Watersports death tolls in the Cayman Islands are at a precarious point.
The death of an 83-year-old man while snorkelling at Kaibo last month made his the fourth fatality this year involving divers and snorkellers.
In the previous four years, watersports related fatalities have averaged between nine and 10 cases per year. Should the trend from the first two months of this year continue, it would mark a significant increase in the number of deaths involving water-based activities.
Dive industry professionals are at pains to point out that what is classed as a diving accident is ambiguous. Any incident that occurs during a dive, be it decompression sickness, an injury such as a sting or bite, or a heart attack sustained while in the water, are all classed as dive accidents.
“If a person playing golf suffers a heart attack, it is not called a golfing accident,” says Steve Surrey, owner of Divers Down.
The available statistics for fatalities involving snorkellers and divers in the Cayman Islands shows some clear trends in terms of age and gender.
Out of 26 recorded fatalities between 2003 and the present, 18 were men and eight were women. Twenty two of the 26 were older than 50 and the youngest was 39.
Globally, statistics for dive accidents put drowning as the most common cause at 33 per cent, with arterial gas embolisms – caused by ascending too rapidly and/or holding the breath on ascent – a close second at 29 per cent and the third major cause being cardiac arrest, at 26 per cent.
The Caymanian Compass reviewed 17 autopsy reports from dive and snorkel related deaths in the Cayman Islands between 2003 and 2009 and found the cause of death in 11 cases was due to drowning and in five cases was heart failure or heart disease. Only one was due to an air embolism. In no instance was dive equipment found to be faulty.
However, this is not the whole picture, as Dr. Denise Osterloh, a physician specialising in dive medicine, explains.
“Some fatalities may present as drowning, but the underlying causes of drowning may not have been identified. A person may have suffered a cardiac arrest, which then led to panic and to accidentally swallowing water,” she said.
This applies both to divers and snorkellers.
The autopsy reports support this. In the 11 cases of drowning, six of the victims were found to have significant heart conditions. All six had moderate to severe narrowing of the coronary arteries, three had enlarged hearts and two had ischaemic heart disease. In the other instances of drowning, circumstances leading up to the drowning cannot be determined with certainty but panic seems to have played a factor in at least three cases.
In the case of Daniel Childs, 71, who went missing during a dive in April 2007 and was later found floating on the surface, the cause of death was cited as drowning. However, the autopsy revealed he had severe coronary artery narrowing, intracardiac air, diabetes mellitus and left ventricle hypertrophy. The signs pointed to the diver having made an uncontrolled ascent, possibly caused by panic. Although one will never know what caused the diver to panic, the pathologist concluded, “Physical distress related to the patient’s coronary artery disease is a consideration.”
Michael Kuntz was also found unresponsive on the surface following a dive in January 2007. The autopsy found the cause of death to be drowning but noted that the severe narrowing of a coronary artery was also a significant finding.
In the case of John Gilbert Freemeyer, 52, who died 1 March, 2005, the presence of water in the lungs and foamy matter in the airways indicated drowning. Government pathologist, Dr. John Heidingsfelder, noted that the victim’s heart was also twice the normal weight, which could have contributed to the drowning.
“He would not have had the energy reserve of a normal person and diving can be a strenuous activity,” he said.
It would be fair to say that poor health and fitness levels, and in particular heart conditions, are one of the main factors contributing to, if not causing, accidents and fatalities among swimmers, snorkellers and divers.
However, this is no easy matter to police.
Cardiovascular disease in the US has been the No. 1 killer for over a century and on average 2,500 people die each day from heart disease in the US.
With this in mind, one could argue that in some cases a person was going to suffer a heart attack, and the fact they were in the water was incidental.
It would be unrealistic to assume anyone who was at risk could be prevented from entering the water.
As Dr. Osterloh points out, swimmers do not have to produce a certificate of fitness.
For divers there is also no requirement to have a medical examination prior to enrolling on a dive certification course.
“Before someone can start to dive they have to complete a medical questionnaire. It is only if they answer yes to one or more questions on that questionnaire, that they then have to see a doctor who gives them the OK to dive,” clarifies Renee Knight, owner of Cayman Diving School.
Certification is then valid for life, with no stipulated requirement for further medical examinations.
Divers arrive every day in the Cayman Islands bearing certification cards they may have had for 20 or 30 years and may not have consulted a medical professional about their fitness to dive since then.
Local dive operators do what they can to ensure that customers diving with them are in good health and will refuse to allow people to dive if they have known contra-indications or feel they are high risk.
Most, if not all, dive centres here will require all certified divers to sign a waiver stating they have no medical conditions and are in good health.
“We try to get as much information as possible. I wouldn’t want to put either my staff or the customers in that position,” says Steve Surrey.
But the responsibility lies with the customer to be honest. When people know that admitting to a certain condition could preclude them from diving, they may not mention it.
“People can always lie on the form,” says Dr. Osterloh.
Charles Simpson, a 57-year-old diver who was found floating face down was found to have drowned.
The autopsy also revealed that he was moderately obese, diabetic, had severe narrowing of the coronary arteries and was on medication.
In her statement, his wife also mentioned he had been to the doctor a few times for heart problems.
Had all of this been mentioned to dive staff it is highly unlikely he would have been permitted to rent dive equipment in the first place.
An added problem is that visiting divers may have consulted a general practitioner in their home country, but if the doctor in question is not familiar with scuba diving and its effect on the human body, they may have been given the all clear when in reality they should not have.
When it comes to individuals swimming or snorkelling from the beach there are no medical questionnaires, waivers, or safety briefings and on average swimming and snorkelling fatalities outnumber dive-related deaths two to one.
However conscientious dive and water sports staff are about checking medical histories, they cannot hope to foresee or prevent all accidents.
As the Divers Alert Network – a non-profit medical and research organisation dedicated to diver safety – explains on its website, “For many people, the real problem is that the first sign of coronary artery disease is a heart attack.”
Obesity, diabetes, cardiovascular disease and other degenerative diseases affect millions of people worldwide and are a major health concern in the western world.
Of course, some of those who suffer from these conditions will want to dive.
Of the autopsy reports examined, 13 out of 17 were aged over 50, 11 had heart conditions of some kind, three were obese and four diabetic.
This is a reflection of the state of health of the general population. People who suffer from these conditions will know the risks they run.
Dive guidelines can advise recreational divers to ensure they are fit and healthy to dive, and common sense dictates that the same applies to snorkellers and swimmers, but ultimately the responsibility lies with the individual to be honest, and not put themselves, or others, at risk.