Checklists: If surgical teams don't comply, what hope do divers have?

[doctormike]

@doctormike - I am under no impressions. I have not said physical checklists aren’t needed. I’ve said, several times, that initial and sustainment training is needed if you’re trying to drive the long term behavioral changes needed to get people to comply with their use.

Over my 19 years in service, of which 14 were in Infantry and Special Operations units, I have seen training get people through a lot. Certainly mistakes happen but I am hear today because of my training and the training of those I served with.

I have tried to help you solve the question of why CCR divers don’t use the existing checklists and how to correct that. You continue to not see that. Maybe I’m not being clear. Or maybe you’re so stuck on your answer to the problem, yet another checklist, that you’re not able to even acknowledge another idea. Even if that idea is complimentary, not contradictory, to your own.

Thanks for your service.

I think that you are not understanding what my effort here is. And once again, you are bringing up training as if this were some sort of either-or discussion, as if I'm arguing against training.

I am a single, newbie CCR diver with no access to anyone in the industry or the training agencies. So I have no way of influencing training, per se. It is also impossible to retroactively change the initial training of the many experienced CCR divers who don't use checklists.

So MY effort is to recommend in person and on social media (here, other boards, FB, etc..) a very simple, very cheap sticker that has no real drawbacks, but if used might save divers like those referred to upthread. I have printed these stickers out and given them to every CCR diver I know. I'm going to bring a few hundred to the next dive show to give away. I think that the sticker is helpful because it addresses two obvious barriers to usage - availability and stigma. So that's what I can do. That's what I'm doing. My answer isn't "yet another checklist", it's "use the checklist like you know that you should". I'm trying to change the culture in our little world of CCR divers.

If YOUR answer is that we have to change training so that checklists are stressed, I would answer that checklists ARE stressed in CCR training (see post #63), but people still don't use them. And if you think that you know how to do that, feel free to start your own effort.

It's not that I'm stuck on my answer and won't acknowledge other ideas. It's that I think that my answer may help and it's something that I can do. I really don't understand the pushback. I'm not trying to make money or make myself famous. I'm just trying to get people to change their attitude, and give them a little tool to help.

 

[Diver-Drex]

@doctormike - Thanks, it was my honor to serve this country and I was privileged to serve with some of its finest.

I’m not pushing back and I totally get what you’re trying to do. I am trying to help. I have lead people for a long time. In my civilian life I lead people and drive process improvement. I am offering a suggestion to help drive the cultural change you are seeking.

Edit: To be clear, I am talking about training divers to use the tools (checklists) available to them. I don’t mean I showed it to and you went through it once. I mean training that communicates that using a checklist is nonnegotiable. Also the behavior within the diving community that reinforces that nonnegotiable standard.

I asked why CCR divers aren’t using checklists. They all have, or should have, received training, so that question is answered. There are many reasons why they may not be using the checklists but likely reasons are that 1) the checklists are overly difficult or cumbersome to use 2) the absence of a reinforcing event leads to complacency and disuse. You have potentially addressed the ‘too hard to use’ problem.

Reinforcing events can be formal training, the agencies would need to implement this and people would need to seek it out.

A reinforcing event could be a success or failure from either using or not using the checklists. Unfortunately the failures may not be survivable. Likely the successes are few and far between so people become complacent, believing that everything is ok and using the checklist isn’t providing a benefit. Even though it is abundantly clear that deaths could be prevented people tend to base their behavior on their personal experience.

A reinforcing event could also be peer pressure. This is where you and every diver can have a very profound impact. By leading by example and holding yourself and everyone you dive with to a standard you can change the culture. I brought up what I do in OC diving. Whether at the local quarry with someone I’ve dove with multiple time, on a head boat in NC with an instabuddy or with a group of students as a DM I go through my predive and have them go through it with me.

I’m just a single person like you. It’s how I’ve chosen to make difference. Partly because I want to make sure the person I’m in the water with is squared away. Partly because I think it will make them a better diver. It is a slow process but it is what I can do. It’s something you could do as well.

I appreciate your efforts and the fact that you care enough to try. If you help just a few the effort will have been well worth it.

 

[rjack321]

[Edit: To be clear, I am talking about training divers to use the tools (checklists) available to them. I don’t mean I showed it to and you went through it once. I mean training that communicates that using a checklist is nonnegotiable. Also the behavior within the diving community that reinforces that nonnegotiable standard.

I asked why CCR divers aren’t using checklists. They all have, or should have, received training, so that question is answered. There are many reasons why they may not be using the checklists but likely reasons are that 1) the checklists are overly difficult or cumbersome to use 2) the absence of a reinforcing event leads to complacency and disuse. You have potentially addressed the ‘too hard to use’ problem..

Drex do you dive a CCR?

I only have training on two units, but I can tell you that in all my CCR courses (3 of them) there is no such thing as a "jump check". Manufacturers and agencies emphasize build checklists. If the unit is assembled correctly everything that happens after that is "user error". We're oh so good in the diving community at blaming users for their own deaths as if it 'can't happen to us' yet the same mistakes get repeated (and I am guilty of some of them too). So there's a blame game feedback loop going on with manufacturers and agencies providing highly complicated build lists with hints of pre-dive checks at the bottom then ,all get to point fingers at why these lists dont get used or someone dies from a simple error that wasnt even part of the garage build list. Yes divers are getting training on checklists - the wrong kind of list though! They are typically 25 to 50 items long and depending on the unit are completed with a pencil at a table in your garage. They look nothing like the video Simon posted and would not prevent (for instance) the recent hypoxia fatality in Hawaii - the student/diver was distracted by a camera and hadn't turned on his O2.

 

[JohnnyC]

I think there was an engraved rEvo pre-jump checklist (it specifically said "pre-jump" on it) but I don't know if it was rEvo manufactured or aftermarket. I think Sotis was selling them.

I think I might make up a couple generic ones and have them engraved and give them to friends I'm diving on the loop with. Basically just make it the last thing before we splash kind of thing, store it in wet notes, etc.

 

[doctormike]

Drex do you dive a CCR?

I only have training on two units, but I can tell you that in all my CCR courses (3 of them) there is no such thing as a "jump check". Manufacturers and agencies emphasize build checklists.

The short pre-jump check and the distinction from the longer build checklist is what @Dr Simon Mitchell was discussing upthread. Not sure how the different agencies teach that, so I'll take your word for it (more room for improvement at the agency level!). I only trained on one unit with TDI, but they do make and sell this card.

 

[taimen]

I recently trained with IART and we had essentially the same pre jump checklist. No physical cards or other aids other than printed paper was provided. Your sticker checklist is directly applicable to that training.

 

[doctormike]

They look nothing like the video Simon posted and would not prevent (for instance) the recent hypoxia fatality in Hawaii - the student/diver was distracted by a camera and hadn't turned on his O2.

Right, the pre-build checklist wouldn't be relevant there. But the pre-jump checklist would have picked that up, right? That's sort of the whole point of this effort. Now, of course, if you are so distracted that you don't USE the checklist, it's can't physically force you to do so. But by having a short checklist with critical steps always right there in your face, and by changing the culture to stress the importance of running it, it makes it less likely that a diver would jump in with the O2 off, and I think that's a worthy goal.

I guess the only thing that could address this further would be some sort of dive boat policy to require a call and response drill for all divers before they let them in the water. Some of the dive boats that I dive from won't let you splash until you tell the crew member checking run times what your PO2 is. That's a step in the right direction.

 

[CuzzA]

I beg to differ, even in recreational diving there is more to check, what good is a tank with an open valve if there is only 100 psi in it? A dry suit that is not connected, a BCD that is leaking?

Maintaining OC gear is not the same as a printed predive checklist. While on a dive charter do you fill your BC with air and wait and hour or so to see if it's holding?

I've never, ever seen anyone pull out a predive gear check list on an open circuit recreational dive. If you cannot properly put together and evaluate the basic functionality of your gear before splashing, you shouldn't be diving. Obviously, this discussion has been largely about CC and technical diving. That's no coincidence, however the author suggested a pre dive check list should also be used for rec diving. I see no basis for that.

But, I am always willing to see what others are doing. Can you post a picture of your printed predive checklist you bring on dives?

 

[cathal]

I think there was an engraved rEvo pre-jump checklist (it specifically said "pre-jump" on it) but I don't know if it was rEvo manufactured or aftermarket.

Thats a rEvo check list. As a rEvo diver I don't use it. Per Atul Gwande's book, 'Checklist', interactive checklists ideally written by you are the best type of checklists for the following reasons:

1. Interactive checklists are deployed in aviation and medicine for a reason
   
2. They force you to interact with the build process, mentally and physically i.e. you have to complete the task before you can mark off on the slate, the page or sticker, that you have completed that part of the unit build.
3. As you tick off the build process if at any time you are distracted or called away, when you resume you know exactly where you are in the build process with 100% confidence by simply checking what was the last stage you had ticked off as being completed.
4. Why the checklist should be done in your own vocabulary, is that to avoid any confusion or doubt in the build process, the language used is what you would normally use and therefore understand. Hence why I use my own interpretation of the rEvo one.

I do a fair bit of solo diving and I do it in peace knowing the unit has been built via an interactive checklist. My emphasis is placed on the actual build process of the unit. If its build right and is operating perfectly then all you have to do to stay alive is to turn on gases and turn on computers.
Just my 2c.

 

[rjack321]

The short pre-jump check and the distinction from the longer build checklist is what @Dr Simon Mitchell was discussing upthread. Not sure how the different agencies teach that, so I'll take your word for it (more room for improvement at the agency level!). I only trained on one unit with TDI, but they do make and sell this card.

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Yep I have CCR certs from TDI, NSS-CDS, and PSIA. None of them actually talked about or introduced any such prejump card or list (which IANTD also publishes in laminated card form)
I actually have one of those cards and for awhile I thought I would clip it to my BOV and I would have to rundown the list before splashing. It wasn't especially useful and I found it hard to find a place to put it once I was done and unclipping it.