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September 2002 Vol. 28, No. 9   RSS Feed for Undercurrent Issues
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Why Divers Die: Part II

when the heartís not healthy

from the September, 2002 issue of Undercurrent   Subscribe Now

This is the second part of a three part series on what causes the deaths of divers, illustrated by American deaths in the year 2000, as analyzed by the Divers Alert Network. We provide these articles, hoping that if divers study the cause of death of their fellow divers, they will become safter divers, themselves.

* * * * *

Divers die because they make mistakes. Given the inherent demands of scuba, descending with cardiac problems can be a lethal mistake. Diving is stressful. For inexperienced divers, just entering the water is a stressor. For experienced divers, depths, currents, and cold water are stressors.

While training agencies in a few countries require physicals for those taking up scuba diving, in the U.S., U.K., and most other countries, a diver is only required to answer a series of medical questions. While instructors are supposed to eyeball the students to weed out any folks that might be lying, they donít always do a good job. The following case is a good example.

A forty-two-year-old student in an open-water course had several medical problems, including morbid obesity, a condition that one might expect would rule out an applicant. At 105 feet, another student noticed that the forty-twoyear- old was having trouble breathing and motioned to the instructor. While the victim had plenty of air, his eyes appeared large, so the instructor motioned the divemaster to take him to the surface. The man became unconscious as they swam to the anchor line, so the divemaster inflated the victimís BC, ascended rapidly, and began CPR on the boat. Although the diver died of an embolism, the start of his problem on the bottom was apparently cardiac-related, common among the morbidly obese. (Morbid obesity refers to people who are fifty percent or more, or one hundred pounds, above their ideal body weight.)

A forty-eight-year-old obese student in an open-water certification class was in poor physical condition. He made a dive to forty feet for ten minutes before signaling to another diver that he was not feeling well and needed to surface. At the surface, he became motionless. Resuscitation efforts resulted in some improvement, but he died a few hours later. The autopsy revealed significant cardiovascular disease, including evidence of previous small heart attacks.

People who fill out medical forms can easily lie. An instructor canít do much about that. Nor can an instructor be expected to know, by looking at someone, whether he or she has cardiac disease. One would think, however, that an instructor could spot a drunk. A fifty-eight-year-old enrolled in a scuba familiarization class and had difficulty breathing as she entered the water. She was helped into the boat, where she collapsed and could not be resuscitated. She had denied any medical problems on the predive screening form, though she had undergone a coronary angioplasty and had a history of hypertension. Her postmortem blood alcohol level, however, was more than twice the legal limit for driving, probably eight times the limit for diving.

A forty-five-year-old had not dived for several years, so he completed a refresher course and then enrolled in an advanced open-water class. Before his first dive he looked fatigued, but denied any medical problems. The students descended to seventy feet, where the victim had a problem and lost consciousness. He was brought to the surface but could not be resuscitated. The autopsy revealed significant coronary artery disease as well as an old cerebral contusion.

She had denied any medical problems on the predive screening
form, though she had undergone a coronary
angioplasty and had hypertension.

Once certified, divers may dive forever with no further medical prohibitions, unless they indicate problems on predive questionnaires. Some people are in denial about their coronary history and donít think diving can affect them. So they lie on the questionnaire. Others are simply unaware of their coronary problems. A sixty-threeyear- old was an experienced, but infrequent diver, and was making his first dive in more than three years, without a buddy. At ten feet he experienced buoyancy problems, temporarily became entangled in line, and then set his spear gun down before losing consciousness. The autopsy revealed significant cardiac disease.

A fifty-two-year-old diver was morbidly obese and had a medical history of hypertension. Though anxious before the dive, he went to 106 feet to a wreck and became separated from the other divers. A search found him on the bottom and unconscious; his death was cardiac-related.

A sixty-two-year-old possessed advanced open-water and rescue diver certification, despite having made only seventeen lifetime dives. He made a wreck dive to seventy feet and signaled that he needed to ascend because he had used more than 2,500 psi in fifteen minutes. He lost consciousness while hanging on a surface line. Resuscitation efforts were unsuccessful. The autopsy revealed severe coronary artery disease.

A fifty-five-year-old experienced diver made two uneventful dives to seventy-five feet. He surfaced normally from the second dive, then struggled in the water for a short time before losing consciousness. Resuscitation efforts were unsuccessful. He had a history of atrial fibrillation, which was considered a cause of death.

Next Issue: Should physical exams be required of all divers?

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