Who You Gonna Call (in an Emergency)?
In the immediate aftermath of a diving fatality, law enforcement needs to locate an emergency contact for the accident victim. If that person’s phone is locked, social media accounts private, and there’s no emergency contacts for friends or family, it will likely fall to you as a dive buddy, to locate the needed critical information. This can add unbearable stress to an already bad situation. The solution is to be prepared, as Buck Buchanan and Wally Endres with Christine Tamburri and Robert Zink explain.
by Buck Buchanan and Wally Endres with Christine Tamburri and Robert Zink. Images courtesy of the authors unless noted.
According to the 2020 DAN Annual Diving Report, 189 diver fatalities were reported in 2018 across all categories, including recreational, technical, breath-hold, commercial, public safety, and military diving operations. There were 228 diver fatalities reported in 2017. Despite the 17% decrease in fatalities from 2017 to 2018, divers are still dying and there is a lot to learn from these incidents.
Dive accidents happen, not only to reckless divers, but also to the most cautious, most well prepared, most highly trained divers in the world. While we may not want to think about it, the reality is that dive-related emergencies can happen at any time to any diver on any dive. Because of this possibility, all divers should be proactive in their efforts to mitigate the effects of chaos and confusion being added to those of shock and grief.
Whether a diver experiences a minor injury or is the unfortunate victim in a fatal accident, the need for easily accessible and reliable emergency contact information is crucial. This article dives into the importance of such precautions as well as provides specific tips for how to carry them out.
Why is Emergency Contact Information (ECI) important?
Imagine you and a buddy are on a weekend diving getaway. You could be in your home town or half-way around the world. Nevertheless, the sun is shining, the water is crystal clear, and all is well with the world. Soon after submerging, tragedy strikes, and your buddy—maybe even your best friend—never resurfaces. Suddenly, your perfect day has changed your life forever. What happens next can be handled either efficiently or chaotically, depending on the emergency contact information (ECI) on hand.
In the immediate aftermath of a tragedy, law enforcement needs to locate an emergency contact for the accident victim. If that person’s phone is locked with no known passcode, their social media accounts are private, and nothing in their wallet or on their dive gear points to any ECI for friends or family, you as the dive buddy, will need to help locate critical information. Doing this, while dealing with your own shock, adds almost unendurable stress.
Law enforcement’s primary role in any fatality investigation is to secure evidence, to identify the victim, to determine cause of death, and to make proper notifications to next-of-kin. This standard process changes in most, if not all, diving accidents that result in a death because most law enforcement agencies are either ill-equipped, untrained, or unaccustomed to handling a diving fatality.
Consequently, the more identifying information available, the easier it is for law enforcement to be effective. It should also be noted that most law enforcement agencies are not equipped to properly secure an underwater crime scene or to recover a deceased diver at depths.
ECI is a crucial piece of documentation. When a victim is seriously injured or dies, the need to contact someone in their network is necessary to initiate the next steps in the process. These steps may include providing a medical history to help EMS respond accordingly, arranging transportation home from a remote dive site, and/or notifying loved one(s).
Without ECI, an injured diver may be left on their own for hours. In cases where they are unable to advocate for themselves, medical professionals may be forced to make uninformed decisions for care. In the unfortunate case of a fatality, the lack of accessible ECI may mean that families are unaware for hours, days, or even weeks, not knowing the fate of their loved one.
Planning ahead and ensuring that ECI is available is part of “getting our affairs in order.” Divers should make available all vital information needed to assure that their loved ones will be reached in a timely manner.
Emergency Contact (Point of Contact) vs. Next-of-Kin
An emergency contact can be a close friend, a relative, a co-worker, a neighbor, a dive buddy, a mentor, a pastor, or other trusted persons in your life. Remember, naming an emergency contact is not to be taken lightly. This is the person that will be contacted in the event of an unexpected, life-changing event, and often this individual will be the one tasked with informing other people close to the accident victim.
A next-of-kin contact is the closest living relative to the injured or deceased. In some cases, this person may have legal authority to make decisions.
It is important to understand the difference between these two terms so that a diver can choose who to list as their emergency contact. News of this nature is very traumatic for all loved ones, especially significant others. Certified divers understand the inherent risks that they are taking. Even if family members who are not divers think they understand the risks, the shock of losing a loved one is devastating. It may, however, be less traumatic if that horrible news comes from someone familiar to them. For example, the diver may choose to list their best friend as their emergency contact, knowing that a friendly face can soften the tragic news. With this information available, law enforcement would notify the listed emergency contact, and that person would notify the spouse or close loved one.
In the event that there could be estate or legal implications, the decision to use next-of-kin as the emergency contact should be considered carefully.
The More Information the More Efficient
The Emergency Contact
After deciding who is to be listed, it is critical to obtain their most up-to-date contact information. At minimum, the following information should be listed and easily accessible:
- Full Name of the Person to be Contacted
- Relationship of the Person to be Contacted
- Phone Number(s) of the Person to be Contacted
In addition, it is recommended that the following information also be included:
- Email Address of the Person to be Contacted
- Full Street Address of the Person to be Contacted
The more information available, the easier it will be for medical staff or law enforcement to understand the full scope of the relationship between the injured individual and the emergency contact.
It is important to remember that a situation does not instantly resolve when an emergency contact is reached. All divers should be proactive in their approach to ensure that medical staff and law enforcement have quick and easy access to not only ECI in the event of an incident, but to personal information as well. The next section discusses ways in which to house these details but, at minimum, the following personal data should be accessible:
- Full Name
- Date of Birth
- Phone Number
- Email Address
- Full Street Address
- Primary Care Physician Contact Information
- Pertinent Medical History (i.e., Known Allergies, Recent Surgeries, etc.)
- Blood Type
Solutions for All Divers
Gathering ECI and personal information are just two steps in the process of preparing for the event of a dive accident. To be of value, these pieces of information must be easy to obtain quickly. Divers need to be aware that, for their buddies and fellow divers, being unable to contact someone close to an injured or deceased diver is the last place they want to be in the aftermath of a traumatic experience.
These following lists are not comprehensive, but represent simple solutions that all divers can start using TODAY to ensure their ECI and personal information are able to be accessed at a moment’s notice.
Emergency Contact Options
Smartphone Emergency Contact Features (Apple/Android)
Both platforms offer many features that typically include emergency access to a medical ID in the event that the owner becomes incapacitated. Although most people are unaware that this is available, in most cases, a quick internet search will give easy setup guidance.
Visible Gear Solutions
Divers love to label their gear for a number of reasons, but very few make their ECI easily accessible by adding it to their kit.
Duct Tape/Vinyl Tape
Some divers put a piece of tape on their backplate, canister light, or even cylinders that lists emergency contact information. This solution is fast, easy, and cheap.
Dog tags can be attached to a backplate or sidemount harness, or even tucked into a set of wetnotes. These typically contain ECI, as well as one or two pieces of personal information (i.e., blood type, allergies, etc.).
Smart Emergency Stickers by Dive Signs
Technology buffs will love this commercially available option. Dive Signs has created a sticker that can be placed on any non-metal surface, such as on a dive crate, on a certification card, or maybe even on a drysuit bag, and it contains a near field communication (NFC) tag. With one tap of a smartphone, anyone can have access to pre-filled emergency contact and personal information that can be easily programmed by the diver. They can be purchased here: Smart Emergency Stickers
Divers constantly need to communicate underwater. Most use hand signals, some use slates, but a common tool is wetnotes. ECI can be written on the first page for easy access after an incident.
Save-a-Dive Kit Solutions
In similar fashion to labeling dive gear, duct tape/vinyl tape can be put on the inside lid of a save-a-dive kit to list ECI. As an alternative, a printed or hand-written list (preferably laminated) can be used. It should be noted that this method likely won’t do any good if the dive buddy doesn’t know it exists and its location.
These opt-in systems are put in place for law enforcement in the event of an emergency and they are typically linked to a driver’s license. At this time, these services are only available in a few US states, with Florida having over 19 million participants.
The following form can be filled in, then printed and placed in a known location so that it is easy to access in the event of an emergency.
The most basic form of documentation, this is easy to add to a save-a-dive kit, in the console of a car, or in another secure location. This list can also be printed and laminated so that it is durable and easy to read.
Some divers may opt for advanced directives that provide instructions for medical care and only go into effect if the injured diver cannot communicate their own wishes. An emergency binder may contain additional information, including passwords, financial and insurance information, a will, and/or government documents such as a passport and social security information. If this route is taken, it is important to understand who has access to this information and when it is invoked.
The Divers Alert Network (DAN) Medical ID Tags offer divers an easy way to display important information that may help medical personnel respond quicker and more effectively in the event of a dive emergency. An ID tag displays a diver’s name, DAN ID number, date of birth, drug allergies, and an emergency contact. This information can help public safety officials make informed decisions about their care, even if they are unable to advocate for themselves.
Each individual diver will have their own method of listing an emergency contact and ensuring their personal details are comprehensive and accessible. Some divers may use suggestions from the lists above, and some divers may design their own ways of housing this important information. Regardless of the documentation method, there are three important points to remember:
List More than One (1) Emergency Contact
Life happens, and sometimes even the most reachable individual is away from their phone, so it is important to list more than one emergency contact.
Update Information when Anything Changes and Review on an Annual Basis
Information is only useful if it is kept up-to-date. Any time information changes, it should be updated on the emergency contact sheet or a personal information list. It is also good practice to review all information on an annual basis to ensure that it is accurate. An easy way to remember to review this information is at the same time as an annual cylinder visual inspection. In addition, the diver should ask their emergency contact to update them with any changes they might have.
Never List a Dive Buddy as an Emergency Contact
This one may seem obvious, but on any given day, one dive buddy has the other listed as an emergency contact. Unsurprisingly, this becomes useless if either buddy has an incident on the dive. As such, it is best practice to list someone who is never a dive buddy as an emergency contact and, again, to verify and update both your and their details.
No one expects an accident to happen to them.The fact is that even the most cautious diver may one day find themself in the middle of an incident, needing quick access to emergency information. All divers are encouraged to be proactive and to ensure that ECI and personal information are accurate and readily accessible. Making a conscious effort during all pre-dive briefs to discuss where and how to access ECI in the event of an emergency is good practice.
This article is dedicated to Ben Strelnick (NREMT, W-EMT) who died on May 26, 2023, while cave diving at Jackson Blue Spring in Marianna, Florida. He was a medic at Divers Alert Network (DAN), and was an avid diver who always put others before himself. The inspiration for this article was drawn from the lack of ECI following Ben’s death and the hardships that followed. Ben wanted nothing more than for people to dive and to do it safely, and he would without a doubt encourage others to plan ahead so that their future dive buddies, friends, and family could get through any type of tragedy with as little pain as possible.
About The Authors
Buck Buchanan and Wally Endres (NREMT, DMT) are co-owners of Dive911, LLC, a Central Florida-based dive training facility that specializes in instructor professional development and public safety pedagogy. Buck is an SDI/ERDI Instructor Trainer Evaluator and Ambassador who has 35+ years of experience in teaching, commercial diving, and heavy salvage. Wally is a Course Director, Public Safety Instructor, and former law enforcement officer who has 25+ years of experience in risk management operations and OSHA compliance consulting. Christine Tamburri (SDI Instructor) and Robert Zink (former law enforcement officer and crash reconstructionist) were also consulted in the composition and viewpoints of this article.
Does The Sport Diving Community Learn from Accidents?
Do we learn from accidents as a diving culture and, as a result, take the actions, where needed, to improve divers’ safety? Though we might like to think that’s the case, the reality is more complicated as human factors coach Gareth Lock explains in some detail. Lock offers a broad six-point plan to help the community boost its learning chops. We gave him an A for effort. See what you think.
by Gareth Lock
Learning is the ability to observe and reflect on previous actions and behaviours, and then modify or change future behaviours or actions to either get a different result or to reinforce the current behaviours. It can be single-loop, whereby we only focus on the immediate actions and change those, e.g., provide metrics for buoyancy control during a training course, or double-loop where the underlying assumptions are questioned, e.g., are we teaching instructors how to teach buoyancy and trim correctly? The latter has a great impact but takes more time, and more importantly, requires a different perspective. Culture is the ‘way things are done around here’ and is made up of many different elements as shown in this image from Rob Long. Learning culture is a subset of a wider safety culture.
Regarding a safety culture, in 2022 I wrote a piece for InDEPTH, “Can We Create A Safety Culture In Diving? Probably Not, Here’s Why,” about whether the diving industry could have a mature safety culture and concluded that it probably couldn’t happen for several reasons:
- First, ‘safe’ means different things to different people, especially when we are operating in an inherently hazardous environment. Recreational, technical, cave, CCR and wreck diving all have different types and severities of hazards, and there are varying levels of perception and acceptance of risk. The ultimate realisation of risk, death, was only acknowledged in the last couple of years by a major training agency in their training materials. Yet it is something that can happen on ANY dive.
- Second, given the loose training standards, multiple agencies, and instructors teaching for multiple agencies, there is a diffuse organisational influence across the industry which means it is hard to change the compliance-focus that is in place. From the outside looking in, there needs to be more evidence of leadership surrounding operational safety, as opposed to compliance-based safety e.g., ensuring that the standards are adhered to, even if the standards have conflicts or are not clear. This appears to be more acute when agencies have regional licensees who may not be active diving instructors and are focused on revenue generation and not the maintenance of skilled instructors. There is very little, if any, evidence that leadership skills, traits or behaviours are taught anywhere in the diving industry as part of the formal agency staff or professional development processes. This impacts what happens in terms of safety culture development.
- Finally, the focus on standards and rules aligns with the lowest level of the recognised safety culture models – Pathological from Hudson. Rules and standards do not create safety. Rules facilitate the discussion around what is acceptably safe, but they rarely consider the context surrounding the activities at the sharp end, i.e., dive centres and diving instructors and how they manage their businesses. These are grey areas. There is a difference between ‘Work as Imagined’ and ‘Work as Done,’ and individual instructors and dive centre managers must both ‘complete the design’ because the manuals and guides are generic, and manage the tension between safety, financial pressures, and people (or other resources) to maintain a viable business. Fundamentally, people create safety not through the blind adherence to rules, but through developed knowledge and reflecting on their experiences, and then sharing that knowledge with others so that they, too, may learn and not have to make the same mistakes themselves.
The proceeding discussion brings us to the main topics of this article, does the diving industry have a learning culture, and what is needed to support that learning culture?
What is a learning culture?
In the context of ‘safe’ diving operations, a learning culture could be defined as “the willingness and the competence to draw the right conclusions from its safety information system, and the will to implement major reforms when their need is indicated.” (Reason, 1997). Here we have a problem!
The industry is based around siloed operations: equipment manufacturers, training agencies, dive centres/operations, and individual instructors. Adopting a genuine learning approach means that the barriers must be broken down and conversations happen between and within the silos. This is very difficult because of the commercial pressures present. The consumer market is small, and there are many agencies and equipment manufacturers that are competing for the same divers and instructors. Also, agencies and manufacturers have competing goals. Agencies want to maximise the number of dive centres/instructors to generate revenue, and one of the ways of doing that is to maximise the number of courses available and courses that can be taught by individual instructors e.g., different types of CCR units. Manufacturers don’t want to realise the reputational risk because their equipment/CCR is involved in a fatal diving accident, but they also want to maximise their return on investment by making it available to multiple agencies and instructors. The higher-level bodies (WRSTC, RTC, and RESA) are made up of the agencies and manufacturers that will inherit the standards set, so there is a vested interest in not making too much change. Furthermore, in some cases, there is a unanimous voting requirement which means it is easy to veto something that impacts one particular agency but benefits many others.
This will be expanded in the section below relating to information systems as they are highly interdependent.
What safety information systems do we have in the diving community?
Training agencies each have their own quality assurance/control/management systems, with varying levels of oversight. This oversight is determined by the questions they ask, the feedback they receive, and the actions they take. These are closed systems and based around compliance with the standards set by the agency – sometimes those standards are not available to be viewed by the students during or after their class! Research has been carried out on some of this quality data, but it appears to have focused on the wrong part e.g., in 2018, a paper was published by Shreeves at al, which looked at violations outside the training environment involving 122 diving fatalities. While the data would have been available, a corresponding research project involving fatalities inside the training environment was not completed (or if it was, it wasn’t published in the academic literature).
As the ex-head of Quality Control of a training agency, I would have been more interested in what happened inside my agency’s training operations than what occurred outside, not from a retributive perspective, but to understand how the systemic failures were occurring. I also understand that undertaking such research would mean it would be open for ‘legal discovery’, and likely lead to the organisation facing criticism if a punitive approach was taken rather than a restorative one.
Safety organisations like Divers Alert Network collect incident data, but their primary focus is on quantitative data (numbers and types of incidents), not narrative or qualitative data – it is the latter that helps learning because we can relate to it. The British Sub Aqua Club produce an annual report, but there is very limited analysis of the reported data, and there does not appear to be any attempt made to look at contributory or influential factors when categorising events. The report lists the events based on the most serious outcome and not on the factors which may have influenced or contributed to the event e.g., a serious DCI event could have been caused by rapid ascent, following an out-of-gas situation, preceded by a buddy separation, and inadequate planning. The learning is in the contributory factors, not in the outcome. In fairness, this is because the organizations do not have to undertake more detailed investigations, and because the information isn’t contained in the submitted reports.
Research from 2006 has shown that management in organisations often want quantitative data, whereas practitioners want narrative data about what happened, how it made sense, and what can be done to improve the situation. Statistical data in the diving domain regarding safety performance and the effectiveness of interventions e.g., changes to the number of fatalities or buoyancy issues is of poor quality and should not be relied upon to draw significant conclusions.
What is required to populate these systems?
There are several elements needed to support a safety information system.
- Learning-focused ‘investigations’.
- Competent ‘investigators’.
- Confidential and collaborative information management and dissemination systems.
- Social constructs that allow context-rich narratives to be told.
Learning-focused ‘investigations’. The diving industry does not have a structured or formal investigation or learning process, instead relying on law-enforcement and legal investigations. Consequently, investigations are not focused on learning, rather they are about attributing blame and non-compliance. As Sidney Dekker said, “you can learn or blame; you can’t do both”. The evidence that could be used to improve learning e.g., standards deviations, time pressures, adaptations, poor/inadequate rules, incompetence, and distractions… are the same elements of data that a prosecution would like to know about to hold people accountable. Rarely does the context come to the fore, and it is context that shapes the potential learning opportunities. “We cannot change the human condition, but we can change the conditions in which humans work.” (James Reason). Rather than asking ‘why did that happen’ or even ‘who was to blame’, we need to move to ‘how did it make sense to do what they did’. ‘Why’ asks for a justification of the status quo, ‘how’ looks at the behaviour and the context, not the individual.
Competent ‘investigators’. As there isn’t any training in the diving domain to undertake a learning-focused investigation, we shouldn’t be surprised that the investigations focus on the individual’s errant behaviour. Even those ‘investigations’ undertaken by bodies like DAN, the NSS-CDS Accident Committee or the BSAC do not involve individuals who have undertaken formal training in investigations processes or investigation tools. A comprehensive learning review is not quick, so who is going to pay for that? It is much easier to deflect the blame to an individual ‘at the sharp end’ than look further up the tree where systemic and cultural issues reside. The education process for learning-focused investigations starts with understanding human error and human factors. The Essentials class, 10-week programme, and face-to-face programmes provide this initial insight, but the uptake across the industry, at a leadership level, is almost non-existent. Four free workshops are planned for Rebreather Forum 4.0 to help address this.
Confidential information management system. Currently, no system allows the storage of context-rich diving incident data outside the law-enforcement or legal system in a manner that can be used for learning. After discussions with senior training agency staff, it appears that as little as possible is written down following an incident. When it is, it is shared with the attorney to enable the ‘attorney-client’ privilege to be invoked and protected from discovery. If internal communications occur via voice, then the potential learning is retained in the heads of those involved but will fade over time. Furthermore, if they leave that role or organisation, then the information is almost guaranteed to be lost.
Social Constructs: Two interdependent elements are needed to support learning: psychological safety and a “Just Culture.” With the former, the majority of modern research strongly suggests that it is the presence of psychological safety that allows organisations to develop and learn (Edmondson, 1999). Edmondson describes numerous case studies where organisational and team performance was improved because incidents, problems, and near-misses were reported. Paradoxically, the more reports of failure, the greater the learning. It was not because the teams were incompetent; they wanted to share the learning and realised that they could get better faster with rapid feedback. They also knew that they wouldn’t be punished because psychological safety is about taking an interpersonal risk without fear of retribution or reprisal – this could be speaking up, it could be challenging the status quo, it could be saying “I don’t know”, or it could be about trying something new and coming up with an unexpected outcome.
The second requirement is a Just Culture which recognises that everyone is fallible, irrespective of experience, knowledge, and skills. This fallibility includes when rules are broken too, although sabotage and gross negligence (a legal term) are exceptions. Neither a Just Culture nor psychological safety are visible in the diving industry, although some pockets are present. To support psychological safety (proactive/prospective) and a Just Culture (reactive), there is a need for strong, demonstrable leadership:
- Leaders who have integrity – they walk the talk.
- Leaders who show vulnerability – talking about their own mistakes including the context and drivers; leaders who want to look at organisational issues inside their own organisation – not just point fingers at others problems.
- Leaders who recognise that human error is only the starting point to understand something going wrong, not the end.
‘…the will to implement major reforms…’
This is probably the hardest part because learning involves change. Change is hard. It costs cognitive effort, time, and money, and this has an impact on commercial viability because of the need to generate new materials, to educate instructor trainers/instructors and divers about the change and do it in multiple languages. Unless there is a major external pressure, e.g., the insurance companies threaten to withdraw support, things are unlikely to change because there aren’t enough people dying in a single event to trigger an emotional response for change. For example, in the General Aviation sector in the US approximately 350 people die each year, but if these deaths happened in airliners, it would mean two to three crashes per year, and this would be considered unacceptable.
In 2022, more than 179 people died diving in the US. (personal communications with DAN)
The most radical changes happen when double-loop learning is applied.
NASA did not learn from the Challenger disaster because it focused on single-loop learning, and when Columbia was lost, the investigation unearthed a lack of organisational learning i.e., double-loop learning. Chapter 8 from the Columbia Accident Investigation Board provides many parallels with the diving industry. The recent changes to PADI drysuit training standards following a fatal dive on a training course provide an example of single-loop learning – fix the ‘broken instructor’ and clarify course training requirements. The double-loop learning approach would be to look at self-certification and the wider quality management across the agency/industry; however, such an approach has significant commercial disadvantages across the board.
Creating a Learning Culture
The previous paragraphs talk about many of the issues we’ve got, but how do we improve things?
- Move to using a language that is learning-based, not ‘knowing’-based. This video from Crista Vesel covers the topic relatively quickly. This includes not using counterfactuals (could have, should have, would have, failed to…) which are informed by hindsight bias. Fundamentally, counterfactuals tell a story that didn’t exist.
- Look to local rationality rather than judging others. Move from who (is to blame) and ‘why did you do that?’, to ‘how did it make sense for you to do that?’. Separate the individual from the actions/behaviours and stop applying the fundamental attribution bias where we believe the failure is due to an individual issue rather than the context.
- Look to break down the barriers between the silos and share information. Ultimately, the stakeholders within the diving community should be looking to create a safe diving environment. Throwing rocks and stones at each other for ‘incompetence’ is not going to help.
- Adopt the Five Principles of Human and Organisational Performance as outlined in this blog.
- Build ‘If Only…’ or something produced for the recreational market, into training programmes at the instructor trainer, instructor, and diver level. This way the culture can slowly change by telling context-rich stories that have ‘stickiness’. However, this requires a fundamental shift in terms of how stories are told and how risk is portrayed in the diving industry.
- Finally, recognise we are all fallible. Until we accept that all divers are fallible and are trying to do the best they can, with the knowledge they have, the money they have, the resources they have, the skills they’ve acquired, and the drivers and goals they are facing, then we are unlikely to move forward from where we are, and we’ll keep choosing the easy answer: ‘diver error’.
InDEPTH: Examining Early Technical Diving Deaths: The aquaCORPS Incident Reports (1992-1996) by Michael Menduno
InDEPTH: The Case for an Independent Investigation & Testing Laboratory by John Clarke
Gareth Lock has been involved in high-risk work since 1989. He spent 25 years in the Royal Air Force in a variety of front-line operational, research and development, and systems engineering roles which have given him a unique perspective. In 2005, he started his dive training with GUE and is now an advanced trimix diver (Tech 2) and JJ-CCR Normoxic trimix diver. In 2016, he formed The Human Diver with the goal of bringing his operational, human factors, and systems thinking to diving safety. Since then, he has trained more than 450 people face-to-face around the globe, taught nearly 2,000 people via online programmes, sold more than 4,000 copies of his book Under Pressure: Diving Deeper with Human Factors, and produced “If Only…,” a documentary about a fatal dive told through the lens of Human Factors and A Just Culture.