatal heart attack. In the latest report on Diving Fatalities over the past ten years put out by DAN, cardiovascular factors were found in 6-14% of diving fatalities, averaging about ten percent. Gas embolism caused an average of 8% while DCS caused an average of 1% fatalities. (Annual Review, 2000 Edition).
In a review of autopsies on recreational scuba divers 1989-1992 the DAN group (Mebane et al) reported 33 cases of sudden death while diving - 31 were attributed to coronary disease. One was from aortic stenosis and 1 was a CVA.
There is also a section on sudden cardiac death syndrome in Edmonds' 'Diving and Subaquatic Medicine', Chapter 26, p. 354. Most autopsies of victims revealed at least 50% stenosis of a coronary artery, with some showing 100% blockage and some had evidence of infarction. Those who did not have substantial arteriosclerosis often had pre-existing hypertension.
The nice part of all this is that the risk factors for CAD are for the most part controllable. Smoking, obesity, elevated blood cholesterol, high blood pressure, lack of exercise and cocaine use are all variables that are under your control; any of these or a combination of them can cause heart attacks in the twenties. Cigarette smoking is the most common risk and is easily the most preventable. Family history is important but the information derived from the knowledge can help you avoid CAD by closer attention to your health.
--------------------------------------------------------------------------------
The Disease Process
The process of atherosclerosis (hardening of the arteries) causes narrowing and finally blockage of the arteries supplying the heart with oxygen. Damage is done to the lining of the vessels in a process poorly understood, a plaque is formed likened to rust in a pipe, and grows until it blocks the flow of blood. This blockage causes the heart muscle to die-and this in essence is a heart attack. About 1 million people have this to happen each year-and about half of them die suddenly from the attack.
Detection of CAD before it causes trouble is done by stressing the heart by exposure to exercise on a treadmill or a bicycle. In this way we can detect loss of blood flow before it is totally lost and find the hidden problem before it presents as symptoms at rest. Actual blood flow distribution to the heart muscle can be measured by adding a small amount of isotope to the test via an intravenous injection. This shows up as a defect in the image on the subsequent scan of the heart. EKG abnormalities and drops in blood pressure can also be detected when there is a decrease in the oxygen to the heart. This stress test is the best way to be sure that the heart is capable of performing during diving. By reproducing workloads similar to those that will be seen during diving, we can see whether the heart can handle the exercise of diving. An abnormal test suggests that you could be at risk for a heart problem while diving, and you should not dive until further evaluation is done.
--------------------------------------------------------------------------------
Prevention
The most important choice for your long term health and diving is prevention. Family history should be a clue that you may be at risk for CAD. If a parent, brother or sister had a heart attack before the age of 55, you are likely at increased risk yourself. You should have your blood lipids (cholesterol, triglycerides, HDL, LDL) checked, and if abnormal, begin some program to get them back to a normal range (cholesterol---less than 200, triglycerides--less than 120, LDL-less than 130). Reduction in weight, saturated fat intake, alcohol intake and increase in exercise will improve these measurements. There are drugs that will also help reduce blood lipids to acceptable levels.
Discontinuance of smoking is probably the most important factor in the reduction of risk for CAD. This holds true for men and women.
Moderate exercise, such as walking, has been shown to contribute to lowering the risk for coronary disease. Exercise helps maintain a normal blood pressure, keep weight down, raises the HDL (good component of cholesterol), all of which lower the risks.
Maintaining a normal blood pressure is important, to do this requires a periodic blood pressure check. Basic non-medical measures to reduce blood pressure include stress reduction, reduction in salt intake, reduction in alcohol intake, and exercising.
--------------------------------------------------------------------------------
Diving With CAD
Most people with CAD should not dive without correction of their problem. The blocked arteries increase the risk of sudden death or unconsciousness due to arrhythmias due to the extra demand of the exercise involved. Exceptions to the rule occur as when successful bypass surgery or balloon angioplasty has totally corrected the problem with a normal exercise test. In these situations, diving can be permitted in warm water where heavy exercise will not be required. The person who has had a heart attack with extensive muscle death should not dive -again because of the inability to meet the pumping requirements of the increased exercise while diving.
Finally, it should be obvious that diving is not the time to find out that you have coronary artery disease-the underwater environment would decrease your chances by almost 100 percent.
--------------------------------------------------------------------------------
Risk Factors for Coronary Heart Disease
Coronary artery disease (CAD), is the leading cause of death in the western world, resulting in close to a million deaths a year in the United States alone. DAN's latest report on diving fatalities shows that about a quarter of the deaths discussed cited heart disease as the primary factor or a significant contributing factor.
The importance of preventing, recognizing and treating cardiovascular diseases in scuba divers should be perfectly obvious. Functioning in an underwater environment in remote places far from advanced medical care, divers dramatically reduce their chances of survival should something happen. Therefore it would seem that prevention is our best weapon.
There are certain risk factors that increase the likelihood of CAD and subsequent problems. These are:
high cholesterol
smoking
high blood pressure
obesity
age (over 45 for men, 55 for women)
diabetes
Anyone who meets the age criteria or who has two or more of the other risk factors should have a complete physical evaluation, including an exercise stress test, prior to beginning or continuing diving.
--------------------------------------------------------------------------------
References
Diving Medicine, A.A. Bove, 1997
Diving and Subaquatic Medicine, Edmonds, 1993
Medical Seminars. Inc. 1989-1991
Report on Decompression Illness and Diving Fatalities, DAN, 2000 Edition
Scubamed (Fred Bove's Web Page)
--------------------------------------------------------------------------------
The contents of this site are copyright © 1996-2010
Ernest Campbell, MD, FACS All Rights Reserved.
Crush
Contributor
You are wrong Bob - gas management is taught in almost every course and on almost every dive. Every good DM will teach you as well, within a few seconds, before almost every dive:
Now isn't it too bad that we aren't constantly told how to calculate a turn pressure so that we will know when to begin an ascent so that we can be at the surface with 500 psi...
Similar threads
