Incident Report

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

Lack of equipment checks

Incident Date


Incident Description

The dive was going well until the diver bit through one of the mouthpiece lugs. It was surprising how quickly the cut developed from a small break to a complete failure. The broken lug was retrieved and spat out to prevent it jamming in the rebreather valves. The broken gag resulted in a lopsided attachment to gas which isn't life-enhancing. The prospect of using this for another 3 hours wasn't appealing so the dive was turned. For entertainment value the damaged rebreather was used on the return which highlighted the magnetic qualities between a damaged rebreather and rock; every other bend seemed to drag the mouthpiece from the diver's lips and allow water into the no-longer closed circuit. On inspection the other lug had a small cut in exactly the same corresponding place and was all set to repeat the failure.

Lessons Learned

Whilst this was a simple failure to manage at the time and a bailout was available it could easily have developed into something serious had another stressor occurred. This is not a failure that would allow a dive to continue. The mouthpiece was an old friend of at least 10 years' standing - and that was the problem. Familiarity bred complacency. How many other small but important bits of kit have not been subjected to close scrutiny for a long time?
Line Management Unknown
Gas Management Unknown
Equipment Management Major
Equipment Failure Major
Training Unknown
Medical Unknown
Planning Unknown
Procedural Error Unknown
Cave Environment Unknown
Weather Unknown
Other Factor Unknown