A Tale of Two Accidents

Ed.'s note: This tale presents the anatomy of a diving accident and the lessons to be learned from it. The incidents described coul be real.

Scene 1: The Way It's Supposed To Be    A beautiful day--blue sky and calm, clear water. Suddenly, near the boat, a diver yells for help; next to him, his buddy is obviously in trouble. Immediately, other divers enter the water to help and soon have both divers back on deck. One diver complains of pain, tingling, headache and fatigue. His buddy explains that they were on a deep dive and, during the ascent, his companion ran out of air. They started sharing air, then lost buoyancy control and popped to the surface. At the surface, his buddy was unconscious for a few moments before he had time to yell for help.

The boat crew immediately puts the injured diver on oxygen and treats him for shock. Emergency services are radioed and transportation to the nearest chamber with medical support is quickly arranged.

First aid for shock and the administration of oxygen continue while the injured diver waits for the helicopter and then during the helicopter flight, the short ambulance ride and the brief transition time at the chamber. Before the injured diver enters the chamber, he is not experiencing any symptoms of a diving malady. But to be safe, the attending physician treats him on a short schedule. A few hours later, the diver is released from the chamber, tired but with no residual effects from what could have been a serious case of air embolism or decompression sickness.

Scene 2: A Different Outcome    Meanwhile, in courtroom litigation of an unrelated case concerning a fatal diving accident, an attorney questions a physician who is serving as an expert witness.

"So, doctor, it is your contention that oxygen should have been available at the site of this diving accident?"

"Yes, it is. But that's only part of the issue here."

"Well, what do you see as the whole issue?"

"The people in charge of this dive had both a moral and legal responsibility to have emergency oxygen equipment available, and to use it. In this case we have an air embolism injury that led to a needless fatality, because the victim was not promptly provided proper first aid, including the use of oxygen."

The physician continues: "It is foreseeable that diving accidents will occur. It is also well-known that the administration of oxygen is extremely valuable during decompression sickness, air embolism or any breathing difficulty encountered as a result of diving, and that there is no significant contraindication to the use of oxygen in diving emergencies. The value of administering oxygen is so great that it can mean the difference between life and death, or between full recovery and a life of permanent disability. We are not dealing with a 'maybe' here, but a sure thing--oxygen does no harm and makes a significant contribution to the recovery of a diving accident victim. Not to use it is irresponsible, negligent behavior."

The trial and the questions continue with the calling of a diving expert.

"So, as a diving expert, what is your opinion as to the use of oxygen by dive operators?"

"The standard of care is perfectly clear: have it, be able to find it, have it in working order, have the cylinder full, have training in using it, and actually use it, giving the best flow for as long as possible."

"But in this case the victim was not breathing. So how could oxygen be used?"

"Here it is even more important to give oxygen as mouth-to-mouth is being performed. This is done with a pocket mask or by simply putting the oxygen tube on continuous flow in the victim's mouth."

Because of such testimony, the defense offers a settlement that is accepted by the plaintiffs--the diver's family.

Analysis    Oxygen is a key element in any diving emergency procedure. Other elements include: a written emergency plan; training in first aid, CPR, oxygen use and diver rescue; communications; transportation; and medical support. Of additional importance is calling the emergency services, and being ready and willing to do so. Better to make a call and be told that the symptoms you're calling about are not diving-related, than to have a needed treatment delayed, causing unnecessary suffering or loss.

All dive operators, boats, clubs, instructors, resorts, schools, stores or tour groups must have oxygen available when dives are being conducted. There is no question as to its value. From a practical, medical, human or legal point of view, it is a necessity.

Lessons For Life