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by Michael Menduno
May 1, 2019—Nearly three dozen rebreather aficionados made the biannual trek to Ponza, Italy, a picturesque island in the Tyrrhenian Sea about a three-hour journey from Rome. They were there for the sixth International Rebreather Meeting organized by Andrea Donati, owner of Ponza Diving Center, and his partner Daniela Spaziani. The goal of the four-day meeting, which was sponsored by a number of manufacturers and organizations, including JJ CCR, Shearwater, DAN Europe, Società Italiana Medicina Subacquea e Iperbarica (SIMI), and the Italian rebreather users’ association CCR Italia, was to provide the latest research and information to the rebreather community.
“They’re passionate tech divers hungry for information,” explained Dr. Simon Mitchell, a professor of anesthesiology at the University of Auckland, New Zealand, who was one of the presenters. “That’s what I love about these types of meetings. I am happy to be here and share what I know.”
Taking a cue from the hyperbaric medical community, the meeting was organized to appeal to diver sensibilities; diving in the morning (8:30 a.m.- 2:00 p.m.), and lectures and discussion in the afternoon (3:00 p.m. – 7:00 p.m.) followed by dinner and drinks (9:00p.m. – 11:30 p.m. or later).
Dive Right In!
Donati and his crew did a masterful job of supporting more than twenty rebreather divers bearing scooters, cameras, and bailout bottles, along with a few open circuit divers, without incident. Their enthusiastic attitude and thoughtful attention to detail, whether it was solving specific problems with individual’s rebreathers, or bringing in attendees dry suit underwear hanging on the exterior of the boat before the after dinner rain hit, helped the operation run smoothly and efficiently while feeling relaxed. They were aided by Ponza Diving’s ubiquitous mascot, an amicable large black matif named Ugo.
The boat, which was docked just outside of the dive shop, headed out each morning around 8:30 a.m., as divers huddled over Italian espresso and fresh bread after prepping their breathers. Interestingly, as we were loading up the boat on the first day there, Donati made a point of warning both me and Peter Symes, publisher of X-Ray magazine, to go easy on the coffee. “It can kill you,” he said with all seriousness, citing an American diver who had a heart attack underwater after consuming too many cups of espresso. The boat then made its way to one of the numerous submerged seamounts covered in soft corals surrounding the island, where it would anchor for the morning dive.
Our morning dives were typically 165-261 ft/50-80m deep with one-to-two-hour run times. Visibility was 50-65 ft/15-20 m and water temperature was about 58-60°F/15-16°C. Following each dive, we were treated to a multi-course lunch, which usually included soup, fish, cephalopods, rice, pasta, bread, salad, and dessert, along with the requisite pitcher of wine and more espresso. After lunch, the boat headed back to port, where we prepped gear for the next day’s dive.
Where’s The Manzo, err Beef?
While rebreather diving in Ponza was clearly the attraction that brought people together, the presentations, given by some of the community’s leading scientists, engineers, and practitioners were the meat of the meeting. (Are you detecting a pattern here?) Our group met in an old stone chapel up the hill from the dive shop. Headphones were available for sequential English and Italian translation.
One of the themes that emerged from the meeting was the role of human factors, i.e. the way we process and act on and or fail to act on information, and its impact on diving safety. This is a deep body of knowledge that was developed in the aviation and healthcare fields and is now being applied to diving largely through the efforts of pioneer Gareth Lock at The Human Diver. Several of us noted that human factors were being discussed in the absence of the seemingly ubiquitous Lock, was a sign that this important work was beginning to gain traction. Here are some of the highlights.
Training Doesn’t Work: Technical Diving International (TDI) Rebreather Instructor, Instructor Trainer, and author Mark Powell began with a list of ten improvements in rebreather diving that he would like to see from a community perspective; things like better buoyancy control, the increased use of checklists, and more attention to bailout planning. He then asked the question, “Why hasn’t training made a difference?” That is, why hasn’t training produced permanent observable changes in divers’ behavior in these areas? The answer, documented by numerous studies, is that humans aren’t very good at retaining information.
The solution: deliberate practice of essential skills. “People tend to practice things they like and are good at, which is not very helpful,” Powell explained, noting that practicing things that are very difficult to do doesn’t work either. “The sweet spot,” he said, “is practicing things that are challenging.” He recommended that divers practice something on every dive! Sounded very GUE to me.
In-water Recompression (IWR): The use of in-water recompression to treat divers at remote locations has long been controversial, and until recently the hyperbaric medical community has failed to reach a conclusion regarding its efficacy. But as Simon Mitchell explained, the situation has now changed as a result of a new paper, “In-Water Recompression”, he co-authored with Dr. David Doolette, a decompression physiologist at the U.S. Navy Experimental Diving Unit (and a GUE diver). The two were able to find evidence not previously reported that answers two key questions:
- Does early recompression improve outcomes? (i.e. recompressing an injured diver within minutes vs hours)
- Is shallower, shorter recompression effective? (Note that IWR typically compresses the diver on 100% oxygen to 30 ft/9 m vs. a USN Table 6 to 60 ft/18 m.)
Based on U.S. Navy data derived in part from early research on treatment protocols, Mitchell and Doolette were able to answer both questions strongly in the affirmative. The new recommendation: A diver should be treated with IWR if a chamber is more than two hours away and the team is set up to provide IWR (i.e. has proper equipment such as full face mask and training, support, environmental conditions, and appropriate patent status).
Defensive Dive Profiling/Concerns for Aging Divers
Dr. Neal Pollock, research chair in hyperbaric and diving medicine at Université Laval, gave a pair of eye-opening lectures on the potential long-term impacts of decompression stress, what can be done, and the prospects for aging divers. Was he talking about us?
Pollock began by citing studies that found lesions in the brain and spinal cord have been observed with higher frequency in individuals with a history of repeated decompression stress. Bone lesions have also been found in commercial divers. The factors shown to increase the risk of dysbaric osteonecrosis in commercial divers were: a history of inadequate or experimental decompression, diving deeper than 165 ft/50 m, and a history of decompression sickness (DCS). The conclusion: while dysbaric osteonecrosis has largely been eliminated in commercial diving due to procedural changes, decompression stress poses a potential long-term risk factor for technical divers! Divers need to think about immediate and long-term risk.
As a result, Pollock, who is known for doing extra deco, encouraged divers to do longer shallow decompression adding, “It can’t hurt. It can only help.” Specifically, he recommended several ways of adding conservatism: using conservative gradient factors, primarily reducing GF-high, buffering the dive by slowing down on the final ascent to the surface following the last high pO2 stop, delaying exercise post-dive, extending surface intervals to add more time for recovery, using appropriate gasses (Yes, “air is for tires!”), choosing appropriate partners with similar risk tolerances, and maintaining good physical fitness.
The bottom line for aging divers; there is no upper age limit, though there may come a point where you need greater support. Be forewarned! Note, there were several post 65-year-old divers making the plunge at Ponza!
Human Factors In Rebreather Diving: Mitchell began by noting that human factors were the most important, but also the hardest, path to improving safety in rebreather diving. He then posed the question: Is there a safety problem with rebreather diving?
Mitchell began by reviewing what we know about rebreather safety based on the ground-breaking 2012 paper by Dr. Andrew Fock analyzing recreational rebreather deaths 1998-2010, to wit: There were approximately 20 deaths/year for 2000-2010 from a population, which was then estimated to be about 18,000 rebreather divers based on agency certifications. That means that the fatality rate for rebreather diving was estimated to be about 133 deaths/100,000 divers/year compared to about 16 deaths/100,000 divers/year for open circuit diving. The conclusion: rebreather diving was about 10x more hazardous than open circuit scuba. Note, there is currently a follow up study underway to determine if things have improved.
Mitchell broke down the causes of rebreather fatalities into three buckets:
• Hazards of advanced diving
• Rebreather equipment failures
• Diver error and violations
Overwhelmingly, most incidents arose from diver errors (Trying to do the right thing but doing the wrong thing) and violations (Knowingly creating unnecessary risk of harm to yourself and others, and expecting to get away with it). “I have made errors and violations in my rebreather diving,” Mitchell offered to the assembled group of divers, “and I bet you have too.”
What’s to be done?
Mitchell reviewed several fatalities involving violations, like diving with two-year old oxygen sensors, or using a type of sorb not specified by the manufacturer. He said that we needed to remove the motivation for violations. This involves a culture change: Make safe choices be seen as a strength versus a weakness. Training, mentoring, and role modeling are critical in this regard.
Typical errors might include forgetting to analyze one’s gas, forgetting to turn on the rebreather or open the oxygen valve, or leaving out an O-ring on the scrubber. In fact, each of these errors has resulted in multiple fatalities. Mitchell said that pre-dive checklists are the primary means for preventing errors. As a testament to the power, he cited a study analyzing the impact of using checklists in surgical suites: Deaths were reduced by 50% after the introduction of checklists, and as Mitchell pointed out, these were among highly trained professionals. He then cited a DAN study of some 2041 dives examining the impact of pre-dive checklist use on scuba mishaps; mishaps, including rapid ascents and low/out of air were reduced by 36%.
The barriers to using checklists?
First, misunderstanding about their purpose; checklists are not meant to replace a manual! Second, arrogance/ignorance; I can do it from memory, or I don’t make mistakes. Checklists can be supported by training, practice, and engineering.
Interestingly, after the meeting I asked one of the Italian rebreather divers if he used a checklist on our dives. “My instructor taught me to do it by memory,” the diver told me, “So that is what I do. I haven’t had any problems.” Until he does, and therein lies the problem.
Bruce Partridge, founder of Shearwater Research, also focused his talk on human factors and changing divers’ behaviors. He began by talking a little about the history of Shearwater, which got it start making rebreather controllers before venturing into dive computers. He then discussed the work involved in assuring that rebreather sub-systems like controllers meet safety requirements as part of the CE 14143 standard, which they published in a 2013 IEEE paper. Partridge said he believed that the CE 14134 standard was a really good thing for the rebreather industry. Interestingly, he pointed that there were approximately 600 failure modes possible on a rebreather, however, only 40 were equipment related; the remainder involve diver errors.
Explorer Edoardo Pavia, owner of Sea Dweller Divers, also spoke passionately about rebreather safety in light of human factors from his personal experiences. He began by speaking about British expedition leader Carl Spencer’s tragic death on the 2009 Britannic Expedition. Spencer mistakenly breathed an unmarked, high-oxygen content bailout cylinder at depth and convulsed and drowned. Pavia shared his views about the importance of following manufacturers’ rules and recommendations regarding checklists, oxygen sensors lifetime, scrubber duration, using proper sorb, and the importance of bailout out valves (BOV). He concluded that ignorance was “the hardest monster to defeat.”
Massimo “Max” Pieri, research supervisor for DAN Europe, presented their research focusing on preventing decompression illness (DCI) using DAN’s diving database of some 66,000 dives ranging in depth from 16-628 ft/5-192 m, average depth 100 ft/30 m. Some of the factors they have considered include: gradient factors, hydration, genetic disposition, and hematological parameters. They are also conducting a decompression study with a local (Italian) GUE group in cooperation with instructor Mario Arena, examining the efficacy of so-called “deep stops” vs shallow decompression profiles [See Dr. David Doolette’s post, “Gradient Factors in a Post-Deep Stops World,” in this blog issue for additional data].
Next, DAN Europe president Dr. Alessandro Marroni discussed his visionary program dubbed Advanced Virtually Assisted Telemedicine in Adverse Remoteness (AVATAR). Their goal is to develop tools and procedures to enable real-time monitoring of divers during their dives—think Fitbits on steroids! Marroni described his vision of a DAN doctor able to assess a diver who’s still in the water, and communicate directly with that diver via an underwater communications system. In fact, they have already tested prototypes.
Dott. Pasquale Longobardi, president of SIMI, also presented SIMI’s research examining the biochemical mechanisms involved in decompression stress. He concluded with a set of best practices, namely to run pO2s at 1.3 bar or less, maintain pN2s at 3.16 bar (the equivalent of breathing air at 100 ft/30 m) or less and run pHe as high as possible; Longobardi stated that helium in the form of trimix protects divers from oxidative stress (inflammation) compared to diving air (kick those tires again!). A colleague in the audience told me he had questions about the supporting data.
Having gotten our daily dose of brain food, attendees retired to their hotels and apartments to catch up on email, clean up, and later walk to the ristorante du jour that had been chosen for that evening. There we were greeted by our attentive hosts, Andrea and Daniela, accompanied by Ugo, who had arranged for a family-style dinner with wine and made sure that everyone had enough to eat and drink. If you had trekked to the meeting for the food alone, you would have not been disappointed.
“Mangia,” Dani told me gesturing emphatically with her hands and pointing to my empty plate, after the second, or was it the third course? “Please, you must eat some more,” she insisted passing me a bowl of mussels.” It felt like a family gathering—a family of passionate, geeky divers who were there to commune with their peers in celebration of l’arte e pratica che amiamo. And the eating and drinking and sharing of stories continued into the night.
Header Image: Marco Sieni.
X-Ray International Dive Magazine will be featuring more about the meeting and Ponza diving including some compelling images in their June issue.
Michael Menduno is InDepth’s executive editor and, an award-winning reporter and technologist who has written about diving and diving technology for 30 years. He coined the term “technical diving.” His magazine “aquaCORPS: The Journal for Technical Diving”(1990-1996), helped usher tech diving into mainstream sports diving. He also produced the first Tek, EUROTek, and ASIATek conferences, and organized Rebreather Forums 1.0 and 2.0. Michael received the OZTEKMedia Excellence Award in 2011, the EUROTek Lifetime Achievement Award in 2012 and the TEKDive USA Media Award in 2018.
No Direction Home: A Slovenia Cave Diving Adventure
Suffering from Covid lockdown, young, poetic Italian explorer, instructor, and gear-maker, Andrea Murdock Alpini, decided to take social distancing to the max! He packed his specially designed cave-van and set out on a three-week solo road trip to dive the water-filled caves lying beneath the Slovenian soil. His report and must-see video log, dubbed, “No Direction Home”—an homage to Martin Scorsese’s Bob Dylan docu—will likely satisfy those deeper urges for adventure. Did I mention the killer soundtrack? Kids don’t try this at home!
Text: Andrea Murdock Alpini
Photo & Video: Andrea Murdock Alpini
Ecco la storia originale così com’è stata scritta in italiano
Author’s note: I do not encourage other divers to conduct solo diving. The trip and the dives described in this article were conducted after significant training and experience.
Ed.Note: Global Underwater Explorers does not sanction solo diving.
That was the feeling I had last June 2020 when I left my home to begin a journey alone. Caves, abandoned mines, alpine lakes, and a few wrecks—that was my plan for a great adventure.
The first COVID-19 lockdown had been in place for a couple of weeks, and I was afraid of going out and meeting people. Social distancing left an open wound. I loaded my wreck-van with plenty of stuff to survive alone for a long month traveling amongst rivers, lakes, mountains, and forests, and I was ready to practice scuba diving.
At that time, tourist travel was impossible in Italy or abroad—anywhere in Europe—because the coronavirus had locked the borders. I asked an editor in chief from a magazine—one whom I am used to sending articles to—to prepare a couple of official invitation letters for customs. For my trip, I converted my wreck van into a cave van. It was fully equipped with a 300-bar air compressor, helium, oxygen, deco cylinders, twinsets of different sizes, gas booster, fins, mountain boots, tent, camp burner, and brand-new dry suits, as well as thermal underwear to be tested for my company PHY Diving Equipment.
I remember the day well. I was thrilled as I crossed the border between Italy and Slovenia. I had been restricted to nothing but a 200 m/650 ft walk from my house because of the pandemic restrictions, but with an eight-hour drive, I was free to enjoy walking into wild nature all alone.
The mental switch was awesome, and unexpected. I did make just one phone call from abroad. I talked to an incredible Russian who was the first guy I met in a small rural village in Slovenia. He had emigrated some years ago, and now he welcomed travelers by sharing his farmstead.
However, once I arrived on site, I was not very welcomed by the weather; instead, I was met by heavy rain. After the storm passed, I went out walking and filming with my phone. I had decided to record all of the trip. As luck would have it, the rain returned again, and it never left me for the entire duration of my trip (almost a month).
My tour was articulated throughout Slovenia, Garda Lake (Italy), Austria, and South Tirol’s Alps, Tuscany’s caves, and finally I reached the central part of Italy—Appenini mountains and their peaks. I planned to reach two mines, but heavy rains stopped my dream. Excluding Slovenia, where I slept in a traditional bed, I passed all my time living in my tent. Cold weather and storms were my constant companions.
I managed to see a ray of light for just a few hours, I never had any chance to dry my equipment, and I warmed up inside my van. Every night I slept only a few hours because of loud wind noise or strong rain storms. Day-by-day I grew tireder and more feeble. One day, three weeks after I left home, I was in South Tirol descending a mountain when I decided to conclude my trip, and I returned home safe.
The goal of my trip was to tell scuba adventures from the surface point of view where the water is only a part of the context and not the objective. I made a mini-series film composed of three chapters. Each one brings you inside the scene. What follows here is the first episode of the trip.
Social Distancing Beneath The Slovenian Soil
The first day of cave diving in Slovenia was very tricky and full of adventures. I had no idea how the second day would go.
I left my accommodations around 6 a.m., after a good breakfast of cereal, dark chocolate with black coffee, dried fruit, and tasty Italian Parmesan cheese. I could not see anything from my window because what had fallen was not simply rain; it appeared to be an awesome flood. My plan for that day had been delayed.
I think that most parts of dry caves are condemned for hundreds of kilometers. So, I decided to check the weather forecast and water level conditions in caves close to the Croatian border. It would mean driving about four hours to see for myself whether scuba diving was allowed. I didn’t have to remind myself, I was alone here.
Wheels were on the road and local conditions seemed quite good. I had checked the weather on my laptop and understood the risk. If I was lucky, I could dive; if not, I would have to drive back. I drove through Slovenia forest meeting no one. With less than an hour left to my destination, I came across an abandoned farm village, completely empty.
The dive inside Bilpa Jama was breathtaking. Now I was seated beside the cave shore preparing soup to warm myself. After a stunning solo dive, I was cold and wanted only to taste the peace of this magnificent place. While I was dipping the spoon in my soup cup, I heard a faraway voice, a police woman calling me and asking me to stop eating and come quickly to her.
After I did as I was asked, she started examining my passport, documents, and permissions. A few minutes later, a huge National Army truck reached us. The soldier had an abnormal body shape, a man the size of a walking mountain in an Army uniform. Can you imagine how I was feeling in those moments?!
Well, in the end, everything went really well, and I now have a story to tell my grandchildren.
Once the passport control was over, and they had checked that I did not cross the border from Croatia to Slovenia illegally (customs was only a few hundred meters from us), I had the chance to get back to my soup, which by then had turned cold. I warmed it up again, and I spent half an hour seated on a slippery stone covered with moss and lichens watching the beauty of the forest surrounding me.
On the way back to my accomodations in my cave van, I played a new playlist.
Four hours later, I approached my country lodge. I was really exhausted, but I had to refill tanks and plan the next scuba diving days. Once I finished, I watched the forecast again. Unfortunately, it was growing worse, so I decided not to dive and instead get a surface break. Tomorrow I would drive, search, and catch info and GPS coordinates of caves. My tomorrow plans had turned into a sketching and surveying day.
The Road To Suha Dolca
I drove and walked for hours and hours, up and down the forest or on lonely roads in search of caves where I could return in winter or perhaps next year. During the last survey of the day, I watched a talented young guy playing a traditional concertina and thought, what a lovely atmosphere and a fitting way to close my hard-working day!
I decided to give a last gaze to Suha Dolca cave, my favorite one, on the way home. This was the third consecutive day I had arrived back at this spot. Observing it day-by-day, I tried to find the best moment to dive this cave.
Until now, it was inaccessible due to the strong flow. I wanted to dive here before leaving Slovenia. Tired and driving slowly, I parked my van away from my accommodation. Since I had no lunch, I started feeling very hungry. A simple dinner was quickly served: dried fruits and a cup of hot noodle soup.
My ‘NO DIRECTION HOME’ trip was now at its peak. I had become a wanderer. I was alone in a wild country with, yes, an internet connection for historical research and checking the weather. That was the only technology I used. Aside from that, I lived simply. I walked, dived, wrote, and filmed my experience all with my mobile phone.
Rain was tougher than expected. I had hoped to stop for one day, not the two that it took. Following the surveys, the next day I started fixing my video equipment and saving photos and videos I had made on my hard drive.
I had too many ideas, no one clear till the end, and too many cave sketches and GPS points to reorganize; I needed a day to regroup. I just went out for a few hours to check Suha Dolca’s Cave conditions. On this day it seemed that the flow was getting more stable, and general water conditions were growing better. I had to be patient and wait one or two days more for the right conditions. I tried and failed to find a solution on my own, but the water always showed me the way. She told me to wait and to go back to where I came from. Step-by-step I walked the path again.
The third video chapter of Slovenia Solo Cave Diving is the one I prefer, because I remember the indecision I felt, to stay or to leave. Solo trips are strictly linked to life’s decision.
The last day I was in Slovenia I left the accommodations and asked a new farmer, close to a different cave, if I could sleep inside his barn and dive the river hole on the following day. I was at the same place where I had dived the first day. He told me I could not stay in the barn due to the high risk of bears who live in the surrounding area. I jumped in my van again and I drove to the lake beside Suha Dolca’s Cave.
I descended the path several times and brought all my scuba gear piece-by-piece. I decided to give myself a chance to dive my dream cave in the late afternoon. I had no other choice. Once I was inside the cave it was unbelievable, and I had a very nice dive even though I was really tired, and again I broke my light arms and camera housing. I resurfaced after the dive into a reed’s lake, which made me feel like a beaver.
I had conflicting feelings as I left Slovenia that same night after making a tricky and stunning dive. Bears, awesome forests, and rural areas were now all behind me. The cave-van played a new disc, I needed to shake off these feelings and look forward to my new goals: Garda Lake’s wrecks, South Tyrol’s stunning lakes, and finally Austria. In the country of green and wide grazing land I wish to dive surrounded by the amazing scenario of beautiful Alps mountains.
At 9:30 PM I crossed the border again, and Italy was straight ahead.
Andrea Murdock Alpini is a TDI and CMAS technical trimix and advanced wreck-overhead instructor based in Italy. He is fascinated by deep wrecks, historical research, decompression studies, caves, filming, and writing. He holds a Master’s degree in Architecture and an MBA in Economics for The Arts. Andrea is also the founder of Phy Diving Equipment. His life revolves around teaching open circuit scuba diving, conducting expeditions, developing gear, and writing essays about his philosophy of wreck and cave diving. Recently he published his first book entitled, Deep Blue: storie di relitti e luoghi insoliti.
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