A Diver's Preventable Death in the Azores

Last October, Rob Burstein (Brooklyn, NY) and Sandy Sanford, aged 76 (Bakersfield, CA), with other friends, including Kirk Barrett, travelled to the Portuguese island of São Miguel in the Azores (Açores) to celebrate a 40-year-long friendship. It ended in an unnecessary tragedy.

Three of them booked a dive trip with Açorediving. After they arrived, their divemaster, Mateus (not his real name), checked their credentials, outfitted them with equipment, and they joined three other divers with a second divemaster and the captain. They wore rented 7mm wetsuits to account for the colder waters of the mid-Atlantic, and set off in choppy water in the dive center's RIB (rigid inflatable boat) to the first dive spot about 15 minutes away.

The first group entered the water, leaving Mateus to lead the second group with Rob, Kirk, and Sandy. Unused to such thick wetsuits, the three divers were unable to descend, so Mateus suggested they return to the boat to get additional lead.

Rob Burstein takes up the story:

"Mateus, along with Sandy and Kirk, was the first to return to the ladder, while I trailed shortly behind. Mateus instructed all of us to get back up the ladder and into the inflatable, telling Sandy to go first. After removing her tank and weights, she attempted several times, with increasingly exhausting effort, to grab the sides of the ladder and get her feet onto the first step. Her hands and feet continued slipping off, finally forcing her to fall back into the choppy water.

"The ladder was rather flimsy, not at all stable or secure, with no stable handles. More importantly, its first step did not extend far enough down into the water to allow one to easily access it with dive gear on (Kirk and I tried and couldn't) while remaining fairly vertical. After another couple of exhausting attempts to climb the ladder, Sandy vomited and fell back unconscious into the sea.

"A harrowing, nightmarish situation ensued, with the three of us in the water trying to lift Sandy's unconscious body out of the water enough so that the young guy driving the inflatable, the only person on board, might be able to reach over and grab her to pull her up. None of this was working. Realizing that our efforts were futile, and with time of the essence, we shifted Sandy to the back of the boat, which had a lower profile, where we hoped we might have more success. This took time and great effort from all of us, especially given the choppy seas.

"I finally went on board so that there were two of us up above inside the inflatable and two in the water, and after about 10 or 12 minutes of these efforts, we were able to finally get her up and into the RIB."

"Clearly, the divemaster was not properly knowledgeable about how to get an unconscious person back up on the boat. He should have gone up on the boat with the boat captain, so that there were two people up on top instead of the divemaster being in the water. The procedure then would be for him to reach over and place his arms under her arms, and she would be lifted from beneath by us. With the divemaster and captain boat pulling up at the same time we were lifting, we would have gotten her on board. If this procedure had been done prior to the medical emergency, we might not have had a death."

Rob told us that Mateus's efforts, along with his and Kirk's, to resuscitate Sandy with mouth-to-mouth resuscitation and chest compressions proved fruitless. They asked Mateus to call for a second boat to come pick up the divers who were still in the water, but he didn't and waited for the others to return. They asked Mateus to call for an ambulance to be waiting when they arrived, but he didn't.

An ambulance was called when they finally arrived in port, and she was taken to the hospital, where she was pronounced dead. An autopsy was performed, and Sandy's relatives have been told it will take "months" to get the official cause of death.

The Ladder

Rob says that because of the inadequate ladder, her effort to get aboard caused Sandy's extreme exhaustion, which then set off the medical event, most likely a heart attack, that took her life.

He said "Both Kirk and I, who have hundreds of previous dives and are quite physically fit, had problems with the ladder, finding that it required much more strength and exertion than it should have to then lift oneself out of the water and up the steps onto the boat, and even much more so in the choppy, rough water conditions that existed. This was true even after first trying to get up the ladder with our dive gear on, and then removing our gear to try to make it easier to ascend.

"If a ladder with the safety of its divers in mind had been in use, it would have been a more manageable stable ladder with stable handles, and would have extended farther below the surface, which then would have required just a moderate amount of energy to ascend, and our friend Sandy would not have expended all of her energy leading to her death".

There Were Other Issues

Rob said,

"The divemaster had not given us any recall information during the dive briefing regarding the signal for emergency recall if something should happen during the dive, and divers needed to be called back. This was clearly an emergency, and we asked multiple times that a call be made immediately to the dive shop asking for a second boat to come out, since there were other divers still in the water on their dive. This would have allowed us to leave more quickly, saving precious time to try to get treatment. This was not done since no second boat ever showed up. This caused a delay and added to the cause of Sandy's death.

"Additionally, the divemaster did not follow the proper procedure for clearing the airway of material that is blocking it, such as vomit, by placing a person on their side and clearing the airway of whatever is obstructing it before trying to administer oxygen via mouth-to- mouth resuscitation or with an oxygen canister and mask. Further, the divemaster did not seem familiar with the use of the oxygen machine, causing one to question when he last used it or was trained on its use.

"We also asked multiple times that a call be made immediately to the company, asking that an ambulance be called so that it could be waiting for us when we arrived back at the dock, thus saving precious minutes. This was not done. After the other divers and their divemaster finally returned on board, and when we did get to the dock, we still had to wait several more minutes for the ambulance to arrive.

'Thus, I hope any dive operator, land based or liveaboard, would think about the implications of their boat ladders, and assure that their ladders provide safe and easy access to their boats. They may very well save a life. Had this Azores dive operator given thought to it, my good friend may still be alive.

"It goes without saying that safety should be of paramount importance when it comes to diving. It is, therefore, perplexing, shameful even, that no standard exists in the dive industry for what a safe diving ladder must be. In order to prevent others from suffering the same fate that this experienced diver did, it is critical that this change and that such a standard be quickly developed and mandated for use throughout the world of diving! In an industry that is largely unregulated, it might seem a fool's errand to hope that this could become a reality. However, perhaps if one of the larger entities in the diving industry, like PADI, for example, were to initiate this, others might follow suit."

Age, Fitness, and Exertion

Clearly, Rob is upset, and it's understandable. It's obvious the ladder proved inadequate, and while its inadequacy started the tragic event, it's not the cause, because decisions afterwards may have changed the outcome. It might have been a preventable death had proper medical assistance and equipment been immediately available. We don't know.

Perhaps one, but certainly two, failed attempts in choppy water should be enough for the divemaster to come to her aid. Her determination to keep retrying something she could not do is a cautionary tale for any diver in a similar situation. While we don't know anything about her health, a wise diver has annual medical checkups and visits a cardiologist regularly, especially since the leading cause of diver deaths begins with cardiac issues.

The conundrum as to what to do when a medical emergency requires the boat to leave a dive site while other divers are still underwater haunts every dive guide. Few small boats, if any, carry defibrillators, which might be dangerous to use in wet conditions, but my own hopefully never-to-be-repeated experience tells me impeccably delivered EAR is of little use without a defibrillator if the casualty's heart has finally stopped.

And what of "sniper alley?" We all reach an age when it becomes imperative to reconsider our health, our fitness, and our ability to do some things. When diving, we are usually surrounded by younger, fitter people who are only too willing to help. Don't be ashamed to ask. Even stable liveaboards with properly designed spine ladders can represent a hazard -- pass up your tank, weights, and fins to a crew member before climbing up. (MY. Odyssey in Truk Lagoon has installed a diver's elevator.) Once past the age of 70, the grim sniper is waiting with all of us in his sights.

John Bantin (aged 79)