Incident Report

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Incident Report 2020-05-01T16:26:00+00:00

Diver lost in Flooded Mine

Incident Date

2006-11-04

Incident Description

Diver A (inexperienced 18 cave dives) and diver B (very experienced) undertook a dive together in a flooded mine. Diver A open circuit had not dived there before and had planned to do a very cautious solo dive (his first). Diver B (on a rebreather) knew the system very well and suggested doing a loop. Diver A was persuaded to do the loop (he did not voice his reservations about the plan). Diver A misinterpreted a comment by diver B and believed they were going to dive as a team for the entire dive. Diver B was diving a few meters above the line and diver A followed suit (in order to make his air go further for the loop). Diver B indicated the first juntion (where the loop circuit returns) but not the second junction (where the loop leaves the main line) which diver A failed to notice. Diver A turned the dive on thirds signalling to diver B and turned back. A minute later diver A found that diver B had gone on and he realised that he had been relying on diver B rather than on his own sense of location. A got the the first return junction which was not marked and went the wrong way (west and in rather than east and out). Anxiety levels rose as he realised he could be lost. On following the line west a few minutes he was about to turn and search the other direction when he fortuitously encountered another pair of divers who escorted him out.

Lessons Learned

Diver B writes: 1. Communication is important. 2. Plan the dive and dive the plan but have alternatives. 3. Every diver is responsible for his own safety and route finding even when accompanied by somoeone familiar with the cave and more experienced. In addition Diver A writes: 4)Line management (awareness) pegging junctions other directional indicators are paramount 5) Dont do something you are not 100% comfortable with. If you have anxieties about a team objective voice them and ensure you are satisfied with the resolution 6) Be cautious in an unknown environment (particularly a complex one) 7) Where experience levels between members of a team vary enormously factor that into the plan 8) Further to point 1 and 2 if the team is changing in the course of the dive (ie turning points differ) be explicit in advance
Factors
Line Management Major
Gas Management Minor
Equipment Management Negligible
Equipment Failure Negligible
Training Major
Medical Negligible
Planning Major
Procedural Error Major
Cave Environment Negligible
Weather Negligible
Other Factor Negligible