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Dive, Learn, Eat: Rebreather Meeting in Italy

How would you like to spend four days with a group of passionate adventurers on an island in southern Italy, diving rebreathers on submerged seamounts, getting briefed by some of the biggest diving brains on the planet, and eating to your heart’s content? Thought so! Unfortunately, you missed it. But here are the some of the highlights and takeaways presented by InDepth’s executive editor who was in attendance. Hey someone had to go.

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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.

Photo by Peter Symes.

“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.

Photo by Marco Sieni.

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.

Photo by Peter Symes.

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:

  1. Does early recompression improve outcomes? (i.e. recompressing an injured diver within minutes vs hours)
  2. 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?

Photo by Marco Sieni.

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!

Presenters: L to R: Dott. Pasquale Longobardi, president of SIMI, TDI instructor trainer Mark Powell, Dr. Simon Mitchell, professor of anesthesiology, University of Auckland, New Zealand, Dr. Neal Pollock, research chair in hyperbaric and diving medicine at Université Laval, Dott. Alessandro Marroni, president of DAN Europe, Shearwater founder Bruce Partridge, DAN Europe research supervisor Massimo Pieri and Eduardo Pavia, owner of Sea Dweller Divers.

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%.

Photo by Michael Menduno.

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.”

DCI Research/Telemedicine

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.

Courtesy of DAN Europe.

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.

Mangia Mangia

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.

Photo by Michael Menduno.

“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.

Additional Resources:

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.


Community

Resurrecting a Ghost: The Launch of Ghost Diving USA

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By Katie McWilliams. Photos courtesy of Ghost Diving USA unless noted. Header image by Jim Babor

Ghost Diving, formerly Ghost Fishing, has officially arrived in the United States. Naming Southern California as home for the United States chapter is not an expansion to a new territory; instead, it is a warm welcome home after a long journey. 

Ghost Fishing first arrived in Southern California in the mid 2000s spearheaded by Karim and Heather Hamza. Their team, a group of volunteer technical divers, set out to improve the health and viability of the Southern California waters. The team started with the Infidel, a sunken squid fishing vessel near Catalina Island in 45 m/150 ft. They diligently worked to clean the Infidel which took almost two years. This victory was huge for their effort. Sadly, due to lack of funding, they were unable to continue other projects. Despite this hardship and some time away from their pursuit of the ghosts, Karim and Heather are back and more motivated than ever. 

Heather’s passion is deeply rooted in her mission to advocate for animals. This passion has helped her to push through and focus on advocating for the animals that are often unseen. The marine life that goes undetected but is ever threatened in our oceans. These are the animals Heather makes very certain to see. Her passion and love for them is palpable; it radiates from her like the warmth of a sunny day. It beckons you to join her cause. This is what keeps the fire alive in her heart for Ghost Diving. She knows that she can turn the collection of nets and her experiences into educational opportunities. Heather’s aspirations for Ghost Diving USA include continuing to educate others regarding the threat of abandoned and discarded fishing gear, seeking legislative solutions to the problem, and ultimately, building an informed and empowered community that takes care of our oceans.

Karim thrives in situations that require precision and accuracy. He explains that for him, this new era of Ghost Diving is providing a fresh opportunity to build a community of elite divers that share a passion for and commitment to a great cause. He has the knowledge and experience to help train and mentor divers along their path to becoming ghost divers and intends to give all he can to the process. He wants to bring to fruition teams of divers who trust not only each other but also the process, as well as high training standards and passion for the cause. As Karim described all the things that a ghost diver needs to be, one of the original team members immediately sprang to mind, Jim Babor. 

Jim recounted the arduous process that is becoming a ghost diver and being active with projects. He started with the project as a safety diver. The deep team would come up from the dive to the nets, and Jim would ascend with them through their scheduled decompression. He then progressed into his technical training and began photographing and documenting the work the divers were doing. Jim shared something that truly captures the essence of the passion needed to be a ghost diver. When asked about some of his most memorable incidents, he recounted the amazing experience of rescuing live animals by cutting them out of nets they were trapped in.. When asked what it felt like to cut an animal out of the net and watch it swim away, Jim was simply at a loss for words. We spoke on the phone and despite Jim’s reflective pause as he gathered his thoughts, it was apparent that the experience resonates with him on a deep level rooted in compassion. For Jim, the Ghost Diving USA launch brings his commitment and journey as a ghost diver full circle.  

Helping to lead Ghost Diving USA into the future is scientific coordinator Norbert Lee, Scuba instructor, marine biologist, and active technical diver. To speak to Norbert is to feel his can-do attitude and realize his aspirations are rooted in protecting and fostering the growth of the underwater world while educating the community about ocean conservation. More importantly, his strong sense of commitment to the team effort shines through everything. In asking Norbert about his journey to becoming the US chapter coordinator, he cited the significance of the mentorship he has and continues to receive. This mentorship comes from a variety of sources including Pascal van Erp, the Hamzas and Jim Babor. 

Norbert Lee’s goal is to collect data about the environmental impact of ghost nets and how their removal impacts the health and growth of a given area. By collecting this data, he is confident he can help to educate the community about the true impact of abandoned fishing gear. He does not want to stop with nets. He wants to help recover lobster pots and other fishing apparatus that continue to catch fish after being left behind. Through educating the community, he does not want to villainize or chastise commercial fishing but rather to build working, symbiotic relationships with fishermen. By working together, Norbert hopes to have the nets removed before they do irreversible damage. 

The Founding of Ghost Diving

Pascal van Erp has a commanding grasp on the issue of abandoned fishing gear. As the founder of Ghost Diving. Pascal’s passion has built a formidable and forward-thinking movement. Speaking to Pascal is a unique experience. He exudes a quiet confidence that only time and experience can build. In researching his work to prepare for his visit and subsequent presentations, it became quite apparent that Pascal is consistent in his message. The message is that Ghost Diving breathes new life into abandoned nets that can be recycled or upcycled. To reuse and upcycle the nets means to actively contribute to the health of the planet for today and more importantly, future generations. 

Next, Pascal emphasizes Ghost Diving is dangerous. He explains that the dangers are not always apparent. Instead, they lurk in the shadows cast by ghost nets. Team dynamics are not only critical but a matter of life and death. Pascal frequently mentions the significance of trust. The ability to trust teammates to maintain composure in the face of adversity. Trusting that if something goes wrong, they can and will continue to problem solve. Trusting that they can and will save your life. The team must always perform at the highest levels. It is critical that the dive is executed according to plan and that the procedure is applied with absolute fidelity. The nets do not discriminate between human life and marine life. They are not forgiving. A diver can meet an untimely fate in the grasp of a ghost net. 

Ghost Diving USA provides a unique and exciting opportunity by planting its roots here. With support from Zen Dive Co., ghost divers will have access to equipment, standard gasses and service that will meet all their needs while ensuring the quality and reliability of these resources. While funding issues had previously plagued Ghost Fishing, the Ghost Diving partnership with Healthy Seas along with other community sponsors helps to ensure the security of the critical funding that makes these projects possible. 

Launching Ghost Diving USA

Zen Dive Co. hosted a launch event for Ghost Diving USA on Thursday, April 28. The energy in the building was electric. Everyone was thrilled to network, build community, and work towards supporting Ghost Diving USA in any possible way. Karim opened the evening by describing the net diving mission that the ghost divers had gone on earlier in the day. He explained in detail that the Moody, a Wickes class destroyer, sits at approximately 45m/150 ft. Conditions at sea were challenging. Spring is a rough season in Southern California. Variable winds cause large swells, and upwellings bring up life giving nutrients. Unfortunately, both phenomena significantly reduce visibility. This dive was no exception. Karim described a thick green cloud in the shallower depths cutting visibility to 4.5–6 m/15–20 ft. This green cloud blocked out all ambient light as the ghost divers descended, and then cutting the nets only made visibility worse. Essentially, there was no ambient light, and visibility quickly became next to zero. The ghost divers were forced to rely upon the light they brought with them. Despite the challenges, the net clean-up was successful, but the work is far from done. The ghost divers will have to return to remove more net. 

Pascal made a brief presentation about the problem of ghost nets. It was incredible to experience a room full of people feeling compelled to act, and everyone looking for the way they could best support the mission. Veronika Mikos of Healthy Seas helped to drive the point home when she explained that through partnerships with organizations such as Bracenet and Aquafil, the recycling and upcycling of nets can help to significantly reduce carbon emissions. Additionally, as the ability to recycle nets and the products made from nets grows, they become sustainable and renewable. The yarn made from the nets can be processed infinitely and never loses quality. 

The most precious resource to any of these projects is manpower. Volunteers. People willing to train hard, think of the many versus the one and ultimately focus on safety. A ghost diver is a technical diver that has successfully completed a series of training workshops that help to best prepare them for what they will experience on a net retrieval dive. The workshops also serve to build team cohesion. Pascal and Karim both explain that the need to work with technical divers is not to be exclusionary. Ghost divers need to be able to handle any situation that may arise at any moment. Technical divers are trained to do exactly that. 

For recreational divers and non-divers alike, there is a place for everyone. Ghost divers cannot do what they do without support. Jim shared with me that his son, middle-school-aged at the time, used to volunteer as surface support. He and a friend would help to bring nets onto the boat and then search through them meticulously for any trapped marine life that could be released back into the ocean. Not only did his son help to raise awareness through multiple award-winning science projects, but he also became a diver crediting his experience helping with ghost nets. The Hamzas and Norbert hope to grow Ghost Diving USA to include recreational limit projects that allow for the training and participation of recreational divers. 

Ghost Diving USA is hitting the ground running. If you are looking for a way to get involved, a great place to start is to follow them on their social media pages. They are on Facebook and Instagram as Ghost Diving USA or @GhostDivingUSA. If you would like to inquire about the application process, you can reach the USA chapter via email at info@ghostdivingusa.org

You can also act right now. Learn about what abandoned fishing gear does to our oceans and talk to others about it. Through raising awareness, you can help remind people that while the surface of the ocean is beautiful, it is what is below the surface that desperately needs our help.

Photo by Sean Farkas

Additional Resources

Ghost Diving International:https://ghostdiving.org
Aquafil:https://www.aquafil.com
Bracenet:https://bracenet.net/en
Healthy Seas:https://www.healthyseas.org
Alert Diver:Ghost Fishing by Michael Menduno. The story of Heather Hamza and her team (2014).


Katie McWilliams is an avid diver, spending every spare moment she can in the water. Currently completing her divemaster and training for her technical pass, she wants to not only further her education and ability to explore the ocean but help with the training of divers. Specifically, Katie wants to focus on spreading awareness of how we can help the health and conservation of the oceans and marine life. Outside of diving, Katie works in moderate/severe special education. She enjoys reading, exercise, off-roading, camping and spending time with her husband, family and friends. 

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