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September 2004 Vol. 30, No. 9   RSS Feed for Undercurrent Issues
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Why Divers Die: Part III

the true cause of death – panic, not drowning

from the September, 2004 issue of Undercurrent   Subscribe Now

Panic is the diver’s worst enemy. It makes us forget our training and act illogically. A panic attack is intense fear or discomfort, often accompanied by feelings of imminent danger or impending doom, and an urge to escape. It’s the old “fight or flight” instinct that’s hardwired into all of us.

A Study of Panic in Recreational Scuba Divers conducted by David F. Colvard, MD and Lynn Y. Colvard, PhD found that 15% of survey respondents who reported panicking while diving had made a rapid or uncontrolled ascent. Five percent of them reported symptoms of DCS. And, many who embolized are not alive to respond.

You don’t have to dive deep to risk an embolism; with full lungs, a rise of just a few feet can be enough to cause an embolism. Divers Alert Network’s report on sport diving fatalities in 2002 (their most current) includes the case of a 43-year-old who had difficulty equalizing and aborted the dive after going no deeper than 28 feet. She made a rapid ascent, complained of difficulty breathing, and later died of an air embolism.

Panic is more common than most divers think – and more than most training agencies care to acknowledge. More than half the scuba divers in a national survey reported experiencing panic or near-panic behavior, according to research by Dr. William Morgan at University of Wisconsin-Madison. The incidence of panic was higher in women (64%) than men (50%).

Divers panicking often spit out their
regulators, even though they have air left.

Morgan notes that panic responses can occur when a diver is suddenly exposed to an unanticipated stressor, such as running out of air – a problem that’s almost always avoidable. A welltrained diver knows one can always get a couple of extra breaths from an “empty” tank as one ascends and the ambient pressure decreases. Even a BCD partially tank-inflated can provide an emergency breath or two. Of course, divers must keep their wits about them in the first place.

In his book Medical Examination of Sport Scuba Divers (1998), Alfred Bove wrote, “Panic, or ineffective behavior in the emergency situation when fear is present, is the single biggest killer of sport divers.” But panic is often overlooked as a cause of death underwater, and drowning is to blame. Take the case of the 37- year-old making a training dive in poor visibility. He panicked, struggled with his buddy, and attempted to pull off his mask. The buddy went to the surface for assistance, and the panicked diver’s body was recovered two hours later. The coroner’s report of drowning may be accurate, but it tells nothing of what led to this fatality.

A panicky diver can be dangerous to others, as well as oneself, a result that people who eschew buddy diving like to emphasize. While taking a deep diving course, a 33-year-old on a 130 ft. wreck dive ran out of air and began to breathe from his buddy’s octopus. For some reason he panicked and began descending, dragging his buddy down too. (Panic can also cause disorientation). The buddy broke free, made an emergency ascent, and was transported to a local hospital where he recovered. The 33-year-old’s body was found two days later.

A 57-year-old diver went to 80 ft. Within 15 minutes, he was out of air and pulled his buddy’s regulator from his mouth. The buddy tried unsuccessfully to share air with him, but he took off for the surface, where he passed out and didn’t respond to treatment.

During a planned decompression dive to 150 feet, a 24-year-old advanced open water diver struggled with his buddy and then passed out. As he tried to pull the unconscious diver to the surface, he was dragged deeper and lost his grip. The body was recovered the next day at 140 feet. While nitrogen narcosis likely contributed to the death, the victim was morbidly obese and had been drinking alcohol the previous night.

Diving “rust” can lead to panic. A 55-year-old rescue diver who had not been underwater for two years made a wreck dive to 74 ft. for 24 minutes. At the safety stop, his mask flooded, and he ascended rapidly to the surface. While climbing the ladder to the boat, he collapsed and could not be resuscitated. Air embolism was the killer. As Dr. Morgan pointed out, panic attacks are not restricted to novices. Divers with many years of experience, like this one, can experience attacks for no apparent reason.

Divers panicking often spit out their regulators, even though they have air left. On land, firefighters are sometimes discovered following a fire with their full face mask removed even though air remains in their tank. In studies, some anxious firefighters wearing a respirator will remove their full face mask (hence air supply) if they experience respiratory distress.

One dive trainee, in a basic course, suddenly spat her regulator out while practicing recovery drills. Her buddy offered his octopus, and they proceeded to the surface. The 60-year-old woman was fine on the surface but then abruptly lost consciousness and could not be resuscitated.

A 30-year-old technical diver with extensive experience made a cave dive to 100 feet using Nitrox. Her dive buddies saw her twitch at depth during her ascent, but she did not appear to have a seizure. She dropped the regulator from her mouth and wouldn’t take an alternate gas source. Her dive buddies, who skipped 22 minutes of decompression time, brought her to the surface. She had drowned.

A 24-year-old had made 15 dives since receiving her openwater certification seven months previously. At 60 ft. her buddy was having difficulty with his weight belt. While coming to his aid, she dropped the regulator from her mouth; the buddy attempted to assist her, but lost his weight belt and had to surface. The young woman was found on the bottom 15 minutes later, unconscious and with the regulator out of her mouth. The autopsy indicated death by drowning.

Some serious divers speculate whether regulator manufacturers should be including neck straps to help keep a lost mouthpiece from floating too far away. Often, technical and cave divers mount the primary regulator on a long hose, looped around the torso, which can easily be unwound and donated to an out-of-air buddy. The necklace keeps the octopus handy, hanging just below the chin. It also prevents the “octo” from dangling in the sand or dragging across a reef.

In almost every case, panic is the culmination of a series of events, each increasing stress to the point where it becomes unmanageable. Being alert to signs of increasing stress, both before and during the dive, can help a diver deal with what’s causing stress and solve those problems before they build to a panic situation. The more confidence one develops in the water, the more likely he is to deal successfully with unanticipated stressors. For instance, knowing you can make a free ascent from your diving depth could make it a lot easier to deal with an out-of-air situation.

A key to avoiding panic is to recognize our comfort zones, and to exceed them only when we’re ready. Managed stress is a good thing – it heightens our perceptions and mental acuity, and adds excitement to what otherwise is usually a pretty placid sport. When we place ourselves into situations we’re not ready for, that’s when stress turns from friend to foe.

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