Those Dangerous Errors of Divers

The British Sub-Aqua Club publishes an annual report on diving incidents, collecting data from its members and divers involved in the incidents, some of whom have had unfortunate consequences. Some of these offer real lessons for divers, so we have selected a few to share. While the reports spare the blushes of those who might have been foolhardy, the details are invaluable in keeping divers alert to unique incidents they will be wise to avoid.

How Self-Serving Divers Affect Others

Two divers, whose certifications did not allow for decompression diving, were on a week-long liveaboard trip. Before diving, they were reminded that they should not carry out dives with mandatory decompression stops. On their first dive, they returned to the dive boat having completed six minutes of decompression stops. They were reminded again by the trip leader about their training limits, but laughed it off.

The next day, they dived to 120 feet and, back at 30 feet, they deployed a DSMB (delayed deployment surface marker buoy) midwater (they had not been trained in this). When one became buoyant, he tried to swim back down unsuccessfully and was soon spotted on the surface. Back on board the charter vessel, the diver was observed by the skipper scratching his back, and upon inspection, it was found that he had a rash. The vessel returned to shore, and the diver was taken to a chamber.

Of course, not only did the diver exhibit bends symptoms and had to give up diving, but the selfish attitude of the two meant that the other divers on the trip lost valuable diving time. We've seen many cases over the years in which it takes hours to return a bent diver to shore, while other passengers lose as much as a full day of diving.

Listen to Your Body

Before boarding a liveaboard, a dive group stopped for an evening meal. One diver reported feeling bloated and did not enjoy eating, which was quite unusual for him. Another group member recalled hugging him and was surprised by how hard his belly felt.

On the liveaboard, the diver made two nitrox dives below 80 feet with stops, but continued to feel bloated. The next day, he completed similar dives. On the second dive, he made no formal decompression stop but spent considerable time in shallow water. Afterward, he still felt bloated and realized he had not passed any urine all day, so he drank over three liters of fluids during the remainder of the day. On the third day, he completed similar dives, but despite his considerable fluid intake, he still hadn't urinated and felt tired and out of breath. The next day, he felt increasingly unwell and experienced bouts of vertigo, especially when standing. He was taken ashore, contacted a GP (medical doctor), and although he was still not producing urine, an ultrasound scan showed no fluid in the bladder. He was rushed to a hospital where he was diagnosed with severely impaired renal function and was administered IV (intravenous) antibiotics and fluids, and quickly improved. He was then transferred to a recompression chamber.

I can't imagine going for days without peeing -- that's serious -- but I can imagine that some people might be reluctant to report the problem. However, this fellow felt unwell and bloated before he even began diving. He dived for two days, even though he hadn't urinated for a day, and made serious dives the third day. It's one thing to ignore such symptoms if you're taking a walk in the park, but diving puts an unusual strain on one's body. If the kidneys weren't processing liquid, it ended up in other parts of his body -- he felt bloated, and even his friend was surprised by how hard his belly felt. The takeaway here is not to ignore even the smallest of unusual symptoms, especially when diving to 100 feet or diving at all. And, if you spot something unusual in your buddy -- like a hard belly on a paunchy guy -- point it out.

Where That SMB Isn't Much Help

One of the most common fatalities among divers concerns being separated from the dive boat and getting lost at sea. Changeable sea conditions make it imperative that an efficient diver recall system is in place.

Six guys in their own RHIB (rigid hull inflatable boat) anchored at a wreck, and two pairs of buddies entered the water with a planned maximum dive time of 60 minutes. Forty minutes after the divers had entered the water, the wind switched direction, and the land no longer protected the site. The two remaining in the boat tried to recall the divers by revving the boat's engine, but there was no sign of the divers surfacing. They continued to monitor the site for an additional 10 minutes, when one of them thought he spotted DSMBs downwind. They dropped a buoy on their site and headed toward what they thought was an SMB, only to discover it was an orange lobster pot flag. They thought they saw another DSMB and then another, only to find out that they were among fifty or more lobster pot flags. It was twenty minutes after the dive was to have ended and the crew was worried, so they issued a 'Mayday', and the Coast Guard successfully recovered the four divers.

Beach Divers Need Training

A preponderance of divers today become certified in lakes, quarries, or warm tropical waters, with little to no preparation for shore diving, especially when entering and exiting the water, especially if the surf is up. Furthermore, divers who travel a long way to reach the coast may rush to get into the water and exercise poor judgment about the sea conditions.

In this case, a group of divers, optimistic about the conditions, entered the water from a beach only to discover later that exiting would be very difficult. They had considered one site but decided it was too rough, so they drove to another, where the sea was apparently calm, with waves a foot high and no wind, though they knew the forecast called for 7-12-knot winds in 2-3 hours. Figuring they could get one dive in, three entered the water, though the waves had risen to three feet. Ten minutes later, buddy pairs entered with the waves' height about four feet. The first group called the dive, and one reached shore, reporting visibility of less than a few feet. The dive manager decided to recall all divers, as the other two pairs were still on the surface. They had been instructed to exit with their fins off and to crawl up the beach with their masks on and regulators in until they were clear of the surge. Three did and exited without difficulty. He attempted to crawl up with their fins on. He was being dragged around in the surge and unable to get out, with the waves rapidly increasing in size. The three divers eventually managed to crawl to a point where they were seenn by the shore support. One diver was fatigued and starting to panic, but others were helping to de-kit him and assist him up the beach. Another diver was having difficulty with his equipment snagging, and had given up trying to de-kit himself. So, the dive manager and another diver worked quickly to de-kit him and remove his weight belt. Just as they did this, they were hit by a 6-foot wave out of nowhere, knocking the dive manager off his feet. The dive manager lost his glasses. His sweater was snagged on the diver's cylinder, and as he ripped it off, he was hit by more large waves. Eventually, they all reached shore. All equipment was recovered, except for a weight belt, one fin, and the dive manager's glasses.

SIPE, A Diver's Worst Enemy

Divers are only just becoming aware of SIPE, or Submersion-Induced Pulmonary Edema, also known as scuba diver's immersion pulmonary edema, and the same applies to some elements of the medical profession. Historically, many deaths were written off to drowning, but the circumstances leading to the drowning were often mysterious. It has only been in the past decade that SIPE has become a recognized cause of diver deaths, and we have further described it in the sidebar accompanying this story.

Many divers still don't know about it, its causes, and its symptoms, and the two divers in the following case, both retired physicians, ironically did not know about SIPE.

A diver and her regular buddy descended to 42-feet, and the diver indicated that something was wrong. Her buddy indicated that they should ascend, but at 36-feet, she signaled "OK" and they continued the dive. [She subsequently reported that she had become short of breath at 42-feet but attributed it to nerves that she was determined to overcome].

They continued their descent to 85-feet and, as instructed by the skipper, deployed a DSMB. Fifteen minutes into the dive, the diver signaled that something was wrong and she needed to abort the dive, although she had 2,600psi remaining.

Upon reaching six meters, the buddy signaled her to conduct a safety stop, and she replied, 'OK.' After a minute, she signaled that she needed to ascend urgently and made a fast but controlled ascent to the surface, followed closely by her buddy. [She later reported that she was concerned that she was becoming confused and less able to read her computer or operate her BC controls.]

On surfacing, she said, "I can't breathe, I can't breathe," and then rolled over onto her back. Her buddy swam to her and inflated her BCD as her head dipped briefly below the surface. She was unconscious, unresponsive, not breathing, and completely limp, with her eyes and mouth open, and appeared to have a slight nosebleed.

Her buddy shouted her name, but got no response, so she signaled by waving to the boat, which was about 165 feet away, and it responded immediately. The buddy administered six rescue breaths before the ship stopped alongside, and the skipper handed him a rope. The buddy indicated that the diver was unconscious, and the skipper lifted the diver into the boat.

The skipper removed the diver's BC and then broadcast a 'Mayday'. She remained lifeless and blue; her buddy commenced CPR for one minute and then checked for a carotid pulse but could not find one. He asked the skipper to bring the defibrillator and continued with CPR. The buddy stripped the diver to the waist while the skipper prepared the defibrillator. The diver started choking, and so the buddy rolled her onto her side and cleared her mouth of blood-stained mucus. Meanwhile, the skipper assembled the oxygen kit and the buddy held the mask over the diver's nose and mouth, while repeating her name and reassuring her.

She began breathing normally, coughing up watery, bloody mucus, and vomited a small amount, and became conscious after two minutes of breathing oxygen and began screaming, as if in a dream. She was able to blink her eyes on command, and when a lifeboat and helicopter paramedic were aboard, she was able to correct her buddy when he was telling the medics what medications she was on. She was transferred to a hospital, which had a hyperbaric unit in proximity in case of DCS, by helicopter. Upon arrival, the diver was responsive but visibly shaken, cold, and shivering, and was warmed up with a bear hugger and warm fluids. She continued to cough frothy blood-stained sputum, and an X-ray revealed signs consistent with SIPE, and she had no signs of DCS.

The examining doctor confirmed she had suffered from Submersion-Induced Pulmonary Edema (SIPE) and should not dive again or go swimming in the open water, owing to the high risk of recurrence. She told the doctor that she had shortness of breath at the end of a dive three months prior, and he concluded it was also likely to have been due to SIPE, as she had experienced a similar episode of shortness of breath at the end of a dive some years earlier.

A Bloody Nose from a Backroll

I'm sure you have seen people backroll off the boat and land on another diver, or hit their heads on their tank valve, or lose their mask or weight belt. Also, be aware of the items dangling from your own BC. This fellow no doubt got a bloody nose when the heavy DSMB reel attached to a D-ring on his BC smacked him in the face when he hit the water.

And a few more stories next time.

Ben Davison

P.S.: We have edited the BSAC cases for brevity and clarity, and take all responsibility for errors.