Background: Diving is a popular recreation with an excellent safety record, with an estimated 1.8 deaths

per 1 million dives. This study investigated the relationship between intentional deviation from accepted

diving practices (violations) and diver fatalities.



Materials and methods: The authors examined 119 incidents/122 diver fatalities that did not involve diver

training in North America and the Caribbean, and identified the presence of violations of accepted diving

safety practices, as well as if the death was associated with an acute medical event such as heart attack.

Results: Of the 122 fatalities, 57% (n = 70) were associated with a medical event and 43% (n = 52) were

non-medical. Violations were found in 45% of fatalities (n = 55) overall. Violations were recorded for 23%

of the 70 medical and 75% of the 52 non-medical fatalities. Divers who died from something other than

a medical cause were 7 times as likely to have one or more violations associated with the fatality (OR 7.3,

95% CI 2.3–23.2). The odds of dying from something other than a medical condition increased approximately

60% for each additional 10 metres of depth. The odds of a death being associated with a medical

condition increased approximately 9% per year of age, or 2.4 times for every 10 years older a diver was.



Conclusions: Medical events are associated with over half of the non-training related diver fatalities in North

America and the Caribbean, with the odds of death being associated with a medical condition doubling

each decade of additional age. These data support recommendations that divers stay physically fit and

have regular medical checkups, particularly as they get older. They also strongly support the safety benefit

of adhering to established safe diving practices.