Diving-related fatalities: multidisciplinary, experience-based investigation
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.
KeywordsSCUBA 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
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.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.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. http://www.ncbi.nlm.nih.gov/books/NBK424394/. Accessed 11 Dec 2018.
- 5.Vinkel J, Bak P, Hyldegaard O. Danish diving-related fatalities 1999-2012. Diving Hyperb Med. 2016;46:142–9.Google Scholar
- 8.Smith N. Scuba diving: how high the risk? J Insur Med. 1995;27:15–24.Google Scholar
- 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. http://www.ncbi.nlm.nih.gov/books/NBK487739/. Accessed 11 Dec 2018.
- 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
- 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
- 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.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.Lawrence C, Cooke C. Autopsy and the investigation of scuba diving fatalities. Diving Hyperb Med. 2006;36:2–8.Google Scholar
- 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
- 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.Fock AW. Analysis of recreational closed-circuit rebreather deaths 1998-2010. Diving Hyperb Med. 2013;43:78–85.Google Scholar
- 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