Vol 69, No 2 (2018)
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Published online: 2018-06-22

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Violations of safe diving practices among 122 diver fatalities

Karl Shreeves1, Peter Buzzacott23, Al Hornsby1, Mark Caney1
Pubmed: 29939385
IMH 2018;69(2):94-98.


Background: Diving is a popular recreation with an excellent safety record, with an estimated 1.8 deaths
per 1 million dives. This study investigated the relationship between intentional deviation from accepted
diving practices (violations) and diver fatalities.

Materials and methods: The authors examined 119 incidents/122 diver fatalities that did not involve diver
training in North America and the Caribbean, and identified the presence of violations of accepted diving
safety practices, as well as if the death was associated with an acute medical event such as heart attack.
Results: Of the 122 fatalities, 57% (n = 70) were associated with a medical event and 43% (n = 52) were
non-medical. Violations were found in 45% of fatalities (n = 55) overall. Violations were recorded for 23%
of the 70 medical and 75% of the 52 non-medical fatalities. Divers who died from something other than
a medical cause were 7 times as likely to have one or more violations associated with the fatality (OR 7.3,
95% CI 2.3–23.2). The odds of dying from something other than a medical condition increased approximately
60% for each additional 10 metres of depth. The odds of a death being associated with a medical
condition increased approximately 9% per year of age, or 2.4 times for every 10 years older a diver was.

Conclusions: Medical events are associated with over half of the non-training related diver fatalities in North
America and the Caribbean, with the odds of death being associated with a medical condition doubling
each decade of additional age. These data support recommendations that divers stay physically fit and
have regular medical checkups, particularly as they get older. They also strongly support the safety benefit
of adhering to established safe diving practices.

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  1. Buzzacott P, Schiller D, Crain J, et al. Epidemiology of morbidity and mortality in US and Canadian recreational scuba diving. Public Health. 2018; 155: 62–68.
  2. Buzzacott P. editor). DAN Annual Diving Report 2016 Edition: A report on 2014 data on diving fatalities, injuries, and incidents. Buzzacott P, editor. Durham, NC: Divers Alert Network; 2016. PMID. 28211666.
  3. Pougnet R, Costanzo LDi, Loddé B, et al. Cardiovascular risk factors and cardiovascular risk assessment in professional divers. Int Marit Health. 2012; 63(3): 164–169.
  4. Buzzacott P, Rosenberg M, Pikora T. Western Australian recreational scuba diving fatalities, 1992 to 2005. Aust N Z J Public Health. 2009; 33(3): 212–214.
  5. Edmonds C, Walker D. Scuba diving fatalities in Australia and New Zealand: The human factor. South Pacific Underwater Medicine Society Journal. 1989; 19: 94–104.
  6. Biersner RJ. Factors in 171 navy diving decompression accidents occurring between 1960-1969. Aviat Space Environ Med. 1975; 46(8): 1069–1073.
  7. Acott CJ. Human error and violations in 1, 000 diving incidents: A review of data from the Diving Incident Monitoring Study (DIMS). South Pacific Underwater Medicine Society Journal. 2005; 35: 11–17.
  8. Puchades VM, Pietrantoni L, Fraboni F, et al. Unsafe cycling behaviours and near crashes among Italian cyclists. Int J Inj Contr Saf Promot. 2018; 25(1): 70–77.
  9. Freeman J, Rakotonirainy A. Mistakes or deliberate violations? A study into the origins of rule breaking at pedestrian train crossings. Accid Anal Prev. 2015; 77: 45–50.
  10. Lagache E. Are divers choosing to die? Undersea Journal. 1993; Fourth Qtr: 50–54.
  11. Reason J. Human Error. Cambridge: Cambridge University Press. 1990.
  12. Buzzacott P, Denoble PJ, Simon O, et al. Dive problems and risk factors for diving morbidity. Diving Hyperb Med. 2009; 39(4): 205–209.
  13. Vann RD, Denoble P, Dovenbarger J, et al. Report on Decompression Illness, Diving Fatalities and Project Dive Exploration: 2005 Edition (Based on 2003 data). Durham, NC: Divers Alert Network. 2005.
  14. Berenji Ardestani S, Buzzacott P, Eftedal I. The aging diver: endothelial biochemistry and its potential implications for cardiovascular health. Diving Hyperb Med. 2015; 45(4): 235–239.
  15. Denoble PJ, Marroni A, Vann RD. Annual fatality rates and associated risk factors for recreational scuba diving. In: Vann RD, Lang MA, editors. Recreational Diving Fatalities Worksho Proceedings; Durham, North Carolina: Divers Alert Network. 2010: 73–85.