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Incident Report: Denial Isn’t Just a River in Egypt

As counter-errorism expert Gareth Lock, principal of Human in The System, explains: the river of denial runs deep through the diving community as demonstrated by this actual DCS incident. His report may help you find safe passage.

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By Gareth Lock

A pair of divers was completing their final dive following a week of 60-70 m/197-230 ft trimix diving off Malta in the Mediterranean Sea. The week had been brilliant. Blue skies, calm seas, and some amazing wrecks from the World War II era. This final dive was to be on the Italian fast patrol/torpedo boat Schnellboot S-31. It lays at 63 m/207 ft, almost intact and upright but broken in the middle, looking like someone had partially snapped it, like a stick.

They were planning on a 30-minute bottom time on open circuit using trimix 15/55, and nitrox 50% and 100% breathing gases. The dive itself was uneventful with some brilliant opportunities for photos in the clear water, and the decompression was completed as planned.

The interesting part started when one of the divers got back on the boat. As he took off his twinset, he noticed some disturbances in his vision. He had never had a migraine before, but it appears. in hindsight, to have been the same as the aura that those who suffer from migraines get. Even though the disturbances were obvious, the diver didn’t say anything to his buddy or others on the boat because they didn’t perceive any neurological or musculoskeletal signs or symptoms. After 20 minutes or so, while they were on their way back to the quayside, the visual disturbances cleared.

Approximately 30 minutes after surfacing, the boat arrived back at the quayside and the divers started to unload their equipment. There were multiple twinsets and stages to lift from the boat to the quayside and from the quayside onto the back of the flatbed trucks.

As the diver lifted the final twinset up onto the back of the flatbed, he immediately had a large “burst of light,” and his vision was disturbed. The disturbance was like an out-of-focus area moving across his vision, which meant that he couldn’t see clearly, especially in the focal area of vision. In the past, the diver had researched diving medical issues like PFOs and the link to DCS, and that physical exertion can open a patent foramen ovale (PFO) thereby allowing bubbles to cross from the venous side to the arterial side, which can lead to decompression sickness. At this point, the diver said to himself “I have a PFO!” However, he didn’t articulate this to the others in the team, again because there were no other signs/symptoms present. In his mind, he couldn’t detect any signs/symptoms of DCS, so it couldn’t be DCS!

Decompressions above the Schnellboot. Photo courtesy of Gareth Lock.

The diver finished up moving the rest of the lighter equipment onto the flatbed and set off back to the dive center. He was unusually quiet, but no one mentioned anything to this effect. After 30-40 minutes, the visual disturbances cleared up. The diver still hadn’t said anything to anyone else at this stage, and there were still no signs or symptoms of DCS.

The following day the diver, his teammate, and the diver’s girlfriend flew back to the UK.

What are your thoughts on what happened? What do you think of the diver who didn’t declare his medical issue? Do your thoughts change if I said that diver was me?!

Most people have a negative thought process about the incident diver. If you fall into that category, you are likely to have one of the strongest biases people exhibit. It’s called a “fundamental attribution error.”

Most people have a negative thought process about the incident diver. If you fall into that category, you are likely to have one of the strongest biases people exhibit. It’s called a “fundamental attribution error.” This error can be summarized as: when a negative behavior is observed in someone else, we blame the individual, but when the same negative behavior is demonstrated by ourselves, then we attribute it to external factors. The Fundamental Attribution Error is one of the greatest barriers to learning when it comes to incidents and accidents because we don’t look at why it made sense for someone to do what they did. Lewin’s equation shows that our behaviour is a function of the person and the environment they are operating in. B=f(p,E). So before you judge, look at why it might have made sense for the person to do what they did. Local rationality is why something can appear irrational to someone on the outside, and yet make sense to the individual “inside”.

So what happened to me and why?

This was the last dive of a week’s great diving. My girlfriend (now wife) was holidaying with me in Malta while Howard (my teammate) and I went trimix diving. Kate doesn’t dive and was happy doing touristy stuff around the island while we dived.

I didn’t say anything to anyone on the quayside because I had a pretty good idea that if I did, I would be in a chamber and that would worry Kate; it would also mean we wouldn’t be flying back home the following day either, and I didn’t want to make a mess of the plans! In hindsight, it could have been a lot worse than it turned out. Irrational in hindsight. Locally rational if you think about what was going on in my head.

Upon my return to the UK, my tech instructor recommended a cardiologist who specializes in PFO treatments. I explained my circumstances to the doctor and told him that the dive had a conservative profile, explaining the gases and stops. He responded that “tech divers are a bunch of (expletive deleted)  guinea pigs,” and upon reflection, I agreed. As a naval diving doctor now involved in commercial dive medicine, he advocates for more control and oversight than is current practice. He does not agree with tech divers taking the risks they do. The only way to confirm that I had a PFO was with a test.

Howard inspecting the Schnellboot. Photo courtesy of Gareth Lock.

Within two weeks, I had a transthoracic echocardiogram (TTE) whereby bubbles and saline were injected into a major vein in my left arm as my heart was imaged with ultrasound. At a specific point I was told to do a Valsalva maneuver to observe if bubbles would cross the heart. No bubbles were seen to cross the area where a PFO would be during any of the three times I complied. However, when I did a massive “sniff” as the bubbles were injected, immediately a shower of bubbles was seen crossing my heart wall through the PFO. Post-test analysis showed that I had an 8 mm x 12 mm PFO. You can see a video of my test here. (See attached video in the email).

Video courtesy of Gareth Lock.

Three months later I was in the operating theatre having the PFO fixed with an Amplatzer device. This is best described as two folded-up umbrellas inserted into the heart; the first is deployed on the inside of the heart, the second on the outside, and then as tension is applied, the two umbrellas close together pulling in the flap and closing the hole. Three months after that, I was back to diving, having been signed off as having no bubbles passing across the PFO. Prior to that event, I had had no signs or symptoms of DCS or anything linked with a PFO despite having completed approximately 400 dives and approximately 15 advanced trimix dives to 60-70 m/197-230 ft.

Summary

Denial is a massive issue in diving incidents, especially when it comes to DCS. I have seen numerous incident reports where the one managing the event is the last person who should be involved in the critical decision-making process! In 1993, Michael Menduno published an excellent article in aquaCORPS #5, BENT, which looked at the stigma associated with DCS. You can find it here.

Because of this stigma, the true prevalence of DCS is not really known and therefore the biases that we use to determine the likelihood of a risk materializing lack the data to inform them. Speaking to experts in the field, the real number of DCS events is likely to be four to eight times the reported level. Consequently, we need to change the attitude toward DCS as Jennifer Hunt’s article in aquaCORPS highlights.

There are numerous biases at play when we examine incidents, accidents, and near-hits. The most powerful of these are hindsight bias (where we “know” it would have happened that way) and the fundamental attribution error. In many cases, it is difficult to resist the effect of these biases, but being aware of them is the first step to improving learning throughout the diving community.

No one gets up in the morning and says “Today is a good day to get bent and not tell anyone anything about it.” We are doing the best we can with the resources we have and the pressures and drivers we are subject to. As Sir Andrew Hidden QC said when discussing the 1988 Clapham Junction train crash in which 35 people were killed and 484 were injured, “There is almost no human action or decision that cannot be made to look flawed and less sensible in the misleading light of hindsight. It is essential that the critic should himself be constantly aware of the fact.”

Like incident reports? Read another. 


Gareth Lock is an OC and CCR technical diver with the personal goal of improving divingsafety and diver performance by enhancing the knowledge, skills, and attitudes towards human factors in diving. Although based in the UK, he runs training and development courses across the globe as well as via his online portal https://www.thehumandiver.com.He is the Director of Risk Management for GUE and has been involved with the organization since 2006 when he completed his Fundamentals class.

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Hal Watts: Plan Your Dive

Known for his deep air diving exploits back in the day, 86-year-old Hal Watts, aka “Mr. Scuba,” is one of the pioneers of early scuba and credited with coining the motto, “Plan Your Dive. Dive Your Plan.” He founded the Professional Scuba Instructors Association International (PSAI) in 1962, which eventually embraced tech diving, but never relinquished its deep air “Narcosis Management” training. Italian explorer and instructor Andrea Murdock Alpini caught up with Watts and teased out a few stories from the training graybeard.

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Interview by Andrea Murdock Alpini 
English text by Vincenza Croce

Hal Watts, Terrence Tysall, and Bill Stone in March of 1993.  This was the last stop in the U.S. for a test dive of the Cis-Lunar Mk-4 rebreather prior to Stone’s San Agustin expedition (1994) for its first real sump dive.

“Plan your dive, dive your plan,” is a common refrain in diving, but it’s easy to forget the meaning of this phrase has changed over time.

The underwater explorers of the early days learned to plan their dives with watches, depth gauges, and US Navy tables. Back then, decompression tables were the Bible for divers—something miraculous, halfway between alchemy and physiology. Those trail-blazing divers defined what it meant to “plan” a dive.

But, at the time, the term “technical diving” did not exist; divers breathed air on the bottom as well as during decompression. Only after many years was oxygen added, followed by the famous jump into the hyperbaric chamber.  

Later came new innovations after a few decades of experiments: hyperoxygenated binary mixtures, the NOAA tables, Heli-air (i.e. the addition of helium in tanks loaded with air), the change in the speed of ascent, new molecules to be studied, new physiological and narcotic effects, and their consequent impacts on humans and their psyches.

In a very short time, diving traditions underwent a metamorphosis. The spool and the coral tank became a proper reel, the ascent bin and the plastic bag disappeared in favor of the buoyancy control device (BCD), the surface marker buoy appeared—and then, even later on, wrists were adorned with underwater computers instead of decompression slates.

Divers later renewed and revolutionized a niche discipline, transforming it into a sporting phenomenon and a vocation. Faced with imminent change, there is often nothing that can be done when an anomalous wave arrives; you cannot stop its irresistible force with the wave of a hand. And thus was the American revolution of underwater technique, where the means of exploration—read mixed gas and scooters—have become the end.

The self-proclaimed originator of the “plan your dive, dive your plan” motto was 86-year old Hal Watts, the founder of American didactic Professional Scuba Association International (PSAI) and a diving pioneer who once held the Guinness Book of World records for deep diving. Though the use of trimix grew in popularity, Hal continued to believe in deep air, in the ancient technique of coral fishermen. He supported wreck and cave diving—with decompressive mixtures and new configurations through PSAI; but, above all, he believed (and continues to believe) that deep air, if properly practiced, is a discipline with unique logistics, hidden dangers, and irresistible charms that can take you to a parallel world.

Hal Watts speaking at aquaCORPS tek.93 Conference

First of all, Hal, what was the dive that changed your way of seeing scuba diving? I mean, a dive that was like an epiphany, a dive which changed your point of view on a technical matter?

Hal Watts: Wow, you sure are really trying to test my old man memory. Now I’ll have to review some of my old logbook entries. 

The first scuba dive that really got my attention as to just how serious and dangerous scuba diving can be was on December 2, 1962. I was diving with Bob Brown, co-owner of Florida State Skindiving School in Orlando, Florida. I was a member of a dive club in Orlando known as Orlando Sport Diving Club. Bob and I had heard of a sinkhole in Ocala known locally as Zuber Sink as well as Blue Sink. Years later, I later leased the property and renamed it as Hal Watts’s 40 Fathom Grotto, and I eventually purchased the Grotto in mid-1979.

We had never talked to anyone about the sinkhole; therefore, we had no idea about the visibility or the depth. Up to this point, I had constructed my favorite BCD, using a large white Clorox plastic jug, which we tied to our twin tank system. We put air into the BCD from our “Safe Second Stage” mouthpieces. 

Bob and I tied our safety line to a tree on the bank of the sink and reviewed our dive plan. I am reminded of the motto I came up with, many moons ago—Plan your dive, dive your plan. 

We all know that motto. I didn’t realize that it was you who coined it.

It was back in the 1960s when I was writing course manuals for NASDS [National Association of Scuba Diving Schools] and opened up my Mr. Scuba dive shop.

Mr. Scuba’s Magic Bus!

But back to the dive at Zuber. I’ve failed to mention the fact that neither of us had been doing any dives below 30 m/100 ft. We followed the cave line down slowly, not paying enough attention to our depth. Before we realized it, we had hit the bottom, stirred it up, and had no clear water.

Lucky for us, I kept the cave diving reel in my hand, and Bob kept his hand on the line. I couldn’t see; however, I could feel Bob’s hand, squeeze his fingers tight on the line, grab his thumb, and give it the “thumbs up” signal. I don’t know how we managed it, but we were both able to use our NASDS safe second stages and add air into the Clorox “BCDs.” We were actually fated to begin an uncontrolled, too-rapid ascent. All of a sudden, we hit an overhead wall, which stopped our ascent at a depth of 9 m/30 ft. 

We looked at each other, and gave the OK hand signal. While decompressing, following the old Scubapro SOS mechanical computer, I started to pull up the loose line until the dive reel appeared. Wow, we sure had an awful lot of loose line floating around us. Were we extremely lucky? Of course, we were. Our problem was that we never planned our dive, and consequently, were unable to dive a plan.

After that dive, I worked with Scuba Pro and Sportsways to create the “Octopus,” or “safe second.” A while later, the octopus appeared for the first time in Scuba Pro catalogs. I was also the first to add a pressure gauge along with the Octopus.

Hal Watts set the world deep air record to 120m/390 ft in 1967

Ah yes, the “Safe Second.” That’s what NASDS called backup second stages, right? Sheck Exley (1949-1994), the legendary cave explorer with whom you were friends, was also credited with fitting a redundant second stage reg with a necklace. I want to ask you more about Exley, but first, I want to know: What are the best wrecks you ever dived?

This is really very hard to answer. I’ll have to list four, in the order that I dived them: the USS Monitor, Andrea Doria, Japanese wrecks located in Truk Lagoon, and the Lusitania in Ireland.

The most important would have to be the USS Monitor, a submarine used during the Civil War. A group of well-known USA divers applied to the National Oceanic and Atmospheric Administration (NOAA) for a permit to dive the Monitor, as she was located in protected waters. In addition to myself, the group consisted of: Gary Gentile, attorney Peter Hess, and several other well-known expert divers. At first, NOAA refused. Then, Peter Hess filed proper papers asking that we get the NOAA permit. To that end, we presented my Deep Air training material to the concerned NOAA group. I appeared as an expert witness and provided NOAA staff and their legal representatives with my internationally accepted training material and my record of training several world record deep air divers. Our deep air training has been accepted worldwide with zero diving deaths. After that, we received the permit. 

Other than the Monitor, my favorite deep wreck dive would be the Lusitania, which is a very personal and proud story for me. The main reason is because venture capitalist Gregg Bemis owned the diving rights to the Lucey at the time. Gregg had contacted me requesting that I train him on PSAI Narcosis Management Level V, on air—which is 73 m/240 ft—and then train him on trimix so he and I could dive to 91 m/300 ft on the Lusitania lying off the coast of Ireland. 

When word got out that I had enrolled Gregg in my Narcosis Management Course, a well-known international course director (a personal friend of mine) called and told me, “Hal, do not teach Gregg deep diving.” 

PSAI’s ad in aquaCORPS Journal circa 1994 offering deep air training.

He told me that he had been training Gregg at his facility, and that he was a “train wreck.” “He is from a very well-off family in Texas, and if you cause him any injuries, you will be sued and put out of business,” my friend said. Well, guess what? Gregg completed the 240 Level V Deep Air course, then our PSAI Trimix course. My wife, Jan Watts, Gregg, and I went to Ireland to dive the Lusitania. He and I made an awesome 91 m/300 ft trimix dive to the deck.

Diving on the Andrea Doria with Tom Mount, Peter Hess, and several great wreck divers was also an awesome dive. Last but not least was a great trip to Truk to dive on some of the Japanese wrecks.

Please tell us about Sheck.  What was your relationship with him like?

Sheck and I became friends and made several dives together, and one of my favorites happened when Sheck, his Mary Ellen, my wife Jan, and I were diving at 40 Fathoms. Sheck wanted to practice gas switches during descents. Sheck was practicing, getting ready for a planned very deep dive (I think in Mexico with Jim Bowden). The four of us swam to the east side of The Grotto, slowly following the wall during our controlled descent, watching Sheck practice gas switching. 

Sheck Exley and Hal Watts at a NSS-CDS conference

After reaching our planned depth of 73 m/240 ft, we began our controlled ascent up to our first planned deco stop. During our last deco stop on our 4.5 m/15 ft platforms, I noticed that Sheck had a funny look on his face and was messing with his drysuit between his legs. I remembered then that he had told me that he had an attachment installed in the drysuit that would allow him to pee underwater. He was clearly in a bit of discomfort and Mary Ellen, Jan and I just floated nearby and watched.

I’ve heard that Sheck later used diapers, or just cut it loose in one of his old neoprene drysuits on his big dives, so evidently he didn’t get that early p-valve to work. What about your friendship and job collaboration with Gary Taylor, your brother-in-arms and a co-owner of PSAI?

Andrea, get comfortable, since this question will take some time to properly answer.

I first met Gary in Miami, which is where we became friends when I was staying in his home and taking Tom Mount’s nitrox course.  I have a photo of Tom, Gary, and me gas blending on the floor of Tom’s garage. During the course, Tom was still using his worn-out hand written paper flip charts as his notes.

Gary was impressed with my deep air program and offered to put together an updated slideshow presentation for me to teach with. PSAI still uses an updated version of this system to date. Gary stayed with Tom until Tom thought he had sold IANTD [International Association of Nitrox and Technical Divers] to another individual. After that sale came about, Gary contacted me wanting to get more involved with PSAI. Being smarter than folks thought I was, I jumped at the chance to have Gary on the PSAI Team. Tom’s deal fell through, but Gary was totally involved with PSAI, and now is a partner and president of our agency. Thanks to Gary and Tom. 

Many, many years ago I was still taking some type of classes—I think regarding mixed gasses, maybe with Rebreathers—at Tom’s house. In fact, I was one of Tom’s instructors who did the final proofreading of one of Kevin Gurr’s manuals. Too far back to recall much about this mixed gas stuff—remember my reputation for being a deep air diver.

Tom Mount and Gary Taylor mixing up some trimix in the garage.

Speaking of the people with whom you’ve dived, was the aim of The Forty Fathom Scubapros Club?

Before I invested in a sinkhole in the Ocala, Florida, area—which was locally referred to as Blue Sink or Zuber Sink, and is now referred to as 40 Fathom Grotto—several diving buddies whom I had dived with and trained for extreme deep air diving—as well as cave exploring—got together and planned to dive The Grotto at least one Friday night per month. Within a short period of time, several other buddies joined our group, which eventually became known as The 40 Fathom Scubapro’s dive club. Each diver had to meet my requirements of training. 

Forty Fathom Grotto aka Zuber Sink
An early Sheck Exley mix course at Forty Fathom Grotto
An Eric Hutcheson drawing of Forty Fathom Grotto

Eventually, our group set specific personal requirements—being a good person, supporting our club safety rules, and making at least one 40 Fathom Grotto dive per month. We set a limit of 14 or 15 members. Three 40 Fathom members eventually set World Records for deep air: I was one, A. J. Muns, and Herb Johnson set ocean records, and later I set the air depth record for cave diving. Naturally, as time passed and we got older, our membership got smaller. It is notable that none of our club members have died during any scuba dive.

Finally, what led you to create the iconic motto, “Plan Your Dive. Dive Your Plan?” 

I used to be a private pilot, and we used to say, “Plan your flight, fly your plan.” This was back in probably 1961 when I had just started diving and there were so many instances where all the other divers would get in the water without saying anything. I’ve seen so many incidents and fatalities that could have been avoided through proper planning.

Dive Deeper

ScubaGuru: LXD 029 : Hal Watts – Record Deep Diver & Technical Diving Pioneer

Netdoc: Netdoc chats with Mr Scuba, Hal Watts

InDEPTH: The First Helium-based Mix Dives Conducted by Pre-Tech Explorers (1967-1988) by Chris Werner

Alert Diver.Eu: Rapture of the Tech: Depth, Narcosis and Training Agencies

Professional Scuba Association International: PSAI History


Andrea Murdock Alpini is a TDI and PSAI 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. He published his first book, Deep Blue: storie di relitti e luoghi insoliti (2018) and IMMERSIONI SELVAGGE, the new one is on the way, out on fall 2022. 

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