Forensic Science, Medicine and Pathology

, Volume 15, Issue 2, pp 224–232 | Cite as

Diving-related fatalities: multidisciplinary, experience-based investigation

  • Josep M. CasadesúsEmail author
  • Fernando Aguirre
  • Ana Carrera
  • Pere Boadas-Vaello
  • Maria T. Serrando
  • Francisco Reina
Original Article


To describe the technical characteristics of fatal diving mishaps and to elucidate the causes of death using a sequence analysis and a multidisciplinary investigation of diving-related fatalities. All cases of diving deaths recorded on the coast of Girona (Spain) between January 2009 and May 2018 were analyzed. Most data were obtained from the police technical reports and the forensic pathology service. Each accident was analyzed in order to identify the trigger, disabling agent, disabling injury, and cause of death. During the study period 25 diving-related fatalities were recorded. Most of the victims were males aged 50–69 years, and 11 were experienced divers. Almost all victims were using open-circuit SCUBA to breathe with compressed air as their sole gas supply. None of the victims were diving alone. The most common identified triggers included exertion, panic, buoyancy problems, disorientation and confusion. The main factors identified as disabling agents were rapid ascent, a cardiac incident, panic and entrapment. Asphyxia, lung over expansion, and myocardial ischemia were the most frequent disabling injuries. Finally, drowning represented the main cause of death, followed by arterial gas embolism and natural causes or internal diseases. A differential diagnosis, performed in the setting of a multidisciplinary investigation, is essential for elucidating the cause of death in diving-related fatalities. The proposed sequence analysis allows to clarify underlying problems in these cases and to identify risk factors and unsafe behaviors in diving.


SCUBA diving Police reports Forensic pathology Autopsy Causes of death 



We gratefully acknowledge our colleagues and technical staff at the Institute of Legal Medicine and Forensic Sciences for their contribution and assistance during autopsies. The authors also thank i2e3 Biomedical Research Institute for editing the final version of the manuscript and Agency for Management of University and Research Grants-AGAUR, Generalitat of Catalonia for your support (Grant number 2017 SGR 1279).

Compliance with ethical standards

Conflict of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments, or comparable ethical standards.


  1. 1.
    Casadesús JM, Aguirre F. Estudio de las muertes durante la práctica de buceo. In: Delgado S, Bandrés F, Lucena J, editors. Tratado de Medicina Legal y Ciencias Forenses III. Patología y Biología. Forense. Barcelona: Bosch; 2011. pp. 691–711.Google Scholar
  2. 2.
    Buzzacott P, editor. DAN annual diving report, 2016 Edition: a report on 2014 data on diving fatalities, injuries, and incidents. Durham (NC): divers alert Network; 2016. Accessed 11 Dec 2018.
  3. 3.
    Edmonds C, Caruso J. Recent modifications to the investigation of diving related deaths. Forensic Sci Med Pathol. 2014;10:83–90.CrossRefGoogle Scholar
  4. 4.
    Ihama Y, Miyazaki T, Fuke C, Mukai T, Ohno Y, Sato Y. Scuba-diving related deaths in Okinawa, Japan, from 1982 to 2007. Leg Med (Tokyo). 2008;10:119–24.CrossRefGoogle Scholar
  5. 5.
    Vinkel J, Bak P, Hyldegaard O. Danish diving-related fatalities 1999-2012. Diving Hyperb Med. 2016;46:142–9.Google Scholar
  6. 6.
    Shreeves K, Buzzacott P, Hornsby A, Caney M. Violations of safe diving practices among 122 diver fatalities. Int Marit Health. 2018;69:94–8.CrossRefGoogle Scholar
  7. 7.
    Desola J. Sudden death of non-cardiological origin during exercise. The dysbarism model. Med Clin (Barc). 2017;148:566–8.CrossRefGoogle Scholar
  8. 8.
    Smith N. Scuba diving: how high the risk? J Insur Med. 1995;27:15–24.Google Scholar
  9. 9.
    Buzzacott P, editor. DAN annual diving report, 2017 edition: a report on 2015 diving fatalities, injuries, and incidents. Durham (NC): divers alert Network; 2017. Accessed 11 Dec 2018.
  10. 10.
    Busuttil A, Obafunwa J. A review of the forensic investigation of scuba diving deaths. Sci Justice. 1995;35:87–95.CrossRefGoogle Scholar
  11. 11.
    Craig L, Nelson MD. Expert panel review of investigation and autopsy findings. In: Denoble PJ, editor. Medical examination of diving fatalities symposium proceedings. Durham: Divers Alert Network; 2015. p. 62–4.Google Scholar
  12. 12.
    Aquila I, Pepe F, Manno M, Frati P, Gratteri S, Fineschi V, et al. Scuba diving death: always due to drowning? Two forensic cases and a review of the literature. Med Leg J. 2018;86:49–51.CrossRefGoogle Scholar
  13. 13.
    Robert G, Teather CV. Scuba fatality-accident investigation. In: Robert G, Teather CV, editors. Encyclopedia of underwater investigations. 2nd ed. Palm Beach Gardens: Best Publishing Company; 2013. p. 303–77.Google Scholar
  14. 14.
    Wheen LC, Williams MP. Post-mortems in recreational scuba diver deaths: the utility of radiology. J Forensic Legal Med. 2009;16:273–6.CrossRefGoogle Scholar
  15. 15.
    Bonastre MV, Casadesús JM, Crespo S, Martínez H, Martínez M, Subirana M, et al. Death in water. In: Castellà J, Marrón MT, Recio I, editors. Specific recommendations for the unification of judicial autopsies at the Institute of Legal Medicine of Catalonia. Barcelona: CEJFE, Generalitat de Catalunya; 2013. p. 63–7.Google Scholar
  16. 16.
    Denoble PJ, Caruso JL, Dear G de L, Pieper CF, Vann RD. Common causes of open-circuit recreational diving fatalities. Undersea Hyperb Med. 2008;35:393–406.Google Scholar
  17. 17.
    Lawrence C, Cooke C. Autopsy and the investigation of scuba diving fatalities. Diving Hyperb Med. 2006;36:2–8.Google Scholar
  18. 18.
    Caruso JL, Appendix F. Autopsy protocol for recreational scuba diving fatality. In: Vann RD, Lang MA, editors. Recreational diving fatalities workshop proceedings. Durham: Divers Alert Network; 2011. p. 277–9.Google Scholar
  19. 19.
    Vinkel J, Bak P, Juel Thiis Knudsen P, Hyldegaard O. Forensic case reports presenting immersion pulmonary edema as a differential diagnosis in fatal diving accidents. J Forensic Sci. 2018;63:299–304.CrossRefGoogle Scholar
  20. 20.
    Buzzacott P, Nelson C, Hill K, Hires L. Recovery of deceased scuba divers from within flooded subterranean caves. Forensic Sci Int. 2017;275:167–70.CrossRefGoogle Scholar
  21. 21.
    Haynes P. Increasing the probability of surviving loss of consciousness underwater when using a rebreather. Diving Hyperb Med. 2016;46:253–9.Google Scholar
  22. 22.
    Fock AW. Analysis of recreational closed-circuit rebreather deaths 1998-2010. Diving Hyperb Med. 2013;43:78–85.Google Scholar
  23. 23.
    Morgan WP. Anxiety and panic in recreational scuba divers. Sports Med. 1995;20:398–421.CrossRefGoogle Scholar
  24. 24.
    Narayanan K, Bougouin W, Sharifzadehgan A, Waldmann V, Karam N, Marijon E, et al. Sudden cardiac death during sports activities in the general population. Card Electrophysiol Clin. 2017;9:559–67.CrossRefGoogle Scholar
  25. 25.
    Vincenzi FF. Drug-induced long QT syndrome increases the risk of drowning. Med Hypotheses. 2016;87:11–3.CrossRefGoogle Scholar
  26. 26.
    Obafunwa JO, Purdue B, Busuttil A. Endomyocardial fibrosis in a scuba diving death. J Forensic Sci. 1993;38:1215–21.CrossRefGoogle Scholar
  27. 27.
    Buzzacott P, Edelson C, Bennett CM, Denoble PJ. Risk factors for cardiovascular disease among active adult US scuba divers. Eur J Prev Cardiol. 2018;25:1406–8.CrossRefGoogle Scholar
  28. 28.
    Zhu BL, Quan L, Li DR, Taniguchi M, Kamikodai Y, Tsuda K, et al. Postmortem lung weight in drownings: a comparison with acute asphyxiation and cardiac death. Leg Med (Tokyo). 2003;5:20–6.CrossRefGoogle Scholar
  29. 29.
    Edmonds C, Lippmann J, Lockley S, Wolfers D. Scuba divers’ pulmonary oedema: recurrences and fatalities. Diving Hyperb Med. 2012;42:40–4.Google Scholar
  30. 30.
    Casadesús JM, Aguirre F, Carrera A, Boadas-Vaello P, Serrando MT, Reina F. Diagnosis of arterial gas embolism in SCUBA diving: modification suggestion of autopsy techniques and experience in eight cases. Forensic Sci Med Pathol. 2018;14:18–25.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institute of Legal Medicine and Forensic Sciences of Catalonia, (Division of Girona, Spain)GironaSpain
  2. 2.Research Group on Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical SciencesUniversity of GironaGironaSpain
  3. 3.Experimental Neurophysiology and Clinical Anatomy (NE∾ 2017 SGR 01279), Department of Medical SciencesUniversity of GironaGironaSpain
  4. 4.Department of Medical Sciences, Faculty of MedicineUniversity of GironaGironaSpain
  5. 5.Special Group for Underwater Activities (GEAS) of the Spanish Civil GuardEstartitSpain
  6. 6.ICS-IAS Girona Clinical LaboratorySaltSpain

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