On June 18, 2014 in collaboration with the Undersea Hyperbaric Medical Society, Divers Alert Network sponsored the Medical Examination of Diving Fatalities Symposium. The talks covered specifics of autopsy in scuba fatalities, field investigation of diving accidents, the complexity of rebreather accidents investigation, integration of various aspects of an investigation into final analysis and principles of the epidemiological approach.

Sudden Cardiac Death (SCD) while scuba diving was discussed extensively. While many cardiac-related deaths in scuba diving may be classified as “natural death” associated with preexisting cardiac conditions, the provocative role of diving could not be excluded in some cases. Cardiac causes were suspected in one-quarter to one-third of all recreational diving accidents in recent decades. Rates of cardiac-related deaths vary reflecting regional demographic differences and trends among divers. Current trends of the increasing age of divers are of concern, but on the other hand, cardiac-related deaths in the general population seem to be gradually decreasing thanks to preventive efforts to reduce exposure to lifestyle risk factors and to control involuntary risk factors. Thus, it is not possible to predict whether the current trends in scuba diving fatalities will continue, but cardiac issues will remain for a concern for divers in years to come. Effective trend monitoring requires reliable data including medical examination, and meetings like this one help to advance medical examination practice.

Interpretation of medical examination findings is not possible without knowing details of the dive, the diver’s medical history and information that may reveal mechanisms of injury not evident at autopsy. The process requires inclusion of all available local information sources involved with diving and consideration of a variety of perspectives. The framework for such approach is exemplified in the San Diego Diver Death Review Committee (SDDDRC). This organization includes medical examiners, Coast Guard representatives, lifeguards, police officers, dive instructors, technical experts and other professionals as needed. When the investigation is complete and the data is collected, the SDDDRC convenes, puts the findings in context and provides expert interpretation of it. The average number of scuba fatalities in their jurisdiction is two to three per year. Similar involvement of local experts in analysis of scuba fatalities, although in a less formal way, exists in the Los Angeles area; they review approximately four to five cases per year. Such efforts improve quality of fatality investigation and provide reliable data for epidemiological analysis. Protocols developed by SDDDRC could help shape similar efforts in other regions, but they need to be published in peer-reviewed medical journals and made publicly available.

DAN continually conducts surveys of recreational diving fatalities and integrates available data into a large dataset, which provides insight into scuba fatalities at the population level. DAN has a review process of its own, but the quality of data primarily depends on local investigation. DAN will establish a review panel leveraging in-house and at-large expertise to advance fatality review methodology and make it available to the public.

This symposium provided excellent insight into fatality investigation advances while always keeping the objective in sight—prevention of injuries and fatal accidents in recreational scuba diving. DAN is proud to have sponsored this symposium dedicated to enhancing diver safety.

Post written by: Petar Denoble, MD, D.Sc.